Spatio-temporal analysis of tuberculosis and its correlation with the Living Conditions Index in an elderly population in Brazil.

The aim of this study was to analyze the spatio-temporal distribution of tuberculosis (TB) in the elderly population in the city of Belém, PA from 2011 to 2015 according to the Living Conditions Index (LCI). This was an epidemiological, descriptive, ecological, and retrospective study involving 1,134 cases. Data were collected through the Information System of Notifiable Diseases (SINAN). For data analysis, we used the incidence coefficient, global and local empirical Bayesian model, Kernel density, and Kernel ratio. The construction of the LCI was based on the United Nations Development Program (UNDP) method. The incidence of TB remained the same over the five years studied. No neighborhood was found to have a high incidence of TB and a high LCI, but most of the cases occurred in the south of the city where the neighborhoods with the most precarious conditions are located. Moreover, the lowest incidence was in neighborhoods that historically had better infrastructure. Spatial analysis tools facilitate studies on the dynamics of disease transmission such as TB. In this study, it was shown that TB is heterogeneously distributed throughout the municipality. Living conditions, especially in slums, influenced TB incidence.

Spatio-temporal analysis of tuberculosis and its correlation with the Living Conditions Index in an elderly population in Brazil

The aim of this study was to analyze the spatio-temporal distribution of tuberculosis (TB) in the elderly population in the city of Belém, PA from 2011 to 2015 according to the Living Conditions Index (LCI). This was an epidemiological, descriptive, ecological, and retrospective study involving 1,134 cases. Data were collected through the Information System of Notifiable Diseases (SINAN). For data analysis, we used the incidence coefficient, global and local empirical Bayesian model, Kernel density, and Kernel ratio. The construction of the LCI was based on the United Nations Development Program (UNDP) method. The incidence of TB remained the same over the five years studied. No neighborhood was found to have a high incidence of TB and a high LCI, but most of the cases occurred in the south of the city where the neighborhoods with the most precarious conditions are located. Moreover, the lowest incidence was in neighborhoods that historically had better infrastructure. Spatial analysis tools facilitate studies on the dynamics of disease transmission such as TB. In this study, it was shown that TB is heterogeneously distributed throughout the municipality. Living conditions, especially in slums, influenced TB incidence.

TV viewing time is associated with increased all-cause mortality in Brazilian adults independent of physical activity.

The purpose of this study was to investigate the association between television (TV) viewing and all-cause mortality among Brazilian adults after 6 years of follow-up. This longitudinal study started in 2010 in the city of Bauru, SP, Brazil, and involved 970 adults aged ≥50 years. Mortality was reported by relatives and confirmed in medical records of the Brazilian National Health System. Physical activity (PA) and TV viewing were assessed by the Baecke questionnaire. Health status, sociodemographic and behavioral covariates were considered as potential confounders. After 6 years of follow-up, 89 deaths were registered (9.2% [95% CI=7.4%-11%]). Type 2 diabetes mellitus was associated with higher risk of mortality (P-value=.012). Deaths correlated significantly with age (ρ=.188; P-value=.001), overall PA score (ρ=-.128; P-value=.001) and TV viewing (ρ=.086; P-value=.007). Lower percentage of participants reported TV viewing time as often (16%) and very often (5.7%), but there was an association between higher TV viewing time ("often" and "very often" grouped together) and increased mortality after 6 years of follow-up (P-value=.006). The higher TV viewing time was associated with a 44.7% increase in all-cause mortality (HR=1.447 [1.019-2.055]), independently of other potential confounders. In conclusion, the findings from this cohort study identified increased risk of mortality among adults with higher TV viewing time, independently of PA and other variables.

LASSBio-881: an N-acylhydrazone transient receptor potential vanilloid subfamily type 1 antagonist orally effective against the hypernociception induced by capsaicin or partial sciatic ligation.

