Headache in chagasic women.

The aim of this study was to compare the frequency of headache between Chagasic and Non-chagasic women. The cross-sectional study comprised 647 female > or = 40 years old, Chagasic (n = 362) and Controls (n = 285) at a Brazilian University Hospital. Chagasic were classified as Cardiac (n = 179), Megas (n = 58) or Indeterminate (n = 125) clinical forms. Headache was ascertained according to Headache International Society diagnostic criteria. The age (57.0 +/- 11.3 versus 57.3 +/- 10.4 years), and the percentage of white women (75.8% versus 77.1%) were similar between Chagasic and Controls, respectively. Headache was more prevalent among Chagasic (32.9%) than Controls (16.1%), mainly in Cardiac form (odds ratio, 2.41; 95% confidence interval, 1.38-4.23), phenomenon possibly related to parasympathetic denervation and cerebral vessels changes.

Nutritonal evaluation of pemphigus foliaceus patients on long term glucocorticoid therapy.

Our objective was to compare food intake and nutritional status of Pemphigus Foliaceus patients (PG) on long term glucocorticoid therapy to a Control Group (CG). Fourteen PG female inpatients receiving prednisone (0.33 +/- 0.22mg/kg) for at least 12 months and twelve CG subjects were submitted to nutritional evaluation, including anthropometry, urinary creatinine determination and serum biochemical measurements, besides 48-h-based food intake records. Groups were compared by Chi-square, Mann-Whitney and "t" tests. PG patients and CG were paired, respectively, in relation to age (24.7 +/- 14.1 vs. 22.0 +/- 12.0 years), body mass index (25.8 +/- 6.4 vs. 24.0 +/- 5.6kg/m2), daily protein intake (132.9 +/- 49.8 vs. 95.2 +/- 58.9g), and serum albumin (median; range) (3.8; 3.5-4.1 vs. 3.8; 3.6-5.0g/dl). However, PG patients had lower height-creatinine index (64.8 +/- 17.6 vs. 90.1 +/- 33.4%), and higher daily energy (3080 +/- 1099 vs. 2187 +/- 702kcal) and carbohydrate (376.8 +/- 135.8 vs. 242.0 +/- 80.7g) intakes. Despite high food, protein and energy consumption, PG patients on long term glucocorticoid therapy had lower body muscle mass than controls, while showing high body fat stores. These findings are possibly related to combined metabolic effects of long term corticotherapy and inflammatory disease plus corticosteroid-induced increased appetite.

[Acute-phase reaction and parasitism in the central adrenal vein in Chagas' disease patients]. / Reação de fase aguda e parasitismo na veia central da supra-renal de chagásicos crônicos.

The systemic reaction to severe trauma and/or infection, acute phase response (APR), are often associated with immunosuppression and reactivation of chronic latent infection. Our main purpose was to verify, in a group of 71 autopsied chronic chagasic with or without APR, the frequency of T. cruzi nests in the central vein of adrenal gland (CVAG). APR, defined by: 1) death secondary to sepsis and/or trauma plus, 2) bleeding stress gastric ulcerations or 3) spleen reactional state or 4) liver steatosis, was observed in 30 chronic chagasic (APR+). Weight, height and body mass index (BMI) were obtained. APR(+) chronic chagasic had worse nutritional status than APR(-) ones: weight = 49.0 vs 54.5 kg; BMI = 17.5 vs 20.6 kg/m2 (median p < 0.05). CVAG T. cruzi nests frequency were similar (43.3% and 43.9%, respectively) between both Groups. We conclude that APR(+) chronic chagasic had worse nutritional status than APR(-) ones, and that APR development did not change the CVAG T. cruzi nests frequency.

[Frequency of precordialgia in chagasic and non-chagasic women]. / Freqüência de precordialgia em mulheres chagásicas e não-chagásicas.

The aim of this study was to compare the frequency of precordialgia between chagasic and non-chagasic women. A cross-sectional study comprised 647 female aged > or = 40, chagasic (n = 362) and controls (n = 285) was done at a Brazilian university hospital. Chagasic were classified as cardiac (n = 179), megas (n = 58) or indeterminate (n = 125) clinical forms. Chest pain was ascertained by typical or atypical retrosternal pain. Age (57.0 +/- 11.3 vs 57.3 +/- 10.4 years), and percentage of white women (75.8% vs 77.1%) were similar between chagasic and controls, respectively. Chest pain was more prevalent (p < 0.01) among chagasic (14.6%) than controls (5.6%), mainly in the cardiac form (relative risk = 2.41; range: 1.38-4.23), a phenomenon possibly related to cardiac parasympathetic denervation and myocardial microvascular changes.

