Molecular analysis of the full-length VP2 gene of Brazilian strains of canine parvovirus 2 shows genetic and structural variability between wild and vaccine strains.

Canine parvovirus 2 (CPV-2), a highly contagious virus, affects dogs worldwide. Infected animals present severe and acute gastroenteritis which may culminate in death. CPV-2 VP2 protein is responsible for important biological functions related to virus-host interactions. Herein we obtained VP2 full-length gene sequences from Brazilian dogs with bloody diarrhea (n=15) and vaccine strains (n=7) produced by seven different laboratories and marketed in Brazil. All wild sequences and one vaccine strain were classified as CPV-2b and six vaccines were the classic CVP-2. Mutations in VP2 protein from vaccine and wild strains obtained in Brazil and worldwide were analyzed (n=906). Amino acid sequences from vaccine strains remarkably diverge from each other, even that classic CPV-2. Phylogenetic analysis based on VP2 gene and conducted with sequences displaying mutations in epitope regions previously described shows that vaccine strains are distantly related from the wide range of wild CPV-2. The impact of amino acid mutations over VP2 protein structure shows that vaccine and wild strains obtained in this study diverge in loop 3, an epitope region that plays a role in the CPV-2 host range. This is the first analysis of CPV-2 VP2 from commercial vaccine strains in Brazil and wild ones from Minas Gerais State, Brazil, and the first detailed attempt to vaccinal VP2 molecular and structural analyses.

Exploring genetic diversity, population structure, and phylogeography in Paracoccidioides species using AFLP markers.

Paracoccidioidomycosis (PCM) is a life-threatening systemic fungal infection acquired after inhalation of Paracoccidioides propagules from the environment. The main agents include members of the P. brasiliensis complex (phylogenetically-defined species S1, PS2, PS3, and PS4) and P. lutzii. DNA-sequencing of protein-coding loci (e.g., GP43, ARF, and TUB1) is the reference method for recognizing Paracoccidioides species due to a lack of robust phenotypic markers. Thus, developing new molecular markers that are informative and cost-effective is key to providing quality information to explore genetic diversity within Paracoccidioides. We report using new amplified fragment length polymorphism (AFLP) markers and mating-type analysis for genotyping Paracoccidioides species. The bioinformatic analysis generated 144 in silico AFLP profiles, highlighting two discriminatory primer pairs combinations (#1 EcoRI-AC/MseI-CT and #2 EcoRI-AT/MseI-CT). The combinations #1 and #2 were used in vitro to genotype 165 Paracoccidioides isolates recovered from across a vast area of South America. Considering the overall scored AFLP markers in vitro (67-87 fragments), the values of polymorphism information content (PIC = 0.3345-0.3456), marker index (MI = 0.0018), effective multiplex ratio (E = 44.6788-60.3818), resolving power (Rp = 22.3152-34.3152), discriminating power (D = 0.5183-0.5553), expected heterozygosity (H = 0.4247-0.4443), and mean heterozygosity (H avp  = 0.00002-0.00004), demonstrated the utility of AFLP markers to speciate Paracoccidioides and to dissect both deep and fine-scale genetic structures. Analysis of molecular variance (AMOVA) revealed that the total genetic variance (65-66 %) was due to variability among P. brasiliensis complex and P. lutzii (PhiPT = 0.651-0.658, P < 0.0001), supporting a highly structured population. Heterothallism was the exclusive mating strategy, and the distributions of MAT1-1 or MAT1-2 idiomorphs were not significantly skewed (1:1 ratio) for P. brasiliensis s. str. (χ2 = 1.025; P = 0.3113), P. venezuelensis (χ2 = 0.692; P = 0.4054), and P. lutzii (χ2 = 0.027; P = 0.8694), supporting random mating within each species. In contrast, skewed distributions were found for P. americana (χ2 = 8.909; P = 0.0028) and P. restrepiensis (χ2 = 4.571; P = 0.0325) with a preponderance of MAT1-1. Geographical distributions confirmed that P. americana, P. restrepiensis, and P. lutzii are more widespread than previously thought. P. brasiliensis s. str. is by far the most widely occurring lineage in Latin America countries, occurring in all regions of Brazil. Our new DNA fingerprint assay proved to be rapid, reproducible, and highly discriminatory, to give insights into the taxonomy, ecology, and epidemiology of Paracoccidioides species, guiding disease-control strategies to mitigate PCM.