BACKGROUND AND PURPOSE: Compound LASSBio-881 is an orally effective antinociceptive that binds to cannabinoid receptors and is active mainly on the neurogenic component of pain models. We investigated whether transient receptor potential vanilloid subfamily type 1 (TRPV1) channels are involved in the effects of LASSBio-881. EXPERIMENTAL APPROACH: Modulation of capsaicin (CAP)- and low pH-induced currents was evaluated in TRPV1-expressing Xenopus oocytes. In vivo effects were evaluated in CAP-induced acute and inflammatory changes in nociception, as well as in partial sciatic ligation-induced thermal hypernociception. KEY RESULTS: LASSBio-881 inhibited TRPV1 currents elicited by CAP with an IC(50) of 14 microM, and inhibited proton-gated currents by 70% at 20 microM. Functional interaction with CAP was surmountable. Locally applied LASSBio-881 decreased time spent in CAP-elicited nocifensive behaviour by 30%, and given orally it reduced measures of CAP- or carrageenan-evoked thermal hypernociception by 60 and 40% respectively. In addition, LASSBio-881 decreased the paw withdrawal responses to thermal stimuli of animals with sciatic neuropathy 7-11 days after nerve ligation, at a dose of 300 micromol*kg(-1)*day(-1) p.o. At this dose, hyperthermia was not observed within 4 h following oral administration. CONCLUSIONS AND IMPLICATIONS: LASSBio-881 is a TRPV1 antagonist that apparently competes with CAP. Accordingly, LASSBio- 881 inhibited nociception in models of acute, inflammatory and neuropathic pain presumed to involve TRPV1 signalling. These in vivo actions were not hindered by hyperthermia, a common side effect of other TRPV1 antagonists. We propose that the antinociceptive properties of LASSBio-881 are due to TRPV1 antagonism, although other molecular interactions may contribute to the effects of this multi-target drug candidate.

The rise of the plasma lipid concentration elicited by dietary sodium chloride restriction in Wistar rats is due to an impairment of the plasma triacylglycerol removal rate.

Studies in humans have indicated that dietary salt restriction raises plasma levels of total cholesterol (TC) and triacylglycerols (TAG). In order to explain the mechanisms involved, a rat experimental model was developed consisting of chronic feeding ad libitum isocaloric diets with variable sodium chloride contents. Rates of synthesis of plasma TAG were measured either as the increase of plasma TAG after blocking its removal from plasma by the intra-arterial pulse infusion of Triton-WR 1339, or as the plasma rate of incorporation of [(14)C]-oleic acid [(14)C]-TAG. Plasma TAG removal rate was determined by the intra-arterial pulse infusion of a lipid emulsion. Severe salt restriction increased the plasma concentrations of TAG (71%) and of TC (10%). This result was not due to modification of the rate of synthesis of plasma TAG but was attributed to a 55% slower rate of removal of the TAG-containing lipoproteins. An increased plasma non-esterified fatty acid concentration, probably due to a salt restriction-related insulin resistance, may have impaired the activity of the enzyme lipoprotein lipase.

Effects of apolipoprotein B-100 on the metabolism of a lipid microemulsion model in rats.

In previous studies, it was shown that lipid microemulsions resembling LDL (LDE) but not containing protein, acquire apolipoprotein E when injected into the bloodstream and bind to LDL receptors (LDLR) using this protein as ligand. Aiming to evaluate the effects of apolipoprotein (apo) B-100 on the catabolism of these microemulsions, LDE with incorporated apo B-100 (LDE-apoB) and native LDL, all labeled with radioactive lipids were studied after intraarterial injection into Wistar rats. Plasma decay curves of the labels were determined in samples collected over 10 h and tissue uptake was assayed from organs excised from the animals sacrificed 24 h after injection. LDE-apo B had a fractional clearance rate (FCR) similar to native LDL (0.40 and 0.33, respectively) but both had FCR pronouncedly smaller than LDE (0.56, P<0.01). Liver was the main uptake site for LDE, LDE-apoB, and native LDL, but LDE-apoB and native LDL had lower hepatic uptake rates than LDE. Pre-treatment of the rats with 17alpha-ethinylestradiol, known to upregulate LDLR, accelerated the removal from plasma of both LDE and LDE-apoB, but the effect was greater upon LDE than LDE-apoB. These differences in metabolic behavior documented in vivo can be interpreted by the lower affinity of LDLR for apo B-100 than for apo E, demonstrated in in vitro studies. Therefore, our study shows in vivo that, in comparison with apo E, apo B is a less efficient ligand to remove lipid particles such as microemulsions or lipoproteins from the intravascular compartment.

Fatal pulmonary embolism in hospitalized patients. Clinical diagnosis versus pathological confirmation.

