Multinational experience with next-generation sequencing: opportunity to identify transthyretin cardiac amyloidosis and Fabry disease.

Background: Sarcomeric hypertrophic cardiomyopathy (HCM) must be differentiated from phenotypically similar conditions because clinical management and prognosis may greatly differ. Patients with unexplained left ventricular hypertrophy require an early, confirmed genetic diagnosis through diagnostic or predictive genetic testing. We tested the feasibility and practicality of the application of a 17-gene next-generation sequencing (NGS) panel to detect the most common genetic causes of HCM and HCM phenocopies, including treatable phenocopies, and report detection rates. Identification of transthyretin cardiac amyloidosis (ATTR-CA) and Fabry disease (FD) is essential because of the availability of disease-specific therapy. Early initiation of these treatments may lead to better clinical outcomes. Methods: In this international, multicenter, cross-sectional pilot study, peripheral dried blood spot samples from patients of cardiology clinics with an unexplained increased left ventricular wall thickness (LVWT) of ≥13 mm in one or more left ventricular myocardial segments (measured by imaging methods) were analyzed at a central laboratory. NGS included the detection of known splice regions and flanking regions of 17 genes using the Illumina NextSeq 500 and NovaSeq 6000 sequencing systems. Results: Samples for NGS screening were collected between May 2019 and October 2020 at cardiology clinics in Colombia, Brazil, Mexico, Turkey, Israel, and Saudi Arabia. Out of 535 samples, 128 (23.9%) samples tested positive for pathogenic/likely pathogenic genetic variants associated with HCM or HCM phenocopies with double pathogenic/likely pathogenic variants detected in four samples. Among the 132 (24.7%) detected variants, 115 (21.5%) variants were associated with HCM and 17 (3.2%) variants with HCM phenocopies. Variants in MYH7 (n=60, 11.2%) and MYBPC3 (n=41, 7.7%) were the most common HCM variants. The HCM phenocopy variants included variants in the TTR (n=7, 1.3%) and GLA (n=2, 0.4%) genes. The mean (standard deviation) ages of patients with HCM or HCM phenocopy variants, including TTR and GLA variants, were 42.8 (17.9), 54.6 (17.0), and 69.0 (1.4) years, respectively. Conclusions: The overall diagnostic yield of 24.7% indicates that the screening strategy effectively identified the most common forms of HCM and HCM phenocopies among geographically dispersed patients. The results underscore the importance of including ATTR-CA (TTR variants) and FD (GLA variants), which are treatable disorders, in the differential diagnosis of patients with increased LVWT of unknown etiology.

New insights on the phylogeography of Hepatozoon canis in Brazil.

This study aimed to molecularly characterize the Hepatozoon spp. infecting domestic and wild dogs in Brazil. A total of 22 whole blood samples tested positive for Hepatozoon spp., and five samples were sequenced for the 18S rDNA gene from H. canis after PCR amplification with four primer sets. Phylogenetic analysis using Bayesian inference showed that the three H. canis isolates from domestic dogs were not monophyletic; however, they were more closely related to each other than to other H. canis sequences. The isolate from the hoary fox (Lycalopex vetulus) was phylogenetically more distant. Two haplotype networks were constructed, identifying 10 haplotypes of H. canis in Brazil, with H10 constituting the largest group. It contains nine isolates, including three from domestic dogs. The H5 haplotype grouped the sequence of L. vetulus with two additional sequences from hosts Tapirus terrestris and L. vetulus, representing the sole haplotype with wild hosts. Bayesian analysis suggested the possible existence of two genetic groups of H. canis in Brazil, indicating gene flow of this agent within the country. These findings contribute valuable insights for a more comprehensive understanding of the molecular diversity of Hepatozoon spp. in Brazil and may help in the development of effective control measures.

Short-term impact of a wildfire on the homeostasis of Tropidurus oreadicus lizards.