Trends in the molecular epidemiology and population genetics of emerging Sporothrix species.

Sporothrix (Ophiostomatales) comprises species that are pathogenic to humans and other mammals as well as environmental fungi. Developments in molecular phylogeny have changed our perceptions about the epidemiology, host-association, and virulence of Sporothrix. The classical agent of sporotrichosis, Sporothrix schenckii, now comprises several species nested in a clinical clade with S. brasiliensis, S. globosa, and S. luriei. To gain a more precise view of outbreaks dynamics, structure, and origin of genetic variation within and among populations of Sporothrix, we applied three sets of discriminatory AFLP markers (#3 EcoRI-GA/MseI-TT, #5 EcoRI-GA/MseI-AG, and #6 EcoRI-TA/MseI-AA) and mating-type analysis to a large collection of human, animal and environmental isolates spanning the major endemic areas. A total of 451 polymorphic loci were amplified in vitro from 188 samples, and revealed high polymorphism information content (PIC = 0.1765-0.2253), marker index (MI = 0.0001-0.0002), effective multiplex ratio (E = 15.1720-23.5591), resolving power (Rp = 26.1075-40.2795), discriminating power (D = 0.9766-0.9879), expected heterozygosity (H = 0.1957-0.2588), and mean heterozygosity (Havp  = 0.000007-0.000009), demonstrating the effectiveness of AFLP markers to speciate Sporothrix. Analysis using the program structure indicated three genetic clusters matching S. brasiliensis (population 1), S. schenckii (population 2), and S. globosa (population 3), with the presence of patterns of admixture amongst all populations. AMOVA revealed highly structured clusters (PhiPT = 0.458-0.484, P < 0.0001), with roughly equivalent genetic variability within (46-48 %) and between (52-54 %) populations. Heterothallism was the exclusive mating strategy, and the distributions of MAT1-1 or MAT1-2 idiomorphs were not significantly skewed (1:1 ratio) for S. schenckii (χ2 = 2.522; P = 0.1122), supporting random mating. In contrast, skewed distributions were found for S. globosa (χ2 = 9.529; P = 0.0020) with a predominance of MAT1-1 isolates, and regional differences were highlighted for S. brasiliensis with the overwhelming occurrence of MAT1-2 in Rio de Janeiro (χ2 = 14.222; P = 0.0002) and Pernambuco (χ2 = 7.364; P = 0.0067), in comparison to a higher prevalence of MAT1-1 in the Rio Grande do Sul (χ2 = 7.364; P = 0.0067). Epidemiological trends reveal the geographic expansion of cat-transmitted sporotrichosis due to S. brasiliensis via founder effect. These data support Rio de Janeiro as the centre of origin that has led to the spread of this disease to other regions in Brazil. Our ability to reconstruct the source, spread, and evolution of the ongoing outbreaks from molecular data provides high-quality information for decision-making aimed at mitigating the progression of the disease. Other uses include surveillance, rapid diagnosis, case connectivity, and guiding access to appropriate antifungal treatment.

Prostate Cancer in Renal Transplant Recipients: Diagnosis and Treatment.