[Frequency of diabetes mellitus and hyperglycemia in chagasic and non-chagasic women]. / Freqüência de diabetes mellitus e hiperglicemia em mulheres chagásicas e não-chagásicas.

Medical records of > or = 40 years old female seen at University Hospital from June/93 to July/95 were submitted to a cross-sectional study. According to Chagas' disease tests, patients were divided into chagasic (n = 362) and controls (n = 285). Diabetes mellitus was defined on the basis of two fasting blood glucose levels > or = 140 mg/dl and hyperglycemia as fasting blood glucose > 110 mg/dl. Chagasic patients were divided into groups with the cardiac form of the disease (n = 179), with megas (n = 58), and asymptomatic (n = 125). Groups were compared by the chi 2 test, analysis of variance, Student's "t" test, and Kruskal-Wallis and Mann-Whitney tests. A significant difference was assumed when p < 0.05. Chagasic and control groups were matched for age, white color and body mass index. Diabetes mellitus was more prevalent in patients with the cardiac form of Chagas' disease than in controls, or patients with the megas or the asymptomatic form (15.1%, 7.4%, 7.4%, and 5.6%, respectively); the same was observed for hyperglycemia (37.4%, 26.7%, 25.9%, 27.2%), in agreement with the hypothesis that the reduced parasympathetic activity caused by Trypanosoma cruzi leads to relative sympathetic hyperactivity.

[Serum levels of vitamin A, E, C and B2, carotenoid and zinc in hospitalized elderly patients]. / Avaliação dos níveis séricos das vitaminas A, E, C e B2, de carotenóides e zinco, em idosos hospitalizados.

Serum levels of carotenoids, zinc and vitamins A, E, C and B2 were measured in al (n = 202) the elderly patients hospitalized in different wards of the hospital studied from February 1986 to October 1988. The study was conducted on 130 men and 72 women with a mean age of 67.8 years (range: 60 to 88 years). The percentage of nutritional deficiency was 59.5% for zinc, 56.5% for vitamin C, 34.5% for vitamin B2, 25.9% for vitamin E, 13.2% for vitamin A, and 6.8% for carotenoids. Elderly patients with leucoses, megaesophagus, chronic obstructive pulmonary disease, and congestive heart failure represent a group with a high prevalence of deficiency both of zinc and of the vitamins under study. These results show the importance of detecting deficiencies of these micronutrients and provide a basis for a more rational approach to the treatment of elderly patients.

[Diarrhea associated with enteral feeding: hyperglycemia and other factors]. / Diarréia associada à nutrição enteral: hiperglicemia e outros fatores.

AIM: To identify clinical and biochemical parameters related to diarrhea occurrence in adult inpatients submitted to tube feeding. METHODS: Weight, height, body mass index (= weight/height2) and triceps skinfold were registered, in addition to serum albumin, glucose and 24-hours urinary creatinine excretion measurements. RESULTS: Patients with diarrhea (n = 17) did not statistically differ from those without diarrhea (n = 20), respectively concerning to age (58.1 +/- 13 vs 52.1 +/- 18.9 years), body mass index (18.5 +/- 6.9 vs 21.2 +/- 3.1 wt/ht2), acute phase response (94 vs 95%) and antibiotic therapy frequency (82.3 vs 95%), urinary creatinine excretion (754.7 +/- 561.2 vs 698.8 +/- 358.5 mg/day) and daily infused diet volume (969.3 +/- 379.8 vs 1037.7 +/- 380.4 ml). Patients with diarrhea showed lower levels of serum albumin (2.59 +/- 0.52 vs 2.92 +/- 0.46 g/dl), and higher blood glucose (157.5 +/- 82.3 vs 111.6 +/- 31.5 mg/dl) and triceps skinfold measurements (13.6 +/- 5.2 vs 10.1 +/- 4.4 mm). CONCLUSIONS: Under similar clinical and nutritional conditions, adults with diarrhea have higher blood glucose and lower serum albumin levels than controls.

[Dietary fiber intake in women with constipation]. / Ingestão de fibras alimentares em mulheres com constipação intestinal.

