The Burden of Spine Structural Damage on Function in Patients With Axial Spondyloarthritis: Adaptation-Mediated Uncoupling?

OBJECTIVE: To investigate the association between spinal damage and functional capacity in patients with axial spondyloarthritis (axSpA) and to compare the performance of 2 radiographic scores (modified Stoke Ankylosing Spondylitis Spine Score [mSASSS] and Combined Ankylosing Spondylitis Spine Score [CASSS]). METHODS: Radiographs from 101 patients with axSpA were scored for cervical facet joints (CFJ) and mSASSS for vertebral bodies. CASSS was calculated as the sum of both scores. Physical function was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI); disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS); mobility by Bath Ankylosing Spondylitis Metrology Index (BASMI); and quality of life by Ankylosing Spondylitis Quality of Life (ASQOL). Univariate and multivariate analyses were performed to investigate the association between possible explanatory variables and outcomes. RESULTS: BASFI correlated strongly with ASQOL (Spearman ρ 0.66) and BASDAI (ρ 0.70), moderately with BASMI (ρ 0.46) and ASDAS (ρ 0.59), and weakly with mSASSS (ρ 0.29) and CASSS (ρ 0.28). A best-fit multivariate model for BASFI, adjusted for symptom duration, age, sex, and smoking status, included BASDAI (B 0.76, P < 0.001), BASMI (B 0.62, P < 0.001), and history of total hip arthroplasty (B 1.22, P = 0.05). Radiographic scores were predictors of BASFI only when BASMI was removed from the model (mSASSS: B 0.03, P = 0.01; CASSS: B 0.02, P = 0.01). CONCLUSION: Spinal damage was independently associated with physical function in axSpA, but to a lesser extent than disease activity and mobility. Moreover, incorporating CFJ assessment in the mSASSS did not improve the ability to predict function.

Malaria in Angola: recent progress, challenges and future opportunities using parasite demography studies.

Over the past two decades, a considerable expansion of malaria interventions has occurred at the national level in Angola, together with cross-border initiatives and regional efforts in southern Africa. Currently, Angola aims to consolidate malaria control and to accelerate the transition from control to pre-elimination, along with other country members of the Elimination 8 initiative. However, the tremendous heterogeneity in malaria prevalence among Angolan provinces, as well as internal population movements and migration across borders, represent major challenges for the Angolan National Malaria Control Programme. This review aims to contribute to the understanding of factors underlying the complex malaria situation in Angola and to encourage future research studies on transmission dynamics and population structure of Plasmodium falciparum, important areas to complement host epidemiological information and to help reenergize the goal of malaria elimination in the country.

Seaweed Secondary Metabolites with Beneficial Health Effects: An Overview of Successes in In Vivo Studies and Clinical Trials.

Macroalgae are increasingly viewed as a source of secondary metabolites with great potential for the development of new drugs. In this development, in vitro studies are only the first step in a long process, while in vivo studies and clinical trials are the most revealing stages of the true potential and limitations that a given metabolite may have as a new drug. This literature review aims to give a critical overview of the secondary metabolites that reveal the most interesting results in these two steps. Phlorotannins show great pharmaceutical potential in in vivo models and, among the several examples, the anti-dyslipidemia activity of dieckol must be highlighted because it was more effective than lovastatin in an in vivo model. The IRLIIVLMPILMA tridecapeptide that exhibits an in vivo level of activity similar to the hypotensive clinical drug captopril should still be stressed, as well as griffithsin which showed such stunning results over a variety of animal models and which will probably move onto clinical trials soon. Regarding clinical trials, studies with pure algal metabolites are scarce, limited to those carried out with kahalalide F and fucoxanthin. The majority of clinical trials currently aim to ascertain the effect of algae consumption, as extracts or fractions, on obesity and diabetes.

Ultrasonographic differentiation of cervical lymph nodes in patients with papillary thyroid carcinoma after thyroidectomy and radioiodine ablation: a prospective study.