Wildfires cause significant changes in natural habitats and can impact lizard populations. Through changes in the thermal environment, reduced prey availability, and increased exposure to parasite vectors, wildfires affect lizard physiology, immunity, and health. We sampled 56 Tropidurus oreadicus lizards from Cerrado savannas of Brazil living in two adjacent sites: one burned 14 days before the study, and the other unburned for 6 years. We logged the air temperatures of those sites throughout fieldwork. We assessed the short-term possible homeostatic imbalances caused by the fires via measuring body mass, circulating levels of corticosterone (CORT), leukocytes profile changes in heterophile-lymphocyte ratios (HLRs), innate immunity using the bacterial killing assay (BKA), and the diagnosis of hemoparasites using molecular techniques. The air temperature was significantly higher in the burned site. There was no difference in lizard body mass between the two sites, suggesting that prey availability was not affected by the wildfire. While parasite presence was seemingly not affected by fire, the timing of initial parasite infection for animals in the study was unknown, so we also evaluated parasitism as an independent variable relative to the other metrics. Our results showed that parasitic infections lead to reduced bactericidal capacity and body mass in lizards, suggesting clinical disease and depletion of innate immune resources. Moreover, we observed increased HLR with fire and parasitic infections and a strong negative correlation with BKA. These findings suggest that the increased environmental temperature following wildfires may lead to increased CORT and decreased BKA.

Herpetofauna of protected areas in the Caatinga VIII: An updated checklist for the Serra das Confusões region with new data from Serra Vermelha, Piauí, Brazil / Herpetofauna das áreas protegidas da Caatinga VIII: Um inventário atualizado para a região da Serra das Confusões com novos dados da Serra Vermelha, Piauí, Brazil

Abstract It is repeatedly stressed the need to characterize the extant biodiversity in tropical ecosystems. However, inventory studies are still progressing slowly in dry ecosystems, leading to the underestimation of their true biodiversity and hindering conservation efforts. In this study, we present primary and secondary data, along with an updated list of amphibians and reptiles from two localities in the São Francisco-Gurguéia region in Piauí. Additionally, we compare the species composition between nine areas within the Caatinga, which were sampled using standardized methods over the past ten years, to examine broader spatial patterns of community composition. To survey reptiles and amphibians, we employed similar methods and sampling efforts in two areas within the Serra das Confusões National Park (SCNP) region. Our surveys recorded a total of 73 species of amphibians and reptiles, of which 24 are new distribution records for the SCNP region. Consequently, our findings increase the known herpetofauna in the region to 94 species. Despite their proximity, the two sites in the SCNP region exhibited only 42% similarity in species composition, and they differed significantly from other areas within the Caatinga. Furthermore, even the closer Caatinga areas presented differences in species composition, highlighting the necessity to evaluate biodiversity across the landscape and contribute to understanding biogeographic patterns.

Resumo É repetidamente enfatizada a necessidade de caracterizar a biodiversidade vivente em ecossistemas tropicais. No entanto, os estudos de inventário ainda estão progredindo lentamente em ecossistemas secos, levando à subestimação de sua verdadeira biodiversidade e dificultando os esforços de conservação. Neste estudo, apresentamos dados primários e secundários, juntamente com uma lista atualizada de anfíbios e répteis de duas localidades na região de São Francisco-Gurguéia, do Piauí. Além disso, comparamos a composição de espécies entre nove áreas dentro da Caatinga, que foram amostradas usando métodos padronizados nos últimos dez anos, para examinar padrões espaciais mais amplos de composição da comunidade. Para estudar répteis e anfíbios, utilizamos métodos e esforços de amostragem semelhantes em duas áreas na região do Parque Nacional da Serra das Confusões (PNSC). Nossos levantamentos registraram um total de 73 espécies de anfíbios e répteis, das quais 24 são novos registros de distribuição para a região do PNSC. Consequentemente, nossos resultados aumentam a herpetofauna conhecida na região para 94 espécies. Apesar da proximidade, os dois locais na região do PNSC exibiram apenas 42% de similaridade na composição de espécies e diferiram significativamente de outras áreas dentro da Caatinga. Mesmo áreas mais próximas da Caatinga apresentaram diferenças na composição de espécies, destacando a necessidade de avaliar a biodiversidade em toda a paisagem e contribuir para a compreensão de padrões biogeográficos.

Salmon poisoning disease in dogs: clinical presentation, diagnosis and treatment.