BACKGROUND: We currently know that prostate cancer (Pca) risk is reduced in patients undergoing kidney transplantation. However, its impact and treatment are not widely studied. METHODS: This was a retrospective study of male patients submitted to kidney transplantation in our center from 1980 to 2016 evaluating incidence, treatment, and follow-up of Pca in our population. RESULTS: In 1805 patients undergoing kidney transplantation, 20 men were diagnosed with Pca, leading to an incidence of 1.1%. Median age at renal transplantation was 53.4 years with a median age at diagnosis of Pca of 61.2 years. Initial median prostate-specific antigen (PSA) was 6 ng/mL and Gleason score was 7 (3 + 4) in about 50% of cases. Bone metastasis developed in 10% and no visceral metastases were diagnosed. The majority of patients were submitted to radical prostatectomy and bilateral pelvic lymph node dissection. Some other cancers occurred in these patients such as skin and pulmonary cancers. In 35% of the cases, the graft was lost. The main cause of patient death was cardiovascular. The mean graft survival was about 14 years. The majority of patients are alive with functioning grafts (65%). CONCLUSION: In our center the clinical incidence of Pca in patients undergoing kidney transplantation is 1.1% and surgical treatment seems to be a good initial option.

Association between non-alcoholic hepatic steatosis and hyper reactive blood pressure response on the exercise treadmill test.

AIMS: Non-alcoholic hepatic steatosis (HS) is associated with hypertension and increased cardiovascular risk. While Blood pressure hyper-reactive response (HRR) during peak exercise indicates an increased risk of incident hypertension and increased cardiovascular risk, no data on the association of non-alcoholic HS and HRR exists. In this study, we have evaluated the association of HS with HRR. METHODS: We included 13 410 consecutive individuals with a mean age: 42.4 ± 8.9 years, 3561 (26.6%) female with normal resting blood pressure and without a previous diagnosis of hypertension, who underwent symptom limited exercise treadmill test, abdominal ultrasonography and clinical and laboratory evaluation. HS was detected by abdominal ultrasonography. HRR was defined by a peak exercise systolic blood pressure >220 mmHg and/or elevation of 15 mmHg or more in diastolic blood pressure from rest to peak exercise. RESULTS: The prevalence of HS was 29.5% (n = 3956). Overall, 4.6% (n = 619) of the study population presented a HRR. Subjects with HS had a higher prevalence of HRR (8.1 vs. 3.1%, odds ratio 2.8, 95% CI 2.4-3.3, P < 0.001). After adjustment for body mass index, waist circumference, fasting plasma glucose and low density lipoprotein cholesterol, HS (odds ratio 1.4, 95% CI 1.1-1.6, P = 0.002) remained independently associated with HRR. HS was additive to obesity markers in predicting exercise HRR. CONCLUSIONS: Non-alcoholic HS is independently associated with hyper-reactive exercise blood pressure response.

Biochemical conversion of sugarcane straw hemicellulosic hydrolyzate supplemented with co-substrates for xylitol production.

Biotechnological production of xylitol is an attractive route to add value to a sugarcane biorefinery, through utilization of the hemicellulosic fraction of sugarcane straw, whose availability is increasing in Brazil. Herein, supplementation of the sugarcane straw hemicellulosic hydrolyzate (xylose 57gL(-1)) with maltose, sucrose, cellobiose or glycerol was proposed, and their effect as co-substrates on xylitol production by Candida guilliermondii FTI 20037 was studied. Sucrose (10gL(-1)) and glycerol (0.7gL(-1)) supplementation led to significant increase of 8.88% and 6.86% on xylose uptake rate (1.11gL(-1)h(-1) and 1.09gL(-1)), respectively, but only with sucrose, significant increments of 12.88% and 8.69% on final xylitol concentration (36.11gL(-1)) and volumetric productivity (0.75gL(-1)h(-1)), respectively, were achieved. Based on these results, utilization of complex sources of sucrose, derived from agro-industries, as nutritional supplementation for xylitol production can be proposed as a strategy for improving the yeast performance and reducing the cost of this bioprocess by replacing more expensive nutrients.

Association between NOx exposure and deaths caused by respiratory diseases in a medium-sized Brazilian city.