OBJECTIVE: The objective of the present study was to validate an ultrasound (US) classification of cervical lymph nodes (LNs) in patients with papillary thyroid cancer (PTC) after thyroidectomy and radioactive iodine (131I) ablation. METHODS: We performed a prospective study in which the patients were submitted to thyroidectomy and 131I ablation and then followed until neck US revealed LN(s) ≥5 mm. A total of 288 LNs from 112 patients with PTC were evaluated. Patient management was based on LN characteristics grouped according to the classification system studied here. RESULTS: The presence of microcalcifications and/or cystic degeneration of cervical LNs were highly suggestive of a metastatic etiology (specificity of 99.4%). In contrast, the most sensitive finding for LNs affected by PTC was the absence of an echogenic hilum (sensitivity of 100%). In the absence of these findings (microcalcifications, cystic degeneration, echogenic hilum), a metastatic etiology was the most likely in the case of a round LN (specificity of 89%). The differentiation of a spindle-shaped LN without a visible hilum by Doppler analysis permitted us to dichotomize an initial probability of metastases of 13% in 25% (with peripheral vascularization) versus 3.3% (without peripheral vascularization). CONCLUSIONS: Our results confirm that the classification proposed for cervical LNs in patients with PTC is valid for determining patient management following initial therapy.

Macaronesian Plants as Promising Biopesticides against the Crop Pest Ceratitis capitata.

Ceratitis capitata is responsible for significant economic losses in the fruit production industry, and the market lacks biopesticides that are effective but also cheaper and less contaminating, with fewer negative impacts on the environment. In this regard, the present study suggests as potential options ethanolic extracts from several Macaronesian plants, which inhibit the oviposition and are toxic to C. capitata, and whose preparation involve a non-toxic solvent (i.e., ethanol), low energy expenditure and cheap apparatus (i.e., maceration at room temperature). Among the evaluated species, the extracts of Hedychium gardnerianum, Cistus symphytifolius and Salvia canariensis are the most active (50 mg/mL), revealing an increase in C. capitata adults' mortality from 21.15% to 27.41% after 72 h, a value statistically identical to azadirachtin (25.93%) at the recommended concentration (0.88 mg/mL). Considering the quantity and biomass available to prepare a biopesticide in the future, and the level of activity, the ethanolic extract of H. gardnerianum was fractionated and each fraction tested. The water fraction at 50 mg/mL proved to be more effective than the original extract, both in terms of mortality (57.69%), with LT50 = 72.5 h, and oviposition deterrence (83.43%), values statistically higher than those obtained by azadirachtin at 0.88 mg/mL. Analysis of this fraction by HPLC-MS/MS showed that it is mainly composed of glycosylated derivatives of quercetin and myricetin in addition to some triterpenes. These findings highlight some Macaronesian species, and in particular, the more polar fraction of H. gardnerianum ethanolic extract, as promising and ecological alternatives to conventional insecticides, for use in the integrated management of the C. capitata pest.

Aqueous and Ethanolic Plant Extracts as Bio-Insecticides-Establishing a Bridge between Raw Scientific Data and Practical Reality.

Global demand for food production is causing pressure to produce faster and bigger crop yields, leading to a rampant use of synthetical pesticides. To combat the nefarious consequences of its uses, a search for effective alternatives began in the last decades and is currently ongoing. Nature is seen as the main source of answers to crop protection problems, supported by several examples of plants/extracts used for this purpose in traditional agriculture. The literature reviewed allowed the identification of 95 plants whose extracts exhibit insecticide activity and can be used as bio-pesticides contributing to sustainable agriculture. The option for ethanol and/or water extracts is more environmentally friendly and resorts to easily accessible solvents, which can be reproduced by farmers themselves. This enables a bridge to be established between raw scientific data and a more practical reality. Azadirachta indica, Capsicum annuum, Nicotiana tabacum and Tagetes erecta are the most researched plants and have the potential to be viable options in the pest management approach. Azadirachta indica showed the most promising results and Brevicoryne brassicae was the most targeted pest species, being tested against the aqueous and/or ethanolic extracts of 23 different plants. Maceration using dried material (usually leaves) is the extraction method preferred by the majority of authors.

Uncharted Source of Medicinal Products: The Case of the Hedychium Genus.