The objective of this study was to investigate the food pattern of women with constipation. It was carried out a 24 h recall and a food frequency survey in 31 constipated women and compared the results with a control of 31 women without constipation. Their mean daily crude fiber intake were no statistical different (2.33 +/- 1.4 vs 2.17 +/- 0.9 g/day), but the usual intake of fruits and vegetables of the constipated ones were irregular. These results call the attention for the influence of the kind and schedule of the food rich fiber intake on the intestinal habit.

[Pancreatic anatomopathologic changes in chronic chagasic women. Preliminary data]. / Alterações anatomo-patológicasdo pâncreas em chagásicas crônicas. Dados preliminares.

The aim of this study was to compare the frequency of pancreas morphologic and morphometric changes in chagasic women (n = 6) aged > or = 40 years, with non-chagasic controls (n = 4), paired concerning to age (59.8 +/- 11.5 versus 59.0 +/- 6.3 years), white color (33.3% versus 50.0%) and body mass index (22.3 +/- 7.0 versus 18.8 +/- 2.1 kg/m2). There were no pancreatic morphometric differences between necropsied chagasic and control groups. However, there was a smaller intrapancreatic neuronal population and a higher frequency of leukocyte perineural infiltrate in the pancreas of chagasic women. This possible intrapancreatic denervation could be associated with changes in carbohydrate metabolism, including hyperglycemia and diabetes mellitus, in some chronic chagasic women.

Chylothorax in hairy cell leukemia.

A case of postoperative left chylothorax in a 43-year-old black woman with hairy cell leukemia is reported. First submitted to pleural drainage, she was successfully treated with a combination of chemotherapy and elemental enteral diet enriched with medium-chain triglycerides.

[Prevalence of electrocardiographic abnormalities in 2,000 aged and non-aged chagasic patients]. / Prevalência de alterações eletrocardiográficas em 2000 pacientes chagásicos idosos e não idosos.

PURPOSE: To assess the prevalence of main electrocardiographic alterations in chagasic patients at University of Triângulo Mineiro Medical School, and compare such alterations between aged and non-aged patients. METHODS: Electrocardiograms (ECG) of 2,000 chagasic patients were interpreted. Age, color, sex and concomitant systemic hypertension, congestive heart failure (CHF) and megaesophagus and/or megacolon were registered. Chi-square test was employed to compare aged (60 years or more; n = 378) and non-aged (age less than 60 years; n = 1622) chagasics. RESULTS: ECG were normal in 9.6% of the patients. The main alterations were: ventricular premature complexes (VPC) 42.2%, left ventricular enlargement (LVE) 38.8%, right bundle branch block (RBBB) 32.4%, left anterior hemiblock 29.2% and ventricular repolarization changes 28.2%. The aged group exhibited greater (p < 0.05) proportion of male patients (1.7:1 vs 1.1:1), white than non-white (3.6:1 vs 2.2:1) and larger percentages (p < 0.01) of systemic hypertension (18.2 vs 7.5) and CHF (26.4 vs 12.0). The following alterations were significantly more common on aged chagasic: VPC (62.7 vs 37.5), LVE (43.4 vs 37.1), atrial fibrillation (19.6 vs 5.5), supraventricular premature complexes (11.9 vs 5.2), electrically inactive zone (9.5 vs 6.6), wandering atrial pacemaker (4.5 vs 2.2) and 2nd-degree atrioventricular (AV) block (2.9 vs 1.5). The non-aged chagasic had greater percentage (p < 0.05) than aged group of normal ECG (10.7 vs 5.0), RBBB (34.1 vs 24.9) and 1st degree AV block (9.7 vs 6.3). CONCLUSION: There was a high prevalence of ECG alterations in chagasic patients seeking medical attention. The different frequencies of those alterations between aged and non-aged chagasic may result of conditions more frequently seen in aged, like ischemic heart disease, CHF and systemic hypertension or to a probable more severe cardiac denervation in non-aged chagasic.

[Myocardial morphometric study in protein-energy malnourished adults]. / Estudo morfométrico do miocárdio em adultos com subnutrição protéico-energética.

PURPOSE: To compare cardiac muscle cells width and cardiomyocyte lipofuscin pigment presence between malnourished and non-malnourished necropsied adults. METHODS: Out of 315 necropsy protocols of adults randomly chosen, those with edema, ascitis, systemic arterial hypertension, chronic liver disease, and heart disease were excluded. Malnutrition was defined by body mass index (BMI) < 17 kg/m2. Cardiomyocytes morphometry study and lipofuscin pigment counts were performed. RESULTS: Malnourished (n = 8) and controls (n = 4), respectively, showed statistical differences in relation to BMI (14.86 +/- 1.13 vs 22.02 +/- 0.9 kg/m2), heart weight/body weight ratio (0.68 +/- 0.09 vs 0.54 +/- 0.07%), cardiomyocytes width (10.91 +/- 0.77 vs 12.90 +/- 1.82 microns) and lipofuscin pigment presence (39.1 vs 54.4%). CONCLUSION: When compared with controls, necropsied malnourished adults showed decreased myocardial fibers diameters and lower lipofuscin pigment presence. These findings might reflect altered metabolism, and would be associated with harmful clinical effects in terminally ill patients.