Salmon poisoning disease (SPD) is caused by a rickettsial organism, Neorickettsia helminthoeca, that is carried by the trematode Nanophyetus salmincola, which encysts in freshwater fish, most commonly salmonids. We reported two dogs from the United States West Coast that had similar clinical signs, hematologic and biochemistry findings. They were both diagnosed with salmon poisoning disease. Lymph node cytology showed morula formation, suggestive of N. helminthoeca organisms in macrophages, while the parasitological fecal test found ova of N. salmincola. The dogs were treated early and showed complete remission of clinical signs within a few days. Lymph node cytology and fecal parasitology are quick and low-cost tests that can be performed whenever SPD is suspected. SPD should be considered as a differential diagnosis for a canine patient with clinical signs of vomiting, diarrhea, lethargy, and lymphadenomegaly; laboratory findings of thrombocytopenia and hypoalbuminemia; and potential exposure to raw fish from the West Coast of the US or Southern Brazil. The earlier the diagnosis and treatment, the greater the chance of survival.

A doença da intoxicação por salmão (SPD) é causada por um organismo rickettsial, Neorickettsia helminthoeca, que é transportado pelo trematódeo Nanophyetus salmincola, que encista em peixes de água doce, mais comumente salmonídeos. Relatamos dois cães da Costa Oeste dos Estados Unidos que apresentaram sinais clínicos, achados hematológicos e bioquímicos semelhantes. Ambos foram diagnosticados com doença de envenenamento por salmão. A citologia de linfonodo evidenciou formação de mórula, sugestiva de organismos de N. helminthoeca em macrófagos, enquanto o exame parasitológico de fezes encontrou ovos de N. salmincola. Os cães foram tratados precocemente e apresentaram remissão completa dos sinais clínicos em poucos dias. A citologia de linfonodo e a parasitologia fecal são exames rápidos e de baixo custo que podem ser realizados sempre que houver suspeita de SPD. A SPD deve ser considerada como diagnóstico diferencial para um paciente canino com sinais clínicos de vômitos, diarreia, letargia e linfadenomegalia; achados laboratoriais de trombocitopenia e hipoalbuminemia; e exposição potencial ao peixe cru da costa oeste dos EUA ou sul do Brasil. Quanto mais precoce o diagnóstico e tratamento, maior a chance de sobrevivência.

Hepatitis C screening, diagnosis, and cascade of care among people aged > 40 years in Brasilia, Brazil.

BACKGROUND: Identifying patients with hepatitis C virus (HCV) infection and enhancing the cascade of care are essential for eliminating HCV infection. This study aimed to estimate the prevalence of positive anti-HCV serology in Brasilia, Brazil, and evaluate the efficiency of the cascade of care for HCV-positive individuals. METHODS: This cross-sectional study analyzed 57,697 rapid screening tests for hepatitis C in individuals aged > 40 years between June 2018 and June 2019. HCV-positive patients were contacted and scheduled to undergo the HCV RNA viral test, genotyping, and transient elastography. RESULTS: The prevalence of positive serology was 0.27%. Among 161 patients with positive anti-HCV serology, 124 (77%) were contacted, 109 (67.7%) were tested for HCV RNA viral load, and 69 (42.8%) had positive results. Genotype 1 (75%) was the most prevalent genotype. Among 65 patients (94.2%) who underwent transient elastography, 30 (46.2%) presented with advanced fibrosis. Additionally, of the 161 patients, 55 (34.1%) were referred for treatment, but only 39 (24.2%) complied, with 36 (22.4%) showing sustained virological response. By the end of the study, 16 patients were still awaiting to receive medication. CONCLUSIONS: The prevalence of HCV-positive patients was low in Brasilia, and the gaps in the cascade of care for these patients were significantly below the targets of HCV infection elimination. This study opens new avenues for eliminating HCV infection and suggests that partnerships with clinical laboratories to conduct anti-HCV tests are a useful strategy to improve HCV diagnosis. TRIAL REGISTRATION: Research Ethics Committee of the Faculty of Health Sciences of the University of Brasília - UNB (CAAE number 77818317.2.0000.0030) and by the Ethics Committee of the Health Science Teaching and Research Foundation - FEPECS/SES/DF (CAAE number 77818317.2.3001.5553).

Transient Elastography and Controlled Attenuation Parameter (CAP) in the Assessment of Liver Steatosis in Severe Adult Growth Hormone Deficiency.