A current research topic of great interest is the study of the therapeutic properties of plants and of their bioactive secondary metabolites. Plants have been used to treat all types of health problems from allergies to cancer, in addition to their use in the perfumery industry and as food. Hedychium species are among those plants used in folk medicine in several countries and several works have been reported to verify if and how effectively these plants exert the effects reported in folk medicine, studying their essential oils, extracts and pure secondary metabolites. Hedychium coronarium and Hedychium spicatum are the most studied species. Interesting compounds have been identified like coronarin D, which possesses antibacterial, antifungal and antitumor activities, as well as isocoronarin D, linalool and villosin that exhibit better cytotoxicity towards tumor cell lines than the reference compounds used, with villosin not affecting the non-tumor cell line. Linalool and α-pinene are the most active compounds found in Hedychium essential oils, while ß-pinene is identified as the most widespread compound, being reported in 12 different Hedychium species. Since only some Hedychium species have been investigated, this review hopes to shed some light on the uncharted territory that is the Hedychium genus.

Inula L. Secondary Metabolites against Oxidative Stress-Related Human Diseases.

An imbalance in the production of reactive oxygen species in the body can cause an increase of oxidative stress that leads to oxidative damage to cells and tissues, which culminates in the development or aggravation of some chronic diseases, such as inflammation, diabetes mellitus, cancer, cardiovascular disease, and obesity. Secondary metabolites from Inula species can play an important role in the prevention and treatment of the oxidative stress-related diseases mentioned above. The databases Scopus, PubMed, and Web of Science and the combining terms Inula, antioxidant and secondary metabolites were used in the research for this review. More than 120 articles are reviewed, highlighting the most active compounds with special emphasis on the elucidation of their antioxidative-stress mechanism of action, which increases the knowledge about their potential in the fight against inflammation, cancer, neurodegeneration, and diabetes. Alantolactone is the most polyvalent compound, reporting interesting EC50 values for several bioactivities, while 1-O-acetylbritannilactone can be pointed out as a promising lead compound for the development of analogues with interesting properties. The Inula genus is a good bet as source of structurally diverse compounds with antioxidant activity that can act via different mechanisms to fight several oxidative stress-related human diseases, being useful for development of new drugs.

MAGNETIC RESONANCE IMAGING PERFUSION TECHNIQUE IN THE EVALUATION OF ACHILLES TENDON INJURY IN RABBITS.

OBJECTIVE: This study aimed to evaluate the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the experimental model of Achilles tendon injury. METHODS: Twelve white male adults New Zealand rabbits were divided into two groups, a group with resection of the central portion of the Achilles tendon (n = 8) and a control group (n = 4). Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was performed 4 weeks after the surgical procedure, followed by histological analysis of the tendons. RESULTS: The main finding of this study was the difference (p < 0.001) in peak contrast enhancement on DCE-MRI, which demonstrated that the operated group had greater contrast uptake. The operated tendons showed histological disruption of their architecture, and cluttered appearance of tendinous fibers, with vascular and fibroblast proliferations. CONCLUSION: DCE-MRI is a technique with a potential to demonstrate changes in the vascularity pattern of the Achilles tendon before and after operation. DCE-MRI has a potential to be used in studies of tendinosis diagnosis and surgical follow-up. Level of evidence II, Experimental Study .

OBJETIVOS: Avaliar a captação do gadolínio (Gd) à ressonância magnética (DCRM) em modelo experimental de lesão do tendão de Aquiles. MÉTODOS: Foram utilizados 12 coelhos machos, adultos e brancos da raça Nova Zelândia, distribuídos em dois grupos: operados (n = 8), com ressecção da porção central do tendão de Aquiles; e o grupo controle (n=4). Após quatro semanas, realizou-se ressonância magnética com técnica de avaliação dinâmica do meio de contraste, seguido de analise histológica dos tendões. RESULTADOS: Houve diferença (p <0,001) do pico máximo de realce de contraste, na DCRM dinâmica do tendão de Aquiles entre os grupos operado e controle, sendo evidenciada maior captação de contraste no grupo operado. À histologia, os tendões operados apresentaram desorganização de sua arquitetura, fibras tendíneas de aspecto desordenado, com neoformação vascular e proliferação de fibroblastos. CONCLUSÃO: A DCRM apresentou potencial de demonstrar alterações do padrão de vascularização do tendão de Aquiles no pré e pós-operatório. A DCRM apresenta potencial para ser usada em estudos para controle de tratamento e diagnóstico da tendinose. Nível de evidência II, Estudo Experimental .