[Acute phase response and serum magnesium levels among hospitalized patients]. / Resposta de fase aguda e níveis séricos de magnésio em pacientes hospitalizados.

UNLABELLED: The acute phase response (APR) is characterized by proteolysis with decreased body cell mass, hyperglycemia, body water retention and renal dysfunction, which we hypothesised could affect magnesium serum levels. The aim of this study was to compare serum magnesium levels among hospitalized patients with or without APR. METHOD: All serum magnesium results (n = 527) corresponding to a six-months period were searched at University Hospital mainframe. Relevant laboratorial and clinical details were also registered. All cases of diabetes mellitus, chronic renal insufficiency, or serum creatinine > 1.5 mg/dl were excluded. APR was defined by the presence of fever plus severe trauma or infection plus leukopenia or leukocytosis. RESULTS: From a total of 214 patients, sixty-nine (32.2%) met the criteria for APR positivity (APR [symbol: see text]). Groups were paired for age, color, gender, diuretic use and edema presence. Hypomagnesemia was registered among 72% of cases, without statistical difference (p = 0.06) among APR [symbol: see text] and APR theta patients (63.8 vs 75.9%). Serum magnesium levels (median; range) were higher among APR [symbol: see text] cases, when compared to APR theta ones: 1.75; 1-3 vs 1.6; 0.9-2.9 m/dl, the same occurring with glycemia (115; 49-236 vs 99; 61-191 mg/dl) and serum creatinine (mean +/- SD): 0.8840 +/- 306 vs 0.803 +/- 0.257 mg/dl. Hypermagnesemia was more common among APR [symbol: see text] cases: 8.7 vs 2.1%. CONCLUSIONS: Our results suggest that higher magnesium serum levels seen in APR [symbol: see text] patients may be attributed to subclinical renal ischemia and possibly to increased glucose serum levels.

[Systemic talc granulomatosis in a HIV-negative intravenous drug addict]. / Correlação anátomo-clínica: granulomatose sistêmica por talco em drogadicto HIV negativo.

Anatomo-pathological correlation in a case of systemic talc granulomatosis affecting lungs, pleura, liver, spleen and mesenteric lymph nodes resulting in pulmonary arterial hypertension and cor pulmonale is described. The patient, a 26-year-old male HIV-negative intravenous drug addict had no lymphopenia or any histopathologic findings at necroscopy compatible with AIDS, despite of a chronic high-risk behavior favoring this illness.

[Nutritional value of soya milk in the treatment of malnourished alcoholic patients]. / Estudo do valor nutricional do leite de soja no tratamento de alcoólatras desnutridos.

The malnourished alcoholic patient requires frequently hospitalization for treatment and an adequate nutritional support is necessary for recovery of their health. The objective of the present study was to evaluate the nutritional value of an enteral diet based on "soya milk", corn sugar, coconut oil and water. Seven alcoholics, males, with 36.4 year mean age, without any clinical evidence of hepatic cirrhosis and/or pancreatitis, were submitted to three periods of metabolic nitrogen balance (NB), with multiple levels of protein intake (0.4, 0.6 and 0.8 grams of proteins/kg of body weight/day). The nitrogen intake (NI), the fecal nitrogen (FN) and the urinary nitrogen (UN) were determined, and the NB and protein digestibility value were calculated. The net protein utilization (NPU) was calculated by correlation studies between the NI and NB, with a value of 101.3%. The mean true digestibility was 100.1% and the mean requirement for that population was 0.5g protein/kg of body weight/day. Using a 97.5% confidence limit, the protein requirement of the enteral diet was calculated to be 0.8g protein/kg of body weight/day. The enteral diet based on "soya milk" can be profitable for this group of patients. It is a good alternative for use in enteral nutrition, easily available, well tolerable, and of high biological value.

Hypophosphatemia in acute-phase response syndrome patients. Preliminary data.