Non-alcoholic fatty liver disease (NAFLD) is common in patients with growth hormone deficiency (GHD). Some noninvasive techniques have been used to quantify liver fat, such as the controlled attenuation parameter (CAP). Objective: To evaluate CAP as a tool to identify liver steatosis and its relationship with different clinical and biochemical metabolic parameters in a group of patients with severe adult growth hormone deficiency (AGHD), and to compare the evolution of metabolic profiles after 6 months of human growth hormone (rhGH) replacement therapy in a subgroup of patients. Methods: Cross-sectional observational study at baseline of naive rhGH multiple pituitary hormonal deficiency (MPHD) hypopituitarism patients. A 6-month intervention clinical trial in a selected group of a non-randomized, non-controlled cohort was also applied. Results: Liver stiffness measurement (LSM) was normal in severe AGHD patients. CAP evaluation showed steatosis in 36.3% of baseline patients (8/22), associated with higher BMI, waist circumference, insulin, and alanine aminotransferase (ALT) levels. According to steatosis degree by CAP, child-onset growth hormone deficiency (CO-GHD) was graded as 68.75% (11/16) S0, 12.5% (2/16) S1, and 18.75% (3/16) S3, whereas AO-GHD was graded as 50% (3/6) S0, 16.66% (1/6) S2, and 33.33% S3. After 6 months of hrGH replacement, CAP measurements did not change significantly, neither on group without hepatic steatosis at baseline (194.4 ± 24.3 vs. 215.4 ± 51.3; p = 0.267) nor on the group with hepatic steatosis (297.2 ± 32.3 vs. 276.4 ± 27.8; p = 0.082). A significant improvement of body composition was observed only in the first group. Conclusions: We have demonstrated the importance of CAP as a non-invasive tool in the liver steatosis identification on hypopituitary patients. This method may be an important indicator of the severity of metabolic disorders in MPHD patients. In our study, no liver health modification in LSM at baseline or after 6 months of rhGH replacement was found. Longer studies can help to establish the potential repercussions of growth hormone replacement therapy on liver steatosis.

Morphological patterns and malignancy criteria of transmissible venereal tumor in cytopathological and histopathological exams / Padrões morfológicos e critérios de malignidade do tumor venéreo transmissível aos exames citopatológico e histopatológico

The aim of this study was to identify morphological patterns and malignancy criteria of the TVT in cytopathological and histopathological evaluations and relate these characteristics to clinical evolution and response to chemotherapy. Regarding studied animals, sixteen dogs were female and four were male. The age of the animals ranged between one and ten years old. Considering breed, 80% of the dogs were mongrel dogs and 20% were of other breeds. It was found that the cytological samples allowed a better characterization of the cell type than histological ones. The plasmacytoid was the most common morphological type of TVT, followed by the lymphocytoid and mixed standards. There was no difference among the scores for the malignancy criteria and morphological types of TVT. Regarding response to chemotherapy, no morphological type of the TVT showed any difference, but the TVT presents morphological peculiarities that may interfere with tumor behavior, especially those related to increased aggressiveness and that are observed in the plasmacytoid TVT.

Este estudo teve por objetivo identificar os padrões morfológicos e os critérios de malignidade do TVT aos exames citológico e histopatológico e relacionar essas características à evolução clínica e à resposta à quimioterapia. Dos ani- mais estudados, dezesseis cães eram fêmeas e quatro machos. A idade dos animais variou entre um e dez anos de idade. Quanto à raça, 80% dos cães eram sem raça definida e 20% de outras raças. Constatou-se que as amostras citológicas permitiram melhor caracterização do tipo celular do que as histológicas. O TVT tipo plasmocitoide foi o de maior ocor- rência, seguido pelos padrões linfocitoide e misto. Não houve diferença entre os escores estabelecidos para os critérios de malignidade e os tipos do TVT. Nenhum tipo morfológico do TVT diferiu quanto à resposta quimioterápica, mas o TVT apresenta particularidades morfológicas que podem interferir no comportamento tumoral, especialmente aquelas relacionadas à maior agressividade, e que são observadas no TVT plasmocitoide.