Methotrexate use, not interleukin 33, is associated with lower carotid intima-media thickness in patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis is a risk factor for early mortality due to cardiovascular disease. Interleukin-33 appears to protect against the development of atherosclerosis. The purpose of this study was to investigate the relationship between serum levels of interleukin-33 and its soluble receptor with the presence of subclinical carotid atherosclerosis in rheumatoid arthritis patients. METHODS: Rheumatoid arthritis patients without atherosclerotic disease were subjected to clinical and laboratory assessments, including carotid ultrasound. Interleukin-33 and its soluble receptor serum levels were measured by ELISA. RESULTS: 102 patients were included. The prevalence of carotid plaques was 23.5% and the median intima-media thickness was 0.7 mm. The median interleukin-33 and its soluble receptor concentration was 69.1 and 469.8 pg/ml. No association was found between serum interleukin-33 or its soluble receptor and intima-media thickness or plaque occurrence. Each 0.1 mm increase of intima-media thickness raised the odds of plaque occurrence by 5.3-fold, and each additional year of rheumatoid arthritis duration increased the odds of plaque occurrence by 6%. Each additional year in patients age and each one-point increase in the Framingham Risk Score were associated with a 0.004 mm and 0.012 mm increase in intima-media thickness. Methotrexate use was associated with a 0.07 mm reduction in intima-media thickness. CONCLUSIONS: Interleukin-33 and its soluble receptor were not associated with subclinical atherosclerosis. Traditional risk factors for atherosclerosis and rheumatoid arthritis duration were associated with intima-media thickness and plaque occurrence; methotrexate use was associated with a lower intima-media thickness.

[Contribution of computed tomography in patients with lung metastases of differentiated thyroid carcinoma not apparent on plain radiography who were treated with radioiodine]. / Contribuição da tomografia computadorizada em pacientes com metástases pulmonares de carcinoma diferenciado de tireóide não-aparentes na radiografia e tratados com radioiodo.

Computed tomography (CT or CAT Scan) of the chest is more sensitive than radiography in the detection of lung metastases of differentiated thyroid cancer (DTC), but little information is available regarding the aggregated value of this method. The present study evaluated the response of patients with lung metastases of DTC not apparent on radiography to treatment with 131I and the value of CT in these cases. Twenty-five patients with lung metastases not apparent on radiography, who initially received 100-200 mCi I151, were evaluated and those presenting pulmonary uptake on post-therapy WBS were submitted to a new treatment after 6 to 12 months, and so on. The chance of detection of pulmonary uptake on post-therapy WBS did not differ between patients with negative and positive CT (100% versus 91.5%). Mean serum Tg levels were higher in patients with positive CT (108 ng/ml versus 52 ng/ml). Negative post-therapy WBS was achieved in 82% of patients with positive CT and in 92.3% with negative CT and the cumulative I131 activity necessary to achieve this outcome did not differ between the two groups (mean=300 mCi). Stimulated Tg was undetectable in 47% of patients with negative CT at the end of treatment, but in none of the patients whose CT continued to be positive. In patients with elevated Tg, the CT result apparently did not change the indication of therapy or the I131 activity to be administered. In cases with lung metastases, the persistence of micronodules on CT was associated with the persistence of detectable Tg in patients presenting negative post-therapy WBS.

The Current Status of the Pharmaceutical Potential of Juniperus L. Metabolites.

Background: Plants and their derived natural compounds possess various biological and therapeutic properties, which turns them into an increasing topic of interest and research. Juniperus genus is diverse in species, with several traditional medicines reported, and rich in natural compounds with potential for development of new drugs. Methods: The research for this review were based in the Scopus and Web of Science databases using terms combining Juniperus, secondary metabolites names, and biological activities. This is not an exhaustive review of Juniperus compounds with biological activities, but rather a critical selection taking into account the following criteria: (i) studies involving the most recent methodologies for quantitative evaluation of biological activities; and (ii) the compounds with the highest number of studies published in the last four years. Results: From Juniperus species, several diterpenes, flavonoids, and one lignan were emphasized taking into account their level of activity against several targets. Antitumor activity is by far the most studied, being followed by antibacterial and antiviral activities. Deoxypodophyllotoxin and one dehydroabietic acid derivative appears to be the most promising lead compounds. Conclusions: This review demonstrates the Juniperus species value as a source of secondary metabolites with relevant pharmaceutical potential.

