Outcomes of acute basilar artery occlusion-real-world experience in a middle-income country.

OBJECTIVES: Our goal was to describe outcomes in a single-center, real-world series of patients with acute basilar artery occlusion in a middle-income country. In addition, we assessed potential outcome predictors. MATERIAL AND METHODS: Data from 28 patients were retrospectively reviewed. The primary outcome was death until last follow-up. Other outcomes were rates of favorable outcome until last follow-up and rates of intracranial hemorrhage. Outcomes were compared in subgroups according to several variables, including reperfusion (REP group) or no reperfusion (NOREP group) interventions, with chi-squared, Fisher's exact test, or Mann-Whitney tests. RESULTS: The rate of overall intrahospital death was 46%. Death until last follow-up occurred in 8/17 (47%) in the REP and in 7/11 (63%) of the NOREP group. Favorable outcomes were observed in 35.7% of the patients: 8/17 (47%) in REP and in 2/11 (18.1%) in NOREP. NIH stroke scale scores were significantly lower in patients with favorable outcomes. Intracranial hemorrhage was observed in 6/28 (21.4%) of the patients (all in REP group). Twenty patients were treated with anticoagulants within the first 24 h. No hemorrhage was observed in those treated with enoxaparin, while three occurred in subjects treated with unfractionated heparin. CONCLUSION: Together with other series, our results underscore the relevance of NIH stroke scale at admission as a prognostic marker, the importance of reperfusion to improve outcomes, and the need of clinical trials to compare the impact of treatment with anticoagulants within first 24 h in basilar artery occlusion.

Targeting the Gut Microbiota in Chagas Disease: What Do We Know so Far?

Chagas disease (CD) is a tropical and still neglected disease caused by Trypanosoma cruzi that affects >8 million of people worldwide. Although limited, emerging data suggest that gut microbiota dysfunction may be a new mechanism underlying CD pathogenesis. T. cruzi infection leads to changes in the gut microbiota composition of vector insects, mice, and humans. Alterations in insect and mice microbiota due to T. cruzi have been associated with a decreased immune response against the parasite, influencing the establishment and progression of infection. Further, changes in the gut microbiota are linked with inflammatory and neuropsychiatric disorders, comorbid conditions in CD. Therefore, this review article critically analyses the current data on CD and the gut microbiota of insects, mice, and humans and discusses its importance for CD pathogenesis. An enhanced understanding of host microbiota will be critical for the development of alternative therapeutic approaches to target CD, such as gut microbiota-directed interventions.

Processo de esterilização sob a ótica dos profissionais do centro de material e esterilização / Sterilization process from the perspective of the professionals of the material and sterilization center / Procedimiento de esterilización bajo la óptica de los profesionales del centro de material y esterilización

Objetivo: Analisar o processo de trabalho dos profissionais de enfermagem atuantes no centro de material e esterilização (CME) acerca da esterilização de material cirúrgico. Método: Estudo descritivo, ancorado pela abordagem qualitativa e realizado com 11 profissionais de enfermagem do CME por meio de entrevista semiestruturada. Para avaliação dos dados, optou-se pela análise de conteúdo, modalidade temática transversal. Resultados: Os depoimentos apresentaram a descrição das etapas envolvidas no processo de esterilização, a relação com a segurança do paciente, as dificuldades no processo de trabalho e a educação permanente em saúde como meio possível de superar as dificuldades. Conclusão: Os trabalhadores têm conhecimento incipiente das etapas do processo de esterilização, com influência direta na segurança do paciente. Ações de gestão e de educação permanente em saúde são necessárias para garantir a qualidade do trabalho e possibilitar a redução de falhas nesse processo. Foram citadas, ainda, as dificuldades diárias encontradas pelo pessoal de enfermagem do CME.

Objective: To analyze the work process of nursing professionals working in the material and sterilization center (MSC) on the sterilization of surgical material. Method: A descriptive study, anchored by qualitative approach and carried out with 11 nursing professionals from MSC, through a semi-structured interview. In order to evaluate the data, content analysis was chosen, with transversal thematic modality. Results: The interviews presented the description of the steps involved in the sterilization process, the relationship with patient safety, difficulties in the work process, and permanent health education as a possible mean of overcoming difficulties. Conclusion: Workers have incipient knowledge of the steps of the sterilization process with a direct influence on patient safety. Management actions and permanent education in health are necessary to guarantee the quality of work and to enable the reduction of failures in the work process. The daily difficulties encountered by MSC nursing staff were also related.