OBJECTIVE: To assess the incidence of fatal pulmonary embolism (FPE), the accuracy of clinical diagnosis, and the profile of patients who suffered an FPE in a tertiary University Hospital. METHODS: Analysis of the records of 3,890 autopsies performed at the Department of General Pathology from January 1980 to December 1990. RESULTS: Among the 3,980 autopsies, 109 were cases of clinically suspected FPE; of these, 28 cases of FPE were confirmed. FPE accounted for 114 deaths, with clinical suspicion in 28 cases. The incidence of FPE was 2.86%. No difference in sex distribution was noted. Patients in the 6th decade of life were most affected. The following conditions-were more commonly related to FPE: neoplasias (20%) and heart failure (18.5%). The conditions most commonly misdiagnosed as FPE were pulmonary edema (16%), pneumonia (15%) and myocardial infarction (10%). The clinical diagnosis of FPE showed a sensitivity of 25.6%, a specificity of 97.9%, and an accuracy of 95.6%. CONCLUSION: The diagnosis of pulmonary embolism made on clinical grounds still has considerable limitations.

Importance of intraoperative transesophageal echocardiography during coronary artery surgery without cardiopulmonary bypass.

The goal of this study was to assess left ventricular segmental wall motion (SWM) abnormalities during coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB), and its impact on the immediate postoperative outcome. Transesophageal echocardiography was used intraoperatively in 27 patients (mean age 57 years) who had CABG without CPB. Images obtained with a 5-MHz biplane transesophageal echocardiographic probe in the transgastric and transesophageal planes were recorded before, during, and after 48 coronary artery clampings for saphenous vein or internal mammary artery anastomosis. Transthoracic echocardiography was performed 1 day before surgery and on the seventh postoperative day. During the 48 coronary artery clampings, 31 (64%) new SWM abnormalities were found. At the time of chest closure, complete recovery occurred in 16 (50%) segments, partial recovery in 10 (33%), and no recovery in 5 (17%). On the seventh postoperative day the new SWM abnormalities persisted in all 5 segments without recovery at the end of the surgery and in 2 of 10 (20%)segments with partial recovery (group 1). Group 1 had higher variation on the echocardiographic point score index between the beginning and end of surgery, higher enzymatic levels, more ST-T changes on the electrocardiogram, and more clinical problems than group 2 (patients without new SWM abnormalities on the seventh postoperative day) (P < .05). We concluded that new SWM abnormalities of the left ventricle occur during CABG without CPB as assessed by intraoperative transesophageal echocardiography. Persistence of these abnormalities at the end of surgery may be a predictor of SWM dysfunction and clinical problems in the immediate postoperative period.

Plasma kinetic behavior in hyperlipidemic subjects of a lipidic microemulsion that binds to low density lipoprotein receptors.

It was previously reported that a protein-free microemulsion (LDE) with structure roughly resembling that of the lipid portion of low density lipoprotein (LDL) was presumably taken up by LDL receptors when injected into the bloodstream. In contact with plasma, LDE acquires apolipoproteins (apo) including apo E that would be the ligand for receptor binding. Currently, apo were associated to LDE by incubation with high density lipoprotein (HDL). LDE-apo uptake by mononuclear cells showed a saturation kinetics, with an apparent K(m) of 13.1 ng protein/mL. LDE-apo is able to displace LDL uptake by mononuclear cells with a Ki of 11.5 ng protein/mL. LDE without apo is, however, unable to displace LDL. The uptake of 14C-HDL is not dislocated by increasing amounts of LDE-apo, indicating that HDL and LDE-apo do not bind to the same receptor sites. In human hyperlipidemias, LDE labeled with 14C-cholesteryl ester behaved kinetically as expected for native LDL. LDE plasma disappearance curve obtained from eight hypercholesterolemic patients was markedly slower than that from 10 control normolipidemic subjects [fractional clearance rate (FCR) = 0.02 +/- 0.01 and 0.12 +/- 0.04 h-1, respectively; P < 0.0001]. On the other hand, in four severely hypertriglyceridemic patients, LDE FCR was not significantly different from the controls (0.07 +/- 0.03 h-1). These results suggest that LDE can be a useful device to study lipoprotein metabolism.

[Non-Hodgkin's lymphoma in children: analysis of nutritional status and other prognostic factors]. / Evolução dos linfomas não-hodgkin na criança: análise do estado nutricional e de outros fatores prognósticos.