Exposure to nitrogen oxides (NOx) emitted by burning fossil fuels has been associated with respiratory diseases. We aimed to estimate the effects of NOx exposure on mortality owing to respiratory diseases in residents of Taubaté, São Paulo, Brazil, of all ages and both sexes. This time-series ecological study from August 1, 2011 to July 31, 2012 used information on deaths caused by respiratory diseases obtained from the Health Department of Taubaté. Estimated daily levels of pollutants (NOx, particulate matter, ozone, carbon monoxide) were obtained from the Centro de Previsão de Tempo e Estudos Climáticos Coupled Aerosol and Tracer Transport model to the Brazilian developments on the Regional Atmospheric Modeling System. These environmental variables were used to adjust the multipollutant model for apparent temperature. To estimate association between hospitalizations owing to asthma and air pollutants, generalized additive Poisson regression models were developed, with lags as much as 5 days. There were 385 deaths with a daily mean (±SD) of 1.05±1.03 (range: 0-5). Exposure to NOx was significantly associated with mortality owing to respiratory diseases: relative risk (RR)=1.035 (95% confidence interval [CI]: 1.008-1.063) for lag 2, RR=1.064 (95%CI: 1.017-1.112) lag 3, RR=1.055 (95%CI: 1.025-1.085) lag 4, and RR=1.042 (95%CI: 1.010-1.076) lag 5. A 3 µg/m3 reduction in NOx concentration resulted in a decrease of 10-18 percentage points in risk of death caused by respiratory diseases. Even at NOx concentrations below the acceptable standard, there is association with deaths caused by respiratory diseases.

O rápido processo de envelhecimento populacional do Brasil: sérios desafios para as políticas públicas / The rapid process of aging in Brazil: serious challenges for public policies

Já são sentidos, no Brasil, os efeitos positivos da transição na estrutura etária (TEE), por exemplo, nos serviços de saúde à infância e na educação. O crescimento diferenciado previsto para a população em idade ativa (PIA), nas próximas décadas, constitui uma nova janela de oportunidades. Com efeito, a combinação do segmento sênior da força de trabalho (idades 25 a 64) - que apresenta crescimento alto - com o segmento júnior (15 a 24 anos) - que registra taxas de crescimento muito baixas ou negativas - aponta para uma tendência de diminuição da pressão demográfica por empregos novos. A qualificação da futura força de trabalho torna-se componente imprescindível para um equilíbrio intergeracional, social e econômico, mais justo. Devido à TEE novos desafios emergem relacionados à expansão da população idosa. Se a atual transferência per capita do governo for mantida constante, a diferença entre receitas e despesas aumentará, provocando um insuportável déficit fiscal. A anunciada crise, causada pelo envelhecimento da população, e o atual sistema irracional previdenciário devem ser matéria de urgente discussão na sociedade brasileira. É extremamente importante aproveitar as oportunidades geradas pela TEE e se preparar para enfrentar os novos desafios dela decorrentes.

The positive effects of the recent age structure transition (AST) in Brazil can be seen in children's health services, education and other areas. The higher growth rate estimated for the economically active population in coming decades constitutes a new area of opportunities. The combination of the older segment of the labor force (ages 25 to 64), which is showing high growth, with the junior segment (ages 15 to 24), which is showing very low or even negative growth rates, indicates a trend toward reducing the demographic pressure for new jobs. The training of the future labor force has become an indispensable component for a more just intergenerational, social and economic balance. Due to the age structure transition, new challenges are emerging related to the expansion of the older population. If the present per capita transfer of funds from the government is maintained constant, the difference between revenue and expenses will increase, causing an unsustainable fiscal deficit. The expected crisis brought about by the aging of the population and the current irrational social security system must be urgently discussed in Brazilian society. The best must be made of the opportunities generated by age structure transition in order to prepare to face the new resulting challenges.