Objetivo: Analizar el proceso de trabajo de los profesionales de enfermería actuantes en el CME sobre la esterilización de material quirúrgico. Método: Estudio descriptivo, anclado por el abordaje cualitativo y realizado con 11 profesionales de enfermería del CME, por medio de entrevista semiestructurada. Para la evaluación de los datos, se optó por el análisis de contenido, modalidad temática transversal. Resultados: Los testimonios presentaron la descripción de las etapas involucradas en el proceso de esterilización, la relación con la seguridad del paciente, las dificultades en el proceso de trabajo y la educación permanente en salud como medio posible de superar las dificultades. Conclusión: Los trabajadores tienen conocimiento incipiente de las etapas del proceso de esterilización con influencia directa en la seguridad del paciente. Las acciones de gestión y de educación permanente en salud son necesarias para garantizar la calidad del mismo y posibilitar la reducción de fallas en el proceso de trabajo. Aún se relacionó las dificultades diarias encontradas por el personal de enfermería del CME.

Early signs of colonic inflammation, intestinal dysfunction, and olfactory impairments in the rotenone-induced mouse model of Parkinson's disease.

The factors that trigger the pathophysiology of Parkinson's disease (PD) are unknown. However, it is suggested that environmental factors, such as exposure to pesticides, play an important role, in addition to genetic predisposition and aging. Early signs of PD can appear in the gastrointestinal (GI) tract and in the olfactory system, preceding the onset of motor impairments by many years. The present study assessed the effects of oral rotenone administration (30 mg/kg) in inducing GI and olfactory dysfunctions associated with PD in mice. Here we show that rotenone transiently increased myeloperoxidase activity within 24 h of administration. Leucocyte infiltration in the colon, associated with histological damage and disrupted GI motility, were observed following treatment with rotenone for 7 days. Moreover, 7 days of treatment with rotenone disrupted olfactory discrimination in mice without affecting social recognition ability. The presence of specific deficits in olfactory function occurred with a concomitant decrease in tyrosine hydroxylase-positive neurons and an increase in serotonin (5-hydroxytryptamine) turnover in the olfactory bulb. These findings suggest that in Swiss mice, exposure to rotenone induces GI and olfactory dysfunction involving immunological and neurotransmitter alterations, similar to early signs of PD. This provides further evidence for the involvement of the gut-brain axis in PD.

[Growth of infants assisted in nursing appointments in childcare]. / Crescimento de lactentes atendidos na consulta de enfermagem em puericultura.

This study aimed to describe the growth during the introduction of complementary feeding to infants assisted in the nursing appointment in childcare. It is a descriptive, cross-sectional, quantitative study developed through research in 51 medical records of children aged 4-8 months, from September to October 2012 in a university hospital in the city of Recife, PE. Data were analyzed using Epi Info software, version 6.04 and described in simple and relative frequencies. It was found that for 33% of the children. complementary foods were introduced at six months. Of these, 88.2%, 69.2% and 57.1% showed ascending weight-for-age growth curves, and 88.2%, 66.7% and 71.4% ascending length-for-age growth curves at six, seven and eight months respectively. Children with appropriate and timely introduction of complementary feeding showed upward growth curves and adequate nutritional status.

Growth of infants assisted in nursing appointments in childcare / El crecimiento de los lactantes atendidos en consulta de enfermería en el cuidado de los niños / Crescimento de lactentes atendidos na consulta de enfermagem em puericultura

This study aimed to describe the growth during the introduction of complementary feeding to infants assisted in the nursing appointment in childcare. It is a descriptive, cross-sectional, quantitative study developed through research in 51 medical records of children aged 4-8 months, from September to October 2012 in a university hospital in the city of Recife, PE. Data were analyzed using Epi Info software, version 6.04 and described in simple and relative frequencies. It was found that for 33% of the children. complementary foods were introduced at six months. Of these, 88.2%, 69.2% and 57.1% showed ascending weight-for-age growth curves, and 88.2%, 66.7% and 71.4% ascending length-for-age growth curves at six, seven and eight months respectively. Children with appropriate and timely introduction of complementary feeding showed upward growth curves and adequate nutritional status.

Estudio tiene como objetivo describir el crecimiento durante la introducción de la alimentación complementaria en los niños tratados en la consulta de enfermería en el cuidado infantil. Estudio descriptivo, transversal, cuantitativo, desarrollado a través de la investigación de 51 casos de niños de cuatro a ocho meses, de septiembre a octubre de 2012, en un hospital universitario de la ciudad de Recife, PE. Los datos fueron analizados mediante Epi Info versión 6.04 y se describen en la frecuencia simple y relativa. Se encontró que 33% de los niños presentó alimentos complementarios a los seis meses. De estos, 88,2%, 69,2% y 57,1% fue la edad ascendente versus curvas de peso y 88,2%, 66,7% y 71,4% de largo versus edad ascendente en seis, siete y ocho meses respectivamente. Los niños que introducen correctamente la alimentación complementaria mostraron curvas de crecimiento al alza y un estado nutricional adecuado.