Effect of different cooking conditions on the profiles of Maillard reaction products and nutrient composition of hairtail (Thichiurus lepturus) fillets.

Much attention has been given to investigate the formation of Maillard reaction products in thermal processing food due to potential health risks. This study aimed to the profiles of Maillard reaction products (MRPs) and changes of nutrient composition in hairtail (Thichiurus lepturus) fillets prepared by three cooking method: boiling, baking and frying. The Nε-carboxymethyllysine (CML) level ranged from non-detectable to 4.24mg/100g protein and furosine ranged from 4.25 to 20.95mg/100g protein. The levels of CML and furosine in boiled hairtail fillets were much lower than baked and fried ones. The formation of CML was only affected by the cooking method. The changes of the lipid and moisture content, and thiobarbituric acid-reactive substances (TBARS) content in cooked hairtail fillet had different effects on the formation of different stages of Maillard reaction. Furosine level significantly correlated with absorbance in 420nm (r=0.74, p<0.05) and 280nm (r=0.73, p<0.05) and fluorescence Intensity (FI) (r=0.65, p<0.05), but did not correlate with CML. The CML level linearly correlated with the moisture (r=0.79, p<0.01) and lipid content (r=0.73, p<0.05), and the formation of TBARS value (r=0.92, p<0.01), but did not correlate with the FI. Overall, the findings may help to better control the cooking conditions of hairtail meat based on the profiles of MRPs.

A randomized trial of carvedilol after renin-angiotensin system inhibition in chronic Chagas cardiomyopathy.

OBJECTIVE: The objective of this study was to determine the safety and efficacy of renin-angiotensin system (RAS) inhibitors and beta-blockers in chronic Chagas cardiomyopathy. BACKGROUND: Chronic Chagas cardiomyopathy causes substantial morbidity and mortality in Latin America. Whether RAS inhibitors and beta-blockers are safe and beneficial has been challenged because of the lack of formal trials. METHODS: We conducted a double-blind, placebo-controlled, and randomized trial in 42 patients with Trypanosoma cruzi infection and cardiomyopathy. All patients received enalapril (up-titrated to 20 mg BID) and spironolactone (25 mg QD). Subsequently, the patients were randomly assigned to receive placebo (n = 20) or carvedilol up-titrated to 25 mg BID (n = 19). The primary end points were change in left ventricular ejection fraction (LVEF) after RAS inhibition and that after the addition of carvedilol. The secondary end points were changes in other echocardiographic parameters, Framingham score, quality of life (36-item Short-Form Health Survey), New York Heart Association class, radiographic indices, brain natriuretic peptide levels, and chemokines as well as safety end points. RESULTS: Optimization of RAS inhibition was safe, hemodynamically well tolerated, and associated with improvements in Framingham score (P = .001) and quality of life as well as reductions in the cardiothoracic index (P = .002), brain natriuretic peptide level (P = .032), and RANTES (regulated on activation, normal T expressed and secreted) level (P = .001). Left ventricular ejection fraction increased by 2.3% (P = .25); in patients with an LVEF < or = 45% at baseline, it increased by 2.8% (P = .017). Treatment with carvedilol was associated with a trend toward an increase in LVEF (absolute difference between groups, 2.3%; P = .094). The addition of carvedilol was safe, hemodynamically well tolerated, and not associated with symptomatic bradycardia. CONCLUSIONS: In patients with chronic Chagas cardiomyopathy, optimization of treatment with enalapril and spironolactone and subsequent addition of carvedilol were safe and associated with benefits in cardiac function and clinical status. Larger trials are needed to show effects on mortality and/or hospitalization.

Anti-CCP antibodies are not a marker of severity in established rheumatoid arthritis: a magnetic resonance imaging study.