The influence of the nutritional status and other prognostic factors on the survival of 43 children with non-Hodgkins lymphoma was investigated in a retrospective study. The median age was 5.3 years. Most children had advanced abdominal disease and Rappaport's diffuse undifferentiated type. The median time of follow-up was 4.7 years (0.1 to 12.9 years). The estimated probability of 5 and 10-year survival was 69% -/+ 7%. The unfavorable prognostic factors were metabolic disturbances, treatment with the LSA(2)L(2) protocol, unresectable tumoral mass, age below 2 years and stage III or IV disease. The nutritional status did not influence the outcome. Eight children died within the first days of hospital admission; five had extensive abdominal Burkitt's type lymphoma with elevated uric acid concentration. All had been treated with nonfractionated high-dose cyclophosphamide in the first four years of the study and had metabolic complications which probably led to their death. The authors conclude that the overall survival is similar to that reported in the literature; the nutritional status did not influence the outcome; the high frequency of early death in the first days of treatment was probably due to the toxic-metabolic effects of nonfractionated high-dose cyclophosphamide, but other adverse factors were clearly associated.

Plasma kinetics of a chylomicron-like emulsion in patients with coronary artery disease.

Chylomicron catabolism in the bloodstream consists of lipolysis by lipoprotein lipase and uptake of remnants by the liver. In rats, triglyceride-rich emulsions can mimic chylomicron metabolism. To further validate this model in man, the emulsion was injected intravenously into fasting and into subjects previously fed a test fatty meal. The plasma kinetic curves of the emulsion 3H-triglyceride and 14C-cholesteryl ester were determined. The fractional clearance rate (FCR) of both labels was markedly reduced in the fed subjects (triglycerides: fed = 0.018 +/- 0.007; fasting = 0.105 +/- 0.013 min-1, P < 0.001; cholesteryl ester: fed = 0.016 +/- 0.001; fasting = 0.040 +/- 0.006 min-1; P < 0.05) indicating that the emulsion and chylomicrons generated from the testinal lipid absorption compete for the same catabolic processes, confirming the validity of the method. The emulsion was injected into 11 patients with CAD and into 11 controls. All had plasma cholesterol < 240 and triglycerides < 250 mg/dl. FCR of triglycerides was 5-fold smaller in CAD compared to controls (0.028 +/- 0.004 and 0.141 +/- 0.069 min-1, respectively, P < 0.01). FCR of cholesteryl ester was 4-fold smaller in CAD than in controls (0.015 +/- 0.004 and 0.056 +/- 0.067 min-1 respectively, P < 0.05). These results indicate that both chylomicron lipolysis and remnant removal are diminished in CAD.

Pharmacokinetic studies of 131I-stevioside and its metabolites.

131I-STEVIOSIDE (1.10 MBq) was injected i.v in Wistar male rats, in distribution in the body and metabolism were studied. The highest concentration of radioactivity was observed in the liver and in the small intestine after 10 and 120 minutes, respectively. At 2 h after injection, the radioactivity eliminated in the bile was 52.0% of the original dose. The results of RP-HPLC analysis of the bile showed that stevioside was degraded in vivo and that steviol appeared as a major metabolite. However, in the urine; RP-HPLC analysis did not show the presence of steviol.

Metabolic behavior in rats of a nonprotein microemulsion resembling low-density lipoprotein.

A protein-free microemulsion (LDE) with a lipid composition resembling that of low-density lipoprotein (LDL) was used in metabolic studies in rats to compare LDE with the native lipoprotein. LDE labeled with radioactive lipids was injected into the bloodstream of male Wistar rats, and plasma kinetics of the labeled lipids were followed on plasma samples collected at regular intervals for 12 h after injection. The 24-h LDE uptake by different tissues was also measured in tissue samples excised after the animals had been sacrificed. We found that LDE plasma kinetics were similar to those described for native LDL [fractional clearance rate (FCR) of cholesteryl ester, 0.42 +/- 0.11 h-1]. The major site for LDE uptake was the liver, and the tissue distribution of the LDE injected radioactivity was as one would expect for LDL. To test whether LDE was taken up by the specific LDL receptors, the LDE emulsion was injected into rats treated with 17 alpha-ethinylestradiol, which is known to increase the activity of these receptors; as expected, removal of LDE from the bloodstream increased (FCR = 0.90 +/- 0.35 h-1). On the other hand, saturation of the receptors that remove remnants by prior infusion of massive amounts of lymph chylomicrons did not change LDE plasma kinetics. These results indicate that LDE is cleared from plasma by B,E receptors and not by the E receptors that remove remnants. Incorporation of free cholesterol into LDE increased LDE plasma clearance. Incubation studies also showed that LDE incorporates a variety of apolipoproteins, including apo E, a ligand for recognition of lipoproteins by specific receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Characteristics of growth hormone binding to liver microsomes of pregnant women.