Estudo que objetivou descrever o crescimento durante a introdução da alimentação complementar em lactentes atendidos na consulta de Enfermagem em puericultura. Estudo descritivo, transversal, quantitativo, desenvolvido por meio de pesquisa em 51 prontuários de crianças de quatro a oito meses, no período de setembro a outubro de 2012, em um hospital universitário localizado na cidade de Recife, PE. Os dados foram analisados no Epi Info versão 6.04 e descritos em frequência simples e relativa. Verificou-se que 33% das crianças introduziram a alimentação complementar aos seis meses. Dessas, 88,2%, 69,2% e 57,1% apresentaram as curvas de peso por idade ascendentes, e 88,2%, 66,7% e 71,4% tiveram curvas de comprimento por idade ascendentes aos seis, sete e oito meses, respectivamente. Crianças com introdução correta da alimentação complementar apresentaram curvas de crescimento ascendentes e estado nutricional adequado.

Characterization of motor, depressive-like and neurochemical alterations induced by a short-term rotenone administration.

BACKGROUND: Rotenone exposure in rodents provides an interesting model for studying mechanisms of toxin-induced dopaminergic neuronal injury. However, several aspects remain unclear regarding the effects and the accuracy of rotenone as an animal model of Parkinson's disease (PD). In this study, we investigated the motor and depressive-like behaviors associated to neurochemical alterations induced by a novel protocol of rotenone administration. METHODS: In the first experiment, we adopted the paw test to characterize an effective dose of rotenone able to promote nigrostriatal toxicity. In the second experiment, control and rotenone 2.5 mg/kg groups were injected (ip) for 10 consecutive days. RESULTS: This test indicated that intraperitonial (ip) rotenone at 2.5 and 5.0 mg/kg promoted a significant neurotoxicity to striatum and nucleus accumbens. However, only 2.5 mg/kg of rotenone was associated to a negligible mortality rate. Open-field tests were conducted on 1, 7, 14 and 21 day after the last day of treatment and showed an important locomotor impairment, confined to 1 and 7 day. Besides, rotenone affected dopamine levels and increased its turnover in the striatum. Modified forced swim test (performed on 22 day) and sucrose preference test (performed on 14 and 21 day) demonstrated that rotenone produced impairments in the swimming and immobility. In parallel, increments in the serotonin and noradrenaline turnovers were observed in the striatum and hippocampus of the rotenone group. CONCLUSIONS: These data suggest important participations of serotonin and noradrenaline in depressive-like behaviors induced by rotenone. Thus, it is proposed that the current rotenone protocol provides an improvement regarding the existing rotenonemodels of PD.

Neonatal exposure to constant light prevents anhedonia-like behavior induced by constant light exposure in adulthood.

Depressive episodes are associated with disturbances in circadian rhythms, and constant illumination has been reported to induce depressive-like behavior in rodents. Rats kept in constant darkness express the endogenous circadian rhythm, and most animals under constant light conditions lose circadian locomotor rhythmicity. Exposure to constant light in rats during lactation was reported to prevent this loss of circadian rhythm in adulthood. Thus, the aim of the present study was to verify whether exposure to constant light during lactation prevents anhedonia-like behavior induced by constant light in adult rats. In experiment 1, we replicated the anhedonia-like effects of constant light in adult male rats. We showed that this effect is reversed by imipramine treatment in the drinking water. In experiment 2, we subjected rats to constant darkness (neonatal-DD), constant light (neonatal-LL) or to normal light/dark cycle (neonatal-LD) during the neonatal phase and evaluated them after constant light exposure in adulthood. The group exposed to constant light during the neonatal phase did not reduce their sucrose preference and exhibited greater locomotor activity than the other groups. The neonatal-DD group exhibited decreased sucrose preference earlier than controls and had higher serum corticosterone concentrations. Prevention of arrhythymicity might protect neonatal-LL rats from anhedonia-like behavior induced by constant light, whereas constant darkness during the neonatal phase rendered the neonatal-DD group more susceptible to depressive-like behavior. These results corroborate with the literature data indicating that circadian disruption may contribute in mood disorders and that early life stress can influence stress responsivity in adulthood.

Acute but not chronic administration of pioglitazone promoted behavioral and neurochemical protective effects in the MPTP model of Parkinson's disease.