Morphological patterns and malignancy criteria of transmissible venereal tumor in cytopathological and histopathological exams / Padrões morfológicos e critérios de malignidade do tumor venéreo transmissível aos exames citopatológico e histopatológico

The aim of this study was to identify morphological patterns and malignancy criteria of the TVT in cytopathological and histopathological evaluations and relate these characteristics to clinical evolution and response to chemotherapy. Regarding studied animals, sixteen dogs were female and four were male. The age of the animals ranged between one and ten years old. Considering breed, 80% of the dogs were mongrel dogs and 20% were of other breeds. It was found that the cytological samples allowed a better characterization of the cell type than histological ones. The plasmacytoid was the most common morphological type of TVT, followed by the lymphocytoid and mixed standards. There was no difference among the scores for the malignancy criteria and morphological types of TVT. Regarding response to chemotherapy, no morphological type of the TVT showed any difference, but the TVT presents morphological peculiarities that may interfere with tumor behavior, especially those related to increased aggressiveness and that are observed in the plasmacytoid TVT.(AU)

Este estudo teve por objetivo identificar os padrões morfológicos e os critérios de malignidade do TVT aos exames citológico e histopatológico e relacionar essas características à evolução clínica e à resposta à quimioterapia. Dos ani- mais estudados, dezesseis cães eram fêmeas e quatro machos. A idade dos animais variou entre um e dez anos de idade. Quanto à raça, 80% dos cães eram sem raça definida e 20% de outras raças. Constatou-se que as amostras citológicas permitiram melhor caracterização do tipo celular do que as histológicas. O TVT tipo plasmocitoide foi o de maior ocor- rência, seguido pelos padrões linfocitoide e misto. Não houve diferença entre os escores estabelecidos para os critérios de malignidade e os tipos do TVT. Nenhum tipo morfológico do TVT diferiu quanto à resposta quimioterápica, mas o TVT apresenta particularidades morfológicas que podem interferir no comportamento tumoral, especialmente aquelas relacionadas à maior agressividade, e que são observadas no TVT plasmocitoide.(AU)

Monitoramento da glicemia capilar na terapia intensiva: elaboração de um protocolo / Monitoring of capillary blood glucose in intensive care: development of a protocol

Trata-se de uma pesquisa quantitativa que tem como objetivo identificar os sítios de punção para controle de glicemia capilar em pacientes em uso de insulinoterapia, discutir a qualidade da assistência de enfermagem e propor um protocolo de sítio de punção para o controle glicêmico horário na Unidade de terapia Intensiva de um Hospital Universitário do Rio de janeiro. Houve muitas repetições dos sítios de punção, causando prejuízos ao paciente. Desenvolvemos um protocolo buscando oferecer um atendimento de qualidade.

[Clinical predictors of growth response in the first year of treatment with a fixed dose of growth hormone in children born small for gestational age]. / Preditores clínicos do ganho estatural do primeiro ano de tratamento com dose fixa de hormônio de crescimento em crianças nascidas pequenas para idade gestacional.

OBJECTIVE: To identify clinical predictors associated with catch-up growth in the first year of treatment with somatropin (rhGH) in a group of children born small for gestational age (SGA). SUBJECTS AND METHODS: Thirty nine children who have been on rhGH therapy for at least one year (0.33 mg/kg/week) were evaluated. The clinical parameters analyzed were chronological age (CA), bone age (BA), target height and standard deviations scores (SDS) of birth weight and length, height, weight and growth rate. RESULTS: rhGH therapy was associated with a first year height increment of 0.67 SDS (p < 0.01). BA and birth weight SDS were predictive of growth response, with statistical difference in height SDS variation between prepubertal and pubertal subgroups (p = 0.016). CONCLUSION: These data show a significant growth response with a fixed rhGH dose, those children who started rhGH in prepubertal ages presented the best outcomes.

Perfil dos pacientes de uma unidade de terapia intensiva baseado no TISS 28 / Profile of patients of an intensive care unit based on the TISS 28

Trata-se de uma pesquisa de caráter prospectivo, descritivo, com abordagem quantitativa baseada no TISS 28. Os objetivos do estudo são conhecer os valores do TISS 28 da unidade; identificar os procedimentos diários mais prevalentes realizados pela equipe de enfermagem de acordo com o TISS 28, e discutir a importância da avaliação do perfil dos pacientes de terapia intensiva. A média de permanência de internação foi de 8,8 dias. A classificação dos pacientes permaneceu de III a IV, denotando um perfil de gravidade. Foi apontado um percentual elevado de pacientes que necessitam de serviço especializado e de pessoal treinado.