Specific binding of hGH to liver microsomes of nonpregnant women and men is low, usually 10% of less in RRA. In pregnant women, however, we found that this binding is 10 times higher. The binding reaction shared the properties common to receptor systems: time, temperature and cation dependence, saturability and reversibility, hGH specific binding without cations was 10 times lower. The cross-reactions of hPRL and human placental lactogen with hGH were 0.49 +/- 0.16% and 0.10 +/- 0.05%, respectively. 125I-hPRL and 125I-human placental lactogen binding to microsomes of two controls and two pregnant women were very low and poorly reproducible. The Scatchard analysis revealed two hGH binding sites, one with an association constant (KA) of 2.7 +/- 0.1 x 10(10) M-1, and the other with a KA of 1.5 +/- 0.1 x 10(9) M-1. In one nonpregnant woman, we found a single hGH binding site with a KA of 1.5 x 10(9) M-1, confirming results previously reported in the literature. A hGH RRA was set up with microsomes of pregnant women. Acromegalic sera produced curves parallel to the hGH standard and pituitary dwarf serum had no 125I-hGH displacing activity. Sera of pregnant women produced curves divergent to the hGH standard and showed a 125I-hGH displacing activity 20 to 40 times higher than could be predicted by hGH levels determined by RIA. Cord sera and sera from puerperal women had similar hGH levels as determined by either RRA or RIA (r = 0.93, P less than 0.001, slope = 0.85, n = 25). Our results show the existence of specific GH receptors and serum factor(s) with high 125I-hGH displacing activity from these receptors in pregnancy. These findings must be related to several metabolic changes of pregnancy, such as glucose intolerance, hyperinsulinemia, increased lipolysis, and ketogenesis.

[Parathyroid function in hyperthyroidism: implications for bone metabolism and effect of the treatment]. / Função paratiroidiana no hipertiroidismo: implicações no metabolismo ósseo e efeito do tratamento.

PURPOSE: using bone densitometry, to evaluate bone loss of hyperthyroidism patients, and to study the possible contribution of parathyroid hormone (PTH) in the genesis of this osteopenia. TYPE: prospective study of patients with hyperthyroidism before and after treatment. PLACE: Division of Endocrinology, Escola Paulista de Medicina. São Paulo, SP. PATIENTS: 14 outpatients with clinical and laboratory diagnosis of toxic diffuse goiter (Basedow-Graves disease). Six of these patients were studied again after treatment, with at least 6 months of clinical and laboratory euthyroidism. METHOD: bone mineral content of the lumbar vertebral bodies was evaluated by dual-photon bone densitometry. Parathyroid hormone secretion was studied with an amino-terminal specific assay after EDTA-induced hypocalcemia; results were compared to those obtained from a group of 10 normal controls. RESULTS: there was a significant increase in bone mineral density after treatment (1.300 +/- 0.079 g/cm2) as compared to the pre-treatment condition (1.229 +/- 0.091 g/cm2, p less than 0.001). Decrement rate of serum calcium during EDTA infusion was significantly lower (p less than 0.001) in hyperthyroid (-0.698 x 10(-3) +/- 0.12 x 10(-5)) than in normal control individuals (-1.486 x 10(-3) +/- 9.33 x 10(-5)), and went back to normal after treatment. EDTA-induced calcium lowering was sufficient to induce a PTH plateau of maximum response. Maximum PTH response in hyperthyroidism patients (2.34 +/- 0.45pmol) was significantly lower (p less than 0.001) than that observed in normal controls (7.51 +/- 0.40), PTH response was normal after six months of euthyroidism. CONCLUSIONS: bone mineral density showed a significant increment in treated patients, suggesting that these patients had suffered some degree of bone loss during the course of thyrotoxicosis. The lower PTH secretory reserve found in untreated hyperthyroid patients suggests that hyperthyroid state-induced bone loss may be a consequence of a direct action of thyroid hormones. This conditions was reverted after 6 months of euthyroidism.