Association of white blood cell count with systolic blood pressure within the normotensive range.

Hypertension and inflammation promote cardiovascular disease (CVD). Even high normal systolic blood pressure (SBP) is associated with increased CVD risk. We assessed the relationship of elevated SBP within the normotensive range and white blood cell (WBC) count. This is a cross-sectional study of 3484 white asymptomatic individuals (mean age: 43+/-8 years, 79% males) without hypertension with SBP<140 mm Hg. White blood cell count >or=75th percentile (8.35 x 10(9) cells/l) was considered cutoff for elevated WBC. Subjects were classified into three levels of SBP (first: <120 mm Hg, n=1,176, 34%; second: 120-129 mm Hg, n=1,654, 47%; third: 130-139 mm Hg, n=654, 19%). Mean WBC count increased linearly across SBP categories (first: 6.14+/-1.54, second: 6.20+/-1.52, third: 6.41+/-1.62, P=0.02 for trend). There was a linear increase in prevalence of elevated WBC across higher SBP categories (22, 24 and 28%, P=0.02). As compared to those with SBP<120 mm Hg, in multivariate linear regression analyses (adjusting for age, gender, smoking status, diabetes, body mass index, physical activity, cholesterol/high-density lipoprotein cholesterol ratio) WBC count was significantly higher among participants with SBP 130-139 mm Hg (regression coefficient: 2.64, 95% confidence interval: 1.04-4.24, P=0.001). Odds ratio for prevalence of elevated WBC with SBP<120 mm Hg as reference group was 1.14 (0.92-1.41) for SBP 120-129 mm Hg and 1.50 (1.15-1.92) for SBP 130-139 mm Hg. In conclusion, Higher SBP within the normotensive range is also associated with elevated WBC count. Further studies are needed to clarify the role of inflammation in high normal SBP and associated CVD risk.

Nine novel mutations in NR0B1 (DAX1) causing adrenal hypoplasia congenita.

X-linked adrenal hypoplasia congenita (AHC) is caused by mutations in the NR0B1 gene. This gene encodes an orphan member of the nuclear receptor superfamily, DAX1. Ongoing efforts in our laboratory have identified nine novel NR0B1 mutations in X-linked AHC patients (Y81X, 343delG, 457delT, 629delG, L295P, 926-927delTG, 1130delA, 1141-1155del15, and E428X). Two additional families segregate previously identified NR0B1 mutations (501delA and R425T). Sequence analysis of the mitochondrial D-loop indicates that the 501delA family is unrelated through matrilineal descent to our previously analyzed 501delA family.

In vitro and in vivo responses to short-term recombinant human insulin-like growth factor-1 (IGF-I) in a severely growth-retarded girl with ring chromosome 15 and deletion of a single allele for the type 1 IGF receptor gene.

OBJECTIVES: Patients with single allele defects in the gene encoding the type 1 IGF receptor have been reported to have growth failure, but fibroblasts from affected patients have not exhibited insensitivity to the effects of IGF-I in vitro. The in vitro and in vivo responses to short-term recombinant human IGF-I (rhIGF-I) in a severely growth-retarded girl with ring chromosome 15 and deletion of a single allele for the type 1 IGF receptor gene have been investigated. DESIGN AND PATIENT: The child exhibited prenatal and severe post-natal growth failure, and delayed psychomotor development. Southern blotting revealed a 50% reduction in IGF-I receptor DNA, and in an RNase protection assay (RPA), a quantitatively similar reduction in steady-state mRNA for type 1 IGF receptor. rhIGF-I was administered in graded doses of 40, 60 and 80 microg/kg twice daily by subcutaneous injection for periods of 2-2.5 days each. RESULTS: During rhIGF-I treatment, mean urinary nitrogen excretion was unchanged and urinary calcium rose to 60% greater than in the pre-treatment period. rhIGF-I injections produced only a modest decrease in indices of GH secretion, assessed by frequent (every 20 min) sampling over periods of 12 h. There was no significant difference between the mean GH concentrations during rhIGF-I treatment (5.32 +/- 6.2 mU/l) compared with that before rhIGF-I treatment (8.46 +/- 10.2 mU/l). Mean IGFBP-3-values were increased (4.5 mg/l before vs. 5.4 mg/l during rhIGF-I). TSH values after injection of TRH were not significantly reduced by IGF-I (mean of all values, 18.6 mU/l vs. 15.5 mU/l during rhIGF-I treatment). In vitro binding of radiolabelled IGF-I to the patient's fibroblasts was less than that bound by control fibroblasts (patient, 0.69% binding by 248 000 cells, vs. 1.41% binding by 260 000 fibroblasts from an age-matched control). However, the patient's fibroblasts exhibited a growth response in vitro to the addition of IGF-I in a fashion similar to that of control fibroblasts. CONCLUSIONS: These studies show evidence in each of the indices examined of in vivo resistance to IGF-I and suggest that the growth retardation observed in such patients may be the direct result of the absence of one of the alleles encoding the type 1 IGF receptor.