This is a survey of a prospective, descriptive and quantitative approach based on TISS 28. The objectives of the study are to know the values of TISS 28 unit, to identify the most prevalent daily procedures performed by nursing staff according to TISS 28 and discuss the importance of evaluating the profile of intensive care patients. The average hospitalization time was of 8.8 days of hospitalization. The classification of patients remained III to IV, showing a profile of gravity. It was observed a large percentage of patients who require specialized treatment and trained personnel.

Esta es una investigación con enfoque prospectivo, descriptivo y cuantitativo basado en el TISS 28. Los objetivos del estudio son conocer los valores del TISS 28 de la unidad; identificar los procedimientos diarios de mayor prevalencia realizados por el personal de enfermería según el TISS 28 y discutir la importancia de evaluar el perfil de los pacientes de cuidados intensivos. El promedio de hospitalización fue de 8,8 días de hospitalización. La clasificación de los pacientes permaneció III a IV, lo que muestra un perfil de la gravedad. Fue señalando un gran porcentaje de pacientes que requieren personal especializado y entrenado.

Preditores clínicos do ganho estatural do primeiro ano de tratamento com dose fixa de hormônio de crescimento em crianças nascidas pequenas para idade gestacional / Clinical predictors of growth response in the first year of treatment with a fixed dose of growth hormone in children born small for gestational age

OBJETIVO: Identificar preditores clínicos associados à recuperação do crescimento no primeiro ano de tratamento com somatropina (rhGH) em um grupo de crianças nascidas pequenas para a idade gestacional (PIG). SUJEITOS E MÉTODOS: Foram avaliadas 39 crianças que estavam em terapia com rhGH por pelo menos um ano (0,33 mg/kg/semana). As variáveis analisadas foram idade cronológica (IC), idade óssea (IO), altura-alvo e escores de desvios-padrão (Z-escore) do peso e comprimento ao nascer, altura, peso e velocidade de crescimento pré e pós-rhGH. RESULTADOS: A terapia com rhGH foi associada a incremento significativo de 0,67 Z-escore (p < 0,01) na estatura nesse primeiro ano. IO e Z-escore de peso ao nascimento foram reconhecidos como preditores dessa resposta, com diferença significativa na variação do Z-escore de estatura entre pré-púberes e púberes (p = 0,016). CONCLUSÃO: Esses dados mostram ganho estatural significativo com dose fixa de rhGH, observando-se melhores resultados quando a terapia foi iniciada na fase pré-puberal.

OBJECTIVE: To identify clinical predictors associated with catch-up growth in the first year of treatment with somatropin (rhGH) in a group of children born small for gestational age (SGA). SUBJECTS AND METHODS: Thirty nine children who have been on rhGH therapy for at least one year (0.33 mg/kg/week) were evaluated. The clinical parameters analyzed were chronological age (CA), bone age (BA), target height and standard deviations scores (SDS) of birth weight and length, height, weight and growth rate. RESULTS: rhGH therapy was associated with a first year height increment of 0.67 SDS (p < 0.01). BA and birth weight SDS were predictive of growth response, with statistical difference in height SDS variation between prepubertal and pubertal subgroups (p = 0.016). CONCLUSION: These data show a significant growth response with a fixed rhGH dose, those children who started rhGH in prepubertal ages presented the best outcomes.

Síndrome de Marine-Lenhart: seguimento de caso por 23 anos / Marine-Lenhart syndrome: follow-up of case along 23 years