INTRODUCTION: The presence of anti-CCP is an important prognostic tool of rheumatoid arthritis (RA). But research is still ongoing on its relationship with disease activity and functional capacity. OBJECTIVES: To study the relationship between anti-CCP and disease activity, functional capacity and structural damage indexes, by means of conventional radiography (CR) and magnetic resonance imaging (MRI), in cases of established RA. METHODS: Cross-sectional study with RA patients with 1-10 disease duration. Participants underwent clinical evaluation with anti-CCP. Disease activity was assessed using the Clinical Disease Activity Index (CDAI), and functional capacity through the Health Assessment Questionnaire (HAQ). CR analysis was carried out by the Sharp van der Heijde index (SvdH), and MRI analysis by RAMRIS (Rheumatoid Arthritis Magnetic Resonance Image Scoring). RESULTS: We evaluated 56 patients, with a median (IqR) age of 55 (47.5-60) years; 50 (89.3%) participants were female and 37 (66.1%) were positive for anti-CCP. Medians (IqR) of CDAI, HAQ, SvdH and RAMRIS were 14.75 (5.42-24.97) 1.06 (0.28-1.75), 2 (0-8) and 15 (7-35), respectively. There was no association between anti-CCP and CDAI, HAQ and SvdH and RAMRIS scores. CONCLUSION: Our results have not established an association of anti-CCP with the severity of disease. To date, we cannot corroborate anti-CCP as a prognostic tool in patients with established RA.

Effects of chronic consumption of green tea on weight and body fat distribution of Wistar rats evaluated by computed tomography.

PURPOSE:: To evaluate the effects of chronic consumption of green tea on body weight and distribution of visceral fat by Computed tomography in female Wistar rats. METHODS:: Wistar rats were divided into control group (n = 5), which received water and feed ad libitum, and green tea group (n = 8), in which water has been replaced by green tea. The animals were weighed weekly and Computed Tomography was used at the beginning (1st week) and end (18th week) of the experiment for evaluating the distribution of visceral fat. The animals were followed for 18 weeks. RESULTS:: There was no significant difference in body weight between the groups. However, there was significant difference in visceral fat area. The green tea group had less visceral fat area at the end of the experiment, 3.67 ± 1.2 cm2, while the control group showed an area of 6.25 ± 2.2 cm (p = 0.00). CONCLUSIONS:: Chronic consumption of green tea leads to decreased visceral adipose tissue area.

Healing of the Achilles tendon in rabbits--evaluation by magnetic resonance imaging and histopathology.

BACKGROUND: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) could provide valuable findings for tendon regeneration. A non-invasive image method that can effectively evaluate the quality of the scar tissue has not yet been employed. METHODS: Thirteen New Zealand rabbits were divided into two groups: group 1--non-treated control (n = 4); group 2--surgical intervention (n = 9). The central portion of the Achilles tendon was resected, and after 30 days, DCE-MRI was performed. Contrast enhancement methods were applied using the region of interest (ROI) technique. In the medium third of the Achilles tendon, the intra-substantial signal intensity and the presence of hyper-intense intra-tendon focus points and of signal heterogeneity were evaluated. Antero-posterior and transversal diameters of the tendon were measured. The Achilles tendon was removed and dissected free from other tissues. Sections from the central part of the tendon were stained for histological analysis. RESULTS: The difference between the contrast enhancement curves of the control and surgical groups (p < 0.0001) was observed. The surgical group had an intense contrast enhancement in the contrast sequences, enlargement of the diameter and intra-substantial signal intensity alteration, with hyper-signal focus points and widening of the tendon sheath, which presented irregular contours and intense contrast enhancement. On histology, the Achilles tendon presented diffuse widening of the tendon sheath and wedge-shaped areas with scarring tissue rich in disordered collagen fibres. These findings were related to alteration in the intra-substantial signal intensity, with hyper-signal focus points in the DCE-MRI. CONCLUSIONS: MRI with perfusion could be a useful technique for evaluating tissue and fibrous scarring in tendons.

Dietary patterns in Brazilian patients with nonalcoholic fatty liver disease: a cross-sectional study.