The present study investigated the neurochemical, motor and cognitive effects of pioglitazone in a rat model of Parkinson's disease induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). In the first experiment, we administered MPTP, and 1h later administered a single oral dose of pioglitazone (5, 15 and 30 mg/kg). The following day, we performed the open-field test and neurochemical dose response curve. We demonstrated that 30 mg/kg of pioglitazone was capable of restoring striatal dopamine (DA) concentrations and motor behaviors. A second experiment was conducted to test the effects of two protocols (acute and chronic) of pioglitazone (30 mg/kg) administration in the open-field test, two-way active avoidance task and in the DA and metabolites levels. The acute protocol consisted of a single oral administration 1 h after MPTP, whereas the chronic protocol was performed with daily administrations starting 1 h after MPTP and ending 22 days after that. Results showed that neither protocol was able to reverse the cognitive impairment promoted by MPTP. We also demonstrated that acute treatment generated some level of neuroprotection, as confirmed by the absence of DA reduction in the group treated with pioglitazone in comparison to the sham group. By contrast, chronic treatment leaded to a reduction of striatal DA, close to MPTP administration alone. These findings suggest that acute administration of pioglitazone (30 mg/kg) was more efficient in generating beneficial effects on motor behaviors and in striatal DA levels. Nevertheless, we failed to demonstrate that pioglitazone administration improved performance on a dopamine-related cognitive task after MPTP.

[Polymorphisms GSTM1 and GSTT1 and sporadic breast cancer mammographic features]. / Características mamográficas do câncer de mama associadas aos polimorfismos GSTM1 e GSTT1.

INTRODUCTION: Enzymes of the Glutathione S-transferase system (GST) modulate the effects of exposure to several cytotoxic and genotoxic agents. The GSTM1 and GSTT1 genes are polymorphic in humans and their deletions have been associated to increased risk of many cancers, including breast cancer. OBJECTIVE: To evaluate the occurrence of homozygous deletions of the GSTM1 and GSTT1 genes in women with sporadic breast cancer and in women without cancer and to compare breast cancer mammographic features between patients with and without these deletions. METHODS: The study evaluated 100 patients with sporadic breast cancer treated from September 2004 to June 2005 and 169 women without cancer, determining the frequency of the above-mentioned deletions by PCR and calculating the odds ratios and their 95% confidence intervals. Medical files and mammograms of 100 patients with breast cancer were evaluated and correlated with mammographic features such as density, mammographic findings and the BI-RADS classification. These findings were correlated with the genetic deletions by the PR (Prevalence-Ratio) with their respective 95% confidence intervals. RESULTS: The GSTM1 gene was deleted in 40% of the cancers and in 44.4% of controls (OR = 1.20; CI 95% 0.70 - 2.04; p=0.5659) while the GSTT1 gene was deleted in 20% and 19.5%, respectively (OR = 0.73; CI 95% 0.37-1.44; p=0.4124). High mammographic density had been associated with GSTM1 deletion (PR 2.43; CI 1.11 to 4.08). GST deletions were not associated with predominant mammographic findings and the BI-RADS classification. CONCLUSION: GSTM1 homozygous deletion was associated with high mammographic density.

Características mamográficas do câncer de mama associadas aos polimorfismos GSTM1 e GSTT1 / Polymorphisms GSTM1 and GSTT1 and sporadic breast cancer mammographic features

INTRODUÇÃO: As enzimas do sistema da glutationa S-transferase (GST) modulam os efeitos da exposição a vários agentes citotóxicos e genotóxicos. Os genes GSTM1 e GSTT1 são polimórficos em humanos e suas deleções têm sido associadas ao aumento do risco de várias neoplasias, dentre elas o câncer de mama. OBJETIVO: Comparar a freqüência das deleções dos genes GSTM1 e GSTT1 em mulheres sadias e com câncer de mama e comparar as características mamográficas do câncer entre mulheres portadoras e não portadoras das referidas deleções. MÉTODOS: Foram determinadas as freqüências das referidas deleções por PCR em 100 pacientes portadoras de câncer de mama esporádico tratadas de setembro de 2004 a junho de 2005 e em 169 mulheres sadias doadoras de sangue no mesmo período e comparadas através do odds ratio (OR) com seus respectivos IC 95 por cento. Foram revistos os prontuários e as mamografias das pacientes com câncer e avaliadas características mamográficas (padrão de distribuição do parênquima fibro-glandular, achados mamográficos ao diagnóstico e classificação BI-RADS), correlacionando-as às deleções gênicas através do cálculo da RP (razão de prevalência) com seus respectivos IC 95 por cento. RESULTADOS: O GSTM1 esteve deletado em 40 por cento dos cânceres e em 44,4 por cento dos controles (OR=1,20; IC 95 por cento 0,70-2,04; p=0,5659) enquanto o GSTT1 em 20 por cento e 19,5 por cento, respectivamente (OR=0,73; IC 0,37-1,44; p=0,4124). O padrão mamográfico denso esteve associado à deleção homozigótica do GSTM1 (RP= 2,43; IC 1,11-4,08). Não se observou associação entre as deleções do sistema GST e achados mamográficos ao diagnóstico e classificação BI-RADS. CONCLUSÃO: A deleção homozigótica do gene GSTM1 associou-se ao padrão mamográfico denso.