Demographic dynamics in Brazil: recent trends and perspectives.

"The evolution of the Brazilian population size, its growth rate and relative age structure between 1940 and 1991 as well as its expected trajectory until 2020 are presented in this paper. After briefly considering the quasi-stability of the Brazilian population in the past, the role of fast fertility decline is emphasised in the current changing age structure."

[Fertility transition in Brazil. Causes and consequences]. / La transicion de la fecundidad en Brasil. Causas y consecuencias.

PIP: This work examines the determinants and most important consequences of the Brazilian fertility decline. Brazil's total fertility rate declined from 6.2 in 1940 to around 3.5 in 1985. the decline began in the 1960s and amounted to 45% in about 20 years. The most rapid drop began in the late 1970s, with much of it concentrated in 2 specific periods: 1970-75 and 1980-85. The early period coincided with Brazil's so-called "Economic Miracle", a period of rapid growth accompanied however by deteriorating living conditions for the poorest population sectors. The second period coincided with the international economic crisis of the early 1980s, which was felt more strongly in Brazil than elsewhere in Latin America because of Brazil's greater degree of industrialization and closer integration into the world economy. Most of the fertility decline has been accomplished by use of just two contraceptive methods, oral contraceptives and sterilization, which together account for around 85% of contraceptive usage throughout Brazil. The third most common method, rhythm, accounts for just 6%. No reliable data on abortion are available, but it appears to be a common practice equally accessible to all socioeconomic strata despite greater associated health risks for poorer women. Brazil's fertility transition appears to have been a response to the process of proletarianization and urbanization underway in the country as well as to particular circumstances in the country. The most evident and immediate consequence of the continuous fertility decline over more than 20 years is the change in the age structure of the population. The proportions of children under 5 will decline from 14.4% in 1980 to 9.2% in 2010. The proportion aged 5-14 will decline from 24.5% to 17.4%, while the proportion aged 65 and over will increase from 4.0% to 5.6%. Brazil's recent demographic changes are scarcely reflected in development plans and political and social projects. There is almost no mention of the new demographic dynamics which entail new problems to be faced, but also new and more favorable conditions for overcoming some old problems. Most planners retain a conception of Brazil's population as very young, rapidly growing, and with a constant age distribution. Some promising areas for social investment are health, nutrition, and preschool education for small children; improvement and expansion of the public educational system; and improvement in the quality of the labor force. The growing elderly population will require health services, pensions, and alternative living arrangements for the increased proportion without close relatives. A regional development strategy should be developed to assure that conditions do not deteriorate in any region as demographic changes progress.^ieng

[The evolution of fertility in Brazil, 1957-1979. The application of the own children method to estimate fertility from year to year]. / A evolucao da fecundidade no Brasil, periodo 1957-1979. Aplicacao da tecnica dos filhos proprios para se estimar a fecundidade ano a ano.