Introdução. A síndrome em estudo, descrita em 1911 por Marine e Lenhart, consiste em doença de Graves com nódulo funcionante (nódulo morno cintilográfico). Corresponde a 2,7 por cento dos casos de bócio difuso tóxico, é aceita como subdivisão desse hipertireoidismo em 1969. Relato do Caso. Paciente, 25 anos, feminina, foi atendida em 1983 com bócio difuso tóxico, exoftalmia à esquerda e nódulo no lobo tireiodiano esquerdo. Dosagens hormonais por radioimunoensaio mostraram T3 e T4 elevados, com TSH suprimido; cintilografia com I131 revelou aumento difuso com nódulo hipocaptante no lobo esquerdo; captação de 58 por cento em 24 horas. Foi tratada com propiltiouracil até 1986, quando foi reavaliada. Realizou-se teste de supressão com triiodotironina, que mostrou o mesmo aspecto cintilográfico, mas com captação de 22% em 24 horas. Em maio de 1987, optou-se por administrar 203,5 MBq (5,5 mCi) de I131 pela adesão irregular da paciente ao uso do antitireoidiano. Em maio de 1988, submeteu-se à craniotomia frontal bilateral para descomprimir a exoftalmia, que afetou ambos os olhos, realizou cintilografia com I131 com nódulo funcionante no lobo esquerdo com supressão total do tecido paranodular. Permaneceu eutireóidea até 1992, e o exame do material obtido por punção aspirativa por agulha fina revelou bócio adenomatoso. Nesse ano, engravidou e desenvolveu hipotireoidismo. Na reposição hormonal, empregou-se levotiroxina, usada irregularmente até 1995. A revisão à época mostrou ainda hipotireoidismo. Foi aumentada a dose de levotiroxina; nova avaliação com uso de punção por agulha fina levou ao diagnóstico de celularidade indicativa de tratamento com radioiodo. O acompanhamento subseqüente com dosagens hormonais, exames de material colhido em punção por agulha fina e avaliação clínica, constatou quadro de normalidade até 2006. Conclusões. O seguimento desse caso por 23 anos, com avaliação citológica de material obtido de punção aspirativa por agulha fina e outros exames...

Introduction. The reported syndrome refers to that described in 1911 by Marine and Lenhart and consists in the coexistence of Graves disease with a functional (hot) nodule. It occurs in 2,7 per cent of toxic diffuse goiter and was accepted as a subdivision of Graves disease in 1969. Case Report. A 25 year old woman developed toxic diffuse goiter with left exophtalm and a left lobe thyroidal nodule in 1983. Hormonal levels by radioimmuneassay showed increased T3 and T4 with suppressed TSH; 131I scintilography revealed diffuse growth with hypocaptating left lobe nodule, 58 per cent 24h uptake. Propiltiouracil was used until 1986 when a triiodotironin suppression test showed similar scintilographic aspect and decreased 24h uptake (22 per cent). In May 1987, because of irregular adherence to antithyroidal drug, application of 203,5 MBq (5,5 mCi) I131 was performed. In May 1988 the patient was submitted to bilateral frontal craniotomy to bilateral exophtalm decompression and another I131 scintilography showed a left lobe functional nodule with total suppression of paranodular tissues. She remained euthyroidal until 1992 and fine needle aspiration exam revealed adenomatous goiter. The patient got pregnant at that year and then developed hypothyroidism. Initiated irregular levothyroxin use until 1995, when mild hypothyroidism was still found. Levothyroxin dose was increased and a new fine needle aspiration exam showed radioiodine-treatment-compatible cellularity. Follow-up with fine needle aspiration, hormonal dosages and clinical evaluation was normal up to 2006. Conclusions. The 23 years follow-up with histopathological fine needle aspiration and other serial exams was adequate at this case. The remnant functional nodule showed neither autonomy nor malignization. The radioiodine-131 constitutes an adequate option for treatment.

Inquerito epidemiologico dos niveis de pressao arterial em universitarios / Epidemiological Inquiry of University Students Blood Pressure Levels

O conhecimento do real papel dos fatores que interferem nos niveis de pressao arterial de uma populacao de adultos jovens tem uma grande importancia no planejamento das politicas de saude publica. Para identificar a prevalencia de niveis pressoricos anormais em uma populacao jovem e sua associacao com fatores de risco, a pressao arterial de 1.027 estudantes da Universidade de Brasilia-DF foi medida em postos montados no Campus Universitario nos periodos de matricula nos anos de 1992 a 1994. Aos estudantes foi aplicado um questionario constando dos seguintes itens: a idade, a raca, o sexo e fatores relacionados ao estilo de vida. A idade media foi de 21 anos (variacao 17 a 36). Participaram do estudo 559 (54,4 por cento) homens e 468 (46,6 por cento) mulheres. As medias de pressao arterial sistolica e diastolica foram respectivamente de 118 mmHg(+/-13) e de 75 mmHg(+/-9). Do grupo estudado, 33 (3,2 por cento) universitarios apresentaram os niveis prescritos anormais segundo os criterios da Organizacao Mundial de Saude. Os fatores que se relacionaram significativamente (p 0,05) com niveis pressoricos elevados em universitarios foram o sexo masculino, a cor da pele negra, a idade acima de 30 anos, a ingestao de alcool, o estresse e o tabagismo