Neuregulin-1 improves right ventricular function and attenuates experimental pulmonary arterial hypertension.

AIMS: Pulmonary arterial hypertension (PAH) is a serious disease that affects both the pulmonary vasculature and the right ventricle (RV). Current treatment options are insufficient. The cardiac neuregulin (NRG)-1/ErbB system is deregulated during heart failure, and treatment with recombinant human NRG-1 (rhNRG-1) has been shown to be beneficial in animal models and in patients with left ventricular (LV) dysfunction. This study aimed to evaluate the effects of rhNRG-1 in RV function and pulmonary vasculature in monocrotaline (MCT)-induced PAH and RV hypertrophy (RVH). METHODS AND RESULTS: Male wistar rats (7- to 8-weeks old, n = 78) were injected with MCT (60 mg/kg, s.c.) or saline and treated with rhNRG-1 (40 µg/kg/day) or vehicle for 1 week, starting 2 weeks after MCT administration. Another set of animals was submitted to pulmonary artery banding (PAB) or sham surgery, and followed the same protocol. MCT administration resulted in the development of PAH, pulmonary arterial and RV remodelling, and dysfunction, and increased RV markers of cardiac damage. Treatment with rhNRG-1 attenuated RVH, improved RV function, and decreased RV expression of disease markers. Moreover, rhNRG-1 decreased pulmonary vascular remodelling and attenuated MCT-induced endothelial dysfunction. The anti-remodelling effects of rhNRG-1 were confirmed in the PAB model, where rhNRG-1 treatment was able to attenuate PAB-induced RVH. CONCLUSION: rhNRG-1 treatment attenuates pulmonary arterial and RV remodelling, and dysfunction in a rat model of MCT-induced PAH and has direct anti-remodelling effects on the pressure-overloaded RV.

A newborn with neck mass / Recém-nascido com massa cervical

Congenital goiter is a rare cause of neonatal neck mass and may result from a fetal defectin synthesis of thyroxine, or administration of antithyroid drugs or iodides during pregnancy. The thyroid dysfunction often accompanies it. This report describes a case of a male term newborn with congenital goiter and primary hypothyroidism. Hormonal replacement treatment was started leading to normal levels of free thyroxine and triiodothyronine. In face of a maternal negative investigation, dyshormonogenesis was considered to be the most probable cause of hypothyroidism.

O bócio congênito é uma causa rara de massa cervical no recém-nascido podendo resultar de um defeito na síntese de tiroxina pelo feto, ou administração de antitiroidianos ou substâncias contendo iodo durante a gravidez. Na maioria das vezes, acompanha-se de disfunção tireoidiana. É descrito o caso de um recém-nascido a termo, de sexo masculino, com bócio congênito e hipotireoidismo primário. Foi iniciada terapia hormonal de reposição com normalização dos níveis de tiroxina e triiodotironina. Como a investigação materna foi negativa, disormonogênese foi considerada a causa mais provável do hipotiroidismo.

A newborn with neck mass.

Congenital goiter is a rare cause of neonatal neck mass and may result from a fetal defectin synthesis of thyroxine, or administration of antithyroid drugs or iodides during pregnancy. The thyroid dysfunction often accompanies it. This report describes a case of a male term newborn with congenital goiter and primary hypothyroidism. Hormonal replacement treatment was started leading to normal levels of free thyroxine and triiodothyronine. In face of a maternal negative investigation, dyshormonogenesis was considered to be the most probable cause of hypothyroidism.

[Degree of patient satisfaction regarding the reception given by emergency service nurses]. / Grau de satisfação do utente relativamente ao acolhimento proporcionado pelo enfermeiro no serviço de urgência.

Humanizing in hospitals begins with the patients' reception. Although this "function" should be considered as the duty of every person who works in Hospital, it is fundamental to be assumed as a nursing service, since we are the professional sector which spends more time with the patient. However, the reception may have positive or negative effects on the patient's recovery and on the Health Unit's image. Thus, and having the mission of optimizing the quality of health care, mainly as far as reception is concerned, with this study came out, through which we intend to analyse the patient's level of satisfaction as for the reception offered by the nurse in the Emergency Service of Hospital São Marcos de Braga. It is a study of a descriptive and exploratory nature, within a quantitative approach. To carry out this empirical study, we considered as target population the patients who needed the Emergency Service in the period between January and March of 2002, both male and female (about 50% of each), 50% of rural patients and 50% of urban patients, between the ages of 18 and 65 who stayed in this service from 3 to 12 hours. A random and representative selection of patients was taken, based on the criteria previously mentioned. We obtained a sample of 1440 patients through a random selection of 5 patients in the morning shift, 6 patients in the afternoon shift and 5 patients in the night shift, during the period in which the study was carried out. This study was carried out without the presence of the participants in the survey.

Anafilaxia induzida por exercício dependente de um alimento específico: relato de um caso / Anaphylaxis induced by dependent exercise in a specific food: report of a case

Apresentamos um caso de anafilaxia induzida pelo exercício (AIE) dependente de um alimento específico. O diagnóstico foi sugerido pela anamnese e confirmado por teste de provocaçäo. O paciente apresentava episódios de urticária e angioedema durante a realizaçäo de esforço, porém isso ocorria apenas quando havia ingerido previamente alimentos contendo trigo. Teste cutâneo com trigo e pesquisa de IgE específica resultaram positivos. Foram realizados testes de provocaçäo com o exercício após a ingestäo de alimentos contendo ou näo trigo. O teste foi positivo apenas quando o paciiente ingeriu päo e em seguida realizou esforço. A ingestäo de trigo seguida de repouso näo provocou o aparecimento de qualquer manifestaçäo alérgica. A AIE dependente de um alimento específico é uma forma rara de alergia física na qual participam dois fatores: um, específico, provavelmente imunológico, e outro inespecífico, relacionado ao esforço, ainda pouco esclarecido. O exercício físico pode desencadear em alguns indivíduos o aparecimento de uma síndrome anafilática caracterizada por urticária, angioedema e até colapso circulatório poucos minutos após seu início. Esse quadro é conhecido como anafilaxia induzida por exercício (AIE). As primeiras descriçöes dessa forma rara e dramática de alergia física já fizeram mençäo a alguns fatores que facilitavam o seu aparecimento. Entre os fatores desencadeantes estäo a ingestäo de alimentos ou de aspirina antes de praticar o exercício. Em um subgrupo de pacientes, os sintomas surgem somente se houver a ingestäo prévia de uma alimento específico. Os alimentos mais comumente relacionados com essa forma peculiar de AIE, säo o trigo, o aipo e o camaräo. No Brasil, o primeiro relato de caso de AIE dependente de um alimento específico foi feito por Geller, em 1993. No presente artigo iremos relatar o caso de um paciente com AIE dependente da ingestäo de trigo