PIP: The general fertility trends are described in Brazil, from 1957 to 1979, using data from the national census surveys. It was found that the fertility rates kept constant over time until the end of 1950's, declining slightly (8%) between 1950 and 1960, and then rapidly (26%) until 1970. The decline was not homogeneous among regions and social groups. The Own Children Method was described to estimate fertility from year to year. The method was useful to study the trend using census data, but it overestimated fertility. Analysis of the fertility trends per region using the Own Children Method confirmed the levels obtained with the use of the Brass' Fertility Method, with the added advantage of permitting greater detailing of the earlier period of acceleration of the fertility rate declines. Fertility in rural areas started declining after 1968, falling from 7.5 to 6 children. In the urban areas, the decline started in the 1950's, accelerating in the 1960's, falling from 5 in 1960 to 3.5 in 1980. The trend was different between the 4 defined regions. In the rural areas of the Amazonia and the Northeast region, the fertility decline began in the 70's. In the urban area, it varied from 6.2 to 7.0 in 1950's, being moderate in the 70's, with a rate of 5 children at the end of the 70's. The Minas Gerais and Central-West Region had the same behavior as the rural areas. The urban area rates decline from the 1950's until 1979, with a rate of 3.5 in 1979. Sao Paulo and Rio de Janeiro Region had the lowest rate in urban areas, ranging from 4 children before 1960 to 3.1 in Sao Paulo and 2.8 children in Rio in 1975. The Southern Region (RS, SC, PR) had a rate in rural areas of 7.5 children in the 1960's, declining to 4 children in 1979. In the urban areas the rate was 5 children in the 1950's, falling to the rates of Sao Paulo and Rio in 1979. The data available to study the 1980's trend suggested a new acceleration of the fertility decline for the 1st 5 years.^ieng

Avaliação comparativa, aberta e randomizada da atividade anti-hipertensiva da nifedipinina e de cloridrato de prazosin / Comparative open and randomized evaluation of the antihypertensive activity of nifedipine and prazosin hydrochloride

Trinta portadores de hipertensäo leve ou moderada foram submetidos a uma avaliaçäo comparativa, aberta e "randomizada" de 12 semanas, durante a qual as doses diárias de nifedipina (em nova formulaçäo retard) e de cloridrato de prazozin foram tateadas, com o objetivo de reduzir a pressäo diastólica a um valor igual ou inferior a 90 mm Hg. Concomitante ao uso de ambas as substâncias, observou-se diminuiçäo significativa (p < 0,001) das pressöes sistólica e diastólica, assim como da freqüência cardíaca. O efeito anti-hipertensivo da nifedipina mostrou-se mais precoce (p < 0,05) e superior (p < 0,02) ao do cloridrato de prazosin. Esta substância mostrou-se de difícil manuseio, pois a dose ótima para a maioria dos pacientes foi alcançada no fim da observaçäo e o ajuste da dose individual foi acompanhado de freqüentes hipotensöes. Ambas as substâncias foram bem toleradas, porém, um paciente teve sua terapia com nifedipina interrompida em virtude de "flush" e edema de membros inferiores, apesar de importante efeito anti-hipertensivo

Sindrome de Noonan / Noonan syndrome

Os autores relatam um caso de sindrome de Noonan em uma menina de 15 anos, portadora de estenose pulmonar valvar associada a defeito do septo atrial. O diagnostico foi baseado nos achados do exame clinico.Salientam a pouca frequencia com que a sindrome e diagnosticada e a importancia de seu reconhecimento e melhor caracterizacao

[Internal migration: direct and indirect measurement]. / Migracoes internas: mensuracao direta e indireta.

PIP: Alternative methods for the estimation of internal migration are described and applied to official Brazilian census data for 1970 and 1980. Consideration is given to the problems caused by the quality of the available data^ieng