INTRODUCTION: Enzymes of the Glutathione S-transferase system (GST) modulate the effects of exposure to several cytotoxic and genotoxic agents. The GSTM1 and GSTT1 genes are polymorphic in humans and their deletions have been associated to increased risk of many cancers, including breast cancer. OBJECTIVE: To evaluate the occurrence of homozygous deletions of the GSTM1 and GSTT1 genes in women with sporadic breast cancer and in women without cancer and to compare breast cancer mammographic features between patients with and without these deletions. METHODS: The study evaluated 100 patients with sporadic breast cancer treated from September 2004 to June 2005 and 169 women without cancer, determining the frequency of the above-mentioned deletions by PCR and calculating the odds ratios and their 95 percent confidence intervals. Medical files and mammograms of 100 patients with breast cancer were evaluated and correlated with mammographic features such as density, mammographic findings and the BI-RADS classification. These findings were correlated with the genetic deletions by the PR (Prevalence-Ratio) with their respective 95 percent confidence intervals. RESULTS: The GSTM1 gene was deleted in 40 percent of the cancers and in 44.4 percent of controls (OR = 1.20; CI 95 percent 0.70 - 2.04; p=0.5659) while the GSTT1 gene was deleted in 20 percent and 19.5 percent, respectively (OR = 0.73; CI 95 percent 0.37-1.44; p=0.4124). High mammographic density had been associated with GSTM1 deletion (PR 2.43; CI 1.11 to 4.08). GST deletions were not associated with predominant mammographic findings and the BI-RADS classification. CONCLUSION: GSTM1 homozygous deletion was associated with high mammographic density.

Magnetic resonance spectroscopy in the diagnosis and etiological definition of brain bacterial abscesses

We report two patients with bacterial brain abscesses whose etiological diagnosis was correctly proposed by association of diffusion weighted images (DWI) and magnetic resonance spectroscopy (MRS) with conventional MRI. Both patients presented ring enhancing lesions with evidences of restricted diffusion. On MRS, the abscess caused by aerobic bacteria presented lactate and aminoacids peaks and the abscess caused by anaerobic facultative bacteria showed also acetate and succinate peaks. These results are in agreement with an unique previous study that related MRS pattern with bacterial etiology. Conventional MRI, associated with DWI and MRS is effective in diagnosing bacterial abscess and promising in exploring its etiology.

Apresentamos dois pacientes com abscessos bacterianos cerebrais cujos diagnósticos etiológicos foram corretamente auxiliados pela associação de difusão e espectroscopia à ressonância magnética convencional. Ambos apresentavam lesões com captação anelar de contraste e evidências de restrição à difusão de moléculas de água. Na espectroscopia, o abscesso causado por bactéria aeróbia apresentou picos de lactato e aminoácidos, enquanto o abscesso causado por bactéria anaeróbia facultativa mostrou, além destes, picos de acetato e succinato. Tais resultados concordam com um único estudo prévio que relacionou o padrão de espectroscopia nos abscessos com sua etiologia bacteriana. A ressonância magnética convencional, associada à difusão e à espectroscopia é uma técnica eficiente no diagnóstico de abscessos bacterianos e promissora em explorar suas etiologias.

Magnetic resonance spectroscopy in the diagnosis and etiological definition of brain bacterial abscesses.

We report two patients with bacterial brain abscesses whose etiological diagnosis was correctly proposed by association of diffusion weighted images (DWI) and magnetic resonance spectroscopy (MRS) with conventional MRI. Both patients presented ring enhancing lesions with evidences of restricted diffusion. On MRS, the abscess caused by aerobic bacteria presented lactate and aminoacids peaks and the abscess caused by anaerobic facultative bacteria showed also acetate and succinate peaks. These results are in agreement with an unique previous study that related MRS pattern with bacterial etiology. Conventional MRI, associated with DWI and MRS is effective in diagnosing bacterial abscess and promising in exploring its etiology.