OBJECTIVE: Recent evidence suggests that non-alcoholic fatty liver disease is associated with diet. Our aim was to investigate the dietary patterns of a Brazilian population with this condition and compare them with the recommended diet. METHODS: A cross-sectional study was conducted on 96 non-alcoholic fatty liver disease patients before any dietetic counseling. All patients underwent abdominal ultrasound, biochemical tests, dietary evaluations, and anthropometric evaluations. Their food intake was assessed by a semi-quantitative food-frequency questionnaire and 24-hour food recall. RESULTS: The median patient age was 53 years, and 77% of the individuals were women. Most (67.7%) participants were obese, and a large waist circumference was observed in 80.2% subjects. Almost 70% of the participants had metabolic syndrome, and 62.3% presented evidence of either insulin resistance or overt diabetes. Most patients (51.5, 58.5, and 61.7%, respectively) exceeded the recommendations for energy intake, as well as total and saturated fat. All patients consumed less than the amount of recommended monounsaturated fatty acids, and 52.1 and 76.6% of them consumed less polyunsaturated fatty acids and fiber, respectively, than recommended. In most patients, the calcium, sodium, potassium, pyridoxine, and vitamin C intake did not meet the recommendations, and in 10.5-15.5% of individuals, the tolerable upper limit intake for sodium was exceeded. The patients presented a significantly high intake of meats, fats, sugars, legumes (beans), and vegetables and a low consumption of cereals, fruits, and dairy products compared with the recommendations. CONCLUSIONS: Although patients with non-alcoholic fatty liver disease exhibited high energy and lipid consumption, most of them had inadequate intake of some micronutrients. The possible role of nutrient-deficient intake in the development of non-alcoholic fatty liver disease warrants investigation.

Echocardiographic parameters associated with pulmonary congestion in outpatients with Chagas' cardiomyopathy and non-chagasic cardiomyopathy.

INTRODUCTION: Despite significant left ventricular (LV) systolic dysfunction and cardiomegaly, pulmonary congestion does not seem to be a major finding in Chagas' cardiomyopathy (CC). This study sought to identify echocardiographic parameters associated with pulmonary congestion in CC and in dilated cardiomyopathy of other etiologies, such as non-CC (NCC), and to compare pulmonary venous hypertension between the two entities. METHODS: A total of 130 consecutive patients with CC and NCC, with similar echocardiographic characteristics, were assessed using Doppler echocardiography and chest radiography. Pulmonary venous vessel abnormalities were graded using a previously described pulmonary congestion score, and this score was compared with Doppler echocardiographic parameters. RESULTS: NCC patients were older than CC patients (62.4 ± 13.5 × 47.8 ± 11.2, p = 0.00), and there were more male subjects in the CC group (66.2% × 58.5%, p = 0.4). Pulmonary venous hypertension was present in 41 patients in the CC group (63.1%) and in 63 (96.9%) in the NCC group (p = 0.0), the mean lung congestion score being 3.2 ± 2.3 and 5.9 ± 2.6 (p = 0.0), respectively. On linear regression multivariate analysis, the E/e' ratio (ß = 0.13; p = 0.0), LV diastolic diameter (ß = 0.06; p = 0.06), left atrial diameter (ß = 0.51; p = 0.08), and right ventricular (RV) end-diastolic diameter (ß = 0.02; p = 0.48) were the variables that correlated with pulmonary congestion in both groups. CONCLUSIONS: Pulmonary congestion was less significant in patients with CC. The degree of LV of systolic and diastolic dysfunction and the RV diameter correlated with pulmonary congestion in both groups. The E/e' ratio was the hallmark of pulmonary congestion in both groups.

Helical computed tomography characteristics of splenic and hepatic trauma in children subjected to nonoperative treatment.

The purpose of this study was to present the radiological characteristics of abdominal computed tomography (CT) in the follow-up of splenic and hepatic injury in children. Children ( n=24) less than 13 years old who had suffered blunt abdominal trauma and were diagnosed with splenic and hepatic injury by CT scan prospectively were enlisted in the study. The CT was performed immediately after the injury was suspected, and 7 and 60 days after the trauma. The clinical course of the patients was observed (red blood transfusion requirement, associated abdominal injuries, and hospital stay). The splenic and hepatic injuries varied from grade II to grade IV of the American Association for the Surgery of Trauma. The CT showed a reduction in the volume of the injury 60 days after the trauma. In this article the radiological findings will be shown and correlated with the clinical course of the patients. This study shows that CT is advantageous for detecting and grading splenic and hepatic injuries. These injuries can be managed nonoperatively in hospitals where CT is available for the evaluation of pediatric patients.