BACKGROUND: Hypophosphatemia is common in acutely ill patients and possibly may occur in the acute-phase response syndrome (APR), secondary to hyperglycemia and shifts of extracellular phosphorus into cells. AIM: To compare the frequency of hypophosphatemia in patients with or without APR. METHODS: All plasma phosphorus results (n = 822) corresponding to a 6-month period were searched using an university hospital mainframe. Relevant laboratory and clinical details were also registered. All cases of alcohol withdrawal, diabetic ketoacidosis, parenteral nutrition, and chronic respiratory alkalosis and patients receiving antacids or intravenous dextrose (5%) in water at a rate higher than 50 g glucose/day were excluded. APR was defined on the basis of severe trauma or infection and at least two of the following: fever, leukopenia (WBC <5,000/mm3), or leukocytosis (WBC >9,000/mm3). Hypophosphatemia was defined as a serum phosphorus concentration <2.0 mg/dl. RESULTS: A total of 227 patients were studied. Thirty-five (15.4%) patients fulfilled the criteria for APR. Hypophosphatemia was observed in 11.4% of the APR-positive patients, in contrast to 0.5% in the APR-negative group. Hyperglycemia was more common in APR-positive patients (60.0 vs. 36. 8%). CONCLUSION: Our results suggest that hypophosphatemia may be attributed to increased serum glucose levels secondary to tissue injury and infection in APR-positive patients.

Sodium serum levels in hypoalbuminemic adults at general medical wards.

Hypoalbuminemia may cause interstitial edema and hemodilution, which we hypothesized may influence serum sodium levels. Our purpose was to compare serum sodium levels of hospitalized adults with or without hypoalbuminemia. All sodium and albumin serum levels of 142 adults hospitalized at general medical wards over a six-month period were searched at a University Hospital mainframe computer. Relevant laboratory data and clinical details were also registered. Hypoalbuminemia was defined by serum albumin concentration < 3.3 g/dl Fisher, Mann-Whitney, and Student's t tests were applied to compare groups with or without hypoalbuminemia. Ninety-nine patients, classified as hypoalbuminemic, had lower blood hemoglobin (10.68 +/- 2.62 vs. 13.54 +/- 2.41), and sodium (135.1 +/- 6.44 vs. 139.9 +/- 4.76 mEq/l) and albumin (2.74 +/- 0.35 vs. 3.58 +/- 0.28 g/dl) serum levels than non-hypoalbuminemic (n = 43). Pearson's coefficient showed a significant direct correlation between albumin and sodium serum levels (r = 0.40) and between serum albumin and blood hemoglobin concentration (r = 0.46). Our results suggest that hypoalbuminemic adults have lower serum sodium levels than those without hypoalbuminemia, a phenomenon that may be at least partially attributed to body water retention associated with acute phase response syndrome.

Morphologic and morphometric evaluation of pancreatic islets in chronic Chagas' disease.

PURPOSE: Hyperglycemia and abnormal glucose tolerance tests observed in some patients with chronic Chagas' disease suggest the possibility of morphological changes in pancreatic islets and/or denervation. The purpose of this study was to describe the morphology and morphometry of pancreatic islets in chronic Chagas' disease. METHODS: Morphologic and computerized morphometric studies were performed in fragments of the head, body, and tail regions of the pancreas obtained at necropsies of 8 normal controls and 17 patients with chronic Chagas' disease: 8 with the digestive form (Megas) and 9 with the congestive heart failure form. RESULTS: The Megas group had a larger (p < 0.05) pancreatic islet area in the tail of the pancreas (10649.3 +/- 4408.8 micrometer2) than the normal control (9481.8 +/- 3242.4 micrometer2) and congestive heart failure (9475.1 +/- 2104.9 micrometer2) groups; likewise, the density of the pancreatic islets (PI) was greater (1.2 +/- 0.7 vs. 0.9 +/- 0.6 vs. 1.9 +/- 1.0 PI/mm2, respectively). In the tail region of the pancreas of patients with the Megas form, there was a significant and positive correlation (r = +0.73) between the area and density of pancreatic islets. Discrete fibrosis and leukocytic infiltrates were found in pancreatic ganglia and pancreatic islets of the patients with Chagas' disease. Trypanosoma cruzi nests were not observed in the examined sections. Individuals with the Megas form of Chagas' disease showed increased area and density of pancreatic islets in the tail of the pancreas. CONCLUSION: The observed morphometric and morphologic alterations are consistent with functional changes in the pancreas, including glycemia and insulin disturbances.