Análise evolutiva da morfologia e da irrigação do timo de javalis (Sus scrofa Linnaeus, 1758) / Evolutionary analysis of morphology and irrigation of the thymus of boar's (Sus scrofa Linnaeus, 1758)

Objetivou-se descrever comparativamente as artérias responsáveis pela irrigação dos lobos tímicos cervicais e torácicos dos javalis, determinando-se também as características morfológicas do referido órgão nessa espécie, a ponto de correlacioná-las evolutivamente com os demais representantes da família Suidae. Os lobos tímicos cervicais direito e esquerdo receberam ramos distribuídos pelas artérias carótidas comuns direita e esquerda e cervicais superficiais direita e esquerda e, por vezes, pelas artérias torácica externa esquerda e subclávia esquerda. Essa característica vascular foi mantida ao longo da evolução, estando presente em linhagens e raças mais recentes de suídeos. A irrigação dos lobos tímicos torácicos direito e esquerdo foi realizada predominantemente por ramos diretos e indiretos ipsilaterais e contralaterais das artérias torácicas internas direita e esquerda, e também por ramos da artéria subclávia esquerda. Ramos diretos das artérias cervicais superficiais direita e esquerda e ramos diretos da artéria torácica interna direita foram encontrados para o lobo tímico médio, sendo essa uma descrição única nessa espécie, o que demonstra uma característica evolutiva primitiva nesse ancestral.(AU)

The objective of this study was to comparatively describe the arteries responsible for the irrigation of the cervical and thoracic thymus lobes of Boars, also determining the morphological characteristics of this body in this species to the point of evolutionarily correlating them with other representatives of the Suidae family. The left and right cervical thymic lobes received branches distributed by common right and left, superficial right and left carotid arteries, and neck and, sometimes, the outer left chest and left subclavian arteries. This feature was vascular maintained throughout evolution and is present in more recent strains and breeds of swine. Irrigation of the right and left thoracic thymic lobes was performed predominantly by direct and indirect ipsilateral and contralateral branches of the right and left internal thoracic arteries and also by branches of the left subclavian artery. Direct branches of the right and left superficial cervical artery and right branches of the right internal thoracic artery were found for the average thymic lobe, this being a unique description in this species, demonstrating a primitive feature in this evolutionary ancestor.(AU)

Evolutionary aspects on the origin, distribution and ramifications of the ischiadicus nerve in the giant anteater (Myrmecophaga tridactyla) / Aspectos evolutivos sobre as origens, distribuições e ramificações dos nervos isquiáticos do tamanduá-bandeira (Myrmecophaga tridactyla)

This work aimed to describe the origin, distribution, and ramifications of the ischiadicus nerve in the giant anteater and to provide anatomical data which could explain not only the evolutionary aspects but also provide important information for other related works. For the present study, four specimens were used, prepared by perfusion of 10% formaldehyde solution via the femoral artery, for conservation and dissection. The origin of the right and left ischiadicus nerves in the giant anteater from the ventral ramification of the third lumbar (L3) and the first (S1), second (S2), and third (S3) sacral spinal nerves. These nerves were symmetrical in all animals studied. The distribution and ramification occurred to the superficial, middle, and deep gluteal, gemelli, piriform, quadratus femoris, tensor fasciae latae, caudal crural abductor, cranial and caudal parts of the biceps femoris, adductor, semitendinous, and cranial and caudal parts of the semimembranous muscles. Based on the origins of the ischiadicus nerves, there is a caudal migration in the nerve location in animals in a more recent position on the evolutionary scale due to reconfiguration of the lumbosacral plexus, resulting from the increase in a number of lumbar vertebrae. There is no complete homology of the muscle innervation.(AU)

Objetivou-se descrever as origens, distribuições e ramificações dos nervos isquiáticos no tamanduá-bandeira, disponibilizando, assim, dados anatômicos que possam não só elucidar os aspectos evolutivos como também fornecer informações importantes para áreas afins. Foram utilizados quatro espécimes preparados por meio da perfusão de formaldeído 10% via artéria femoral, para conservação e dissecação. As origens dos nervos isquiáticos direito e esquerdo no tamanduá-bandeira foram provenientes dos ramos ventrais dos nervos espinhais lombares três e sacrais um, dois e três, sendo simétricos em todos os animais estudados. As distribuições e ramificações ocorreram nos músculos glúteos superficial, médio e profundo; gêmeo; piriforme; quadrado femoral; tensor da fáscia lata; abdutor crural caudal; bíceps femoral parte cranial; bíceps femoral parte caudal; adutor; semitendíneo; semimembranáceo parte cranial e semimembranáceo parte caudal. Notou-se que houve uma migração caudal na localização deste nervo nos animais mais recentes na escala evolutiva, devido a uma reconfiguração do plexo lombossacral decorrente do aumento no número de vértebras lombares, não havendo uma homologia total quanto à inervação dos músculos.(AU)

Long term prognosis of acute pulmonary embolism.

BACKGROUND: Acute pulmonary embolism (PE) can be fatal if left untreated. Long-term prognosis of acute PE in the 21st century has not been fully reported. We aimed to determine the long-term prognosis of patients hospitalized with acute PE and compare survivalof patients with idiopathic and secondary PE. MATERIALS AND METHODS: We retrospectively analysed a cohort of hospitalized patients with acute PE between 2006 and 2013. EXCLUSION CRITERIA: <18 years, venous embolism of non-pulmonary veins, chronic thromboembolic pulmonary hypertension, and presumptive diagnosis without image confirmation. Only patients with a first PE episode were included. End-point: all-cause mortality. Patients were compared according to PE aetiology: idiopathic, secondary to neoplastic conditions and secondary to non-neoplastic conditions. A Cox-regression analysis was used to study the prognostic impact of PE aetiology. RESULTS: We studied 872 hospitalized acute PE patients. Median age 70 years, 56.9% were women. PE was idiopathic in 376 (43.1%), secondary to a neoplastic condition in 284 (32.6%) and secondary to a condition other than neoplasia in 212 (24.3%). Patients were followed for a median 25 months period and 508 (58.3%) died. Patients with PE attributed to a neoplastic condition had the worst survival. Patients with idiopathic PE had a multivariate-adjusted HR of mortality of 1.46 (1.08-1.99) during the over 2-year follow-up period when compared to those with acute PE attributed to a non-neoplastic condition. CONCLUSIONS: Patients with idiopathic acute PE have an almost 50% higher death risk in a median 2-year follow-up period than those with acute PE secondary to a condition other than neoplasia.

Virulence, resistance, and genetic relatedness of Escherichia coli and Klebsiella sp. isolated from mule foals / Virulência, resistência e relação genética de Escherichia coli e Klebsiella sp. isoladas de potros de muar

Respiratory diseases are common in young horses but little is known about such infections in mule foals. This study aimed to characterize Escherichia coli and Klebsiella sp. isolated from tracheal wash (TW) and fecal samples (FS) of mule foals, with or without cytological evidence of respiratory disease. Strains were analyzed against 13 antimicrobials, for presence of Extended spectrum beta-lactamase (ESBL), and virulence genes. Phylogrouping and Randomic (RAPD)-PCR profiles were used to evaluate their genetic relatedness. E. coli strains from TW and FS showed greatest resistance to tetracycline, while Klebsiella strains were mainly resistant to ampicillin; multidrug resistance and ESBL production were also detected. The blaCTX gene prevailed among the E. coli isolates, while the blaSHV gene was more frequently found in K. pneumoniae. The fimH gene was detected in most of the isolates and multiple virulence factors were identified in three E. coli isolates. Most of the E. coli isolates belonged to the B1 phylogroup, but B2 strains displayed more virulence genes. The RAPD assay revealed genetic diversity among strains and was able to distinguish FS isolates from TW isolates. Knowledge of the bacteria associated with the respiratory tract of mule foals is important in the treatment of sick animals.(AU)

Doenças respiratórias são comuns em potros de equinos, porém pouco se sabe sobre tais infecções em potros de muar. Este estudo buscou caracterizar Escherichia coli e Klebsiella sp. isolados de lavados traqueais (TW) e amostras fecais (FS) de potros de muar com e sem evidências citológicas de doença respiratória. As amostras bacterianas foram testadas contra 13 antimicrobianos, para a presença de genes de resistência estendida às betalactamases (ESBL) e de virulência. Filogrupagem e perfis de PCR randômicos (RAPD) foram usados para avaliar sua relação genética. As amostras de E. coli de TW e FS mostraram maior resistência à tetraciclina, enquanto as amostras de Klebsiella foram mais resistentes à ampicilina; multirresistência e produção de ESBL também foram detectadas. O gene blaCTX foi mais frequente entre E. coli, enquanto o gene blaSHV foi mais encontrado entre K. pneumoniae. O gene fimH foi detectado na maioria dos isolados de E. coli, enquanto múltiplos genes de virulência foram identificados em três isolados de E. coli. A maioria dos isolados de E. coli pertenceu ao filogrupo B1, porém somente isolados do filogrupo B2 apresentaram mais genes de virulência. Os ensaios de RAPD demonstraram a diversidade genética entre as amostras e distinguiram amostras TW e FS. O conhecimento de bactérias associadas a infecções de trato respiratório de potros de muar é importante no tratamento de animais doentes.(AU)

Placental hydroxymethylation vs methylation at the imprinting control region 2 on chromosome 11p15.5.

In addition to methylated cytosines (5-mCs), hydroxymethylcytosines (5-hmCs) are present in CpG dinucleotide-enriched regions and some transcription regulator binding sites. Unlike methylation, hydroxymethylation does not result in silencing of gene expression, and the most commonly used methods to study methylation, such as techniques based on restriction enzymatic digestion and/or bisulfite modification, are unable to distinguish between them. Genomic imprinting is a process of gene regulation where only one member of an allelic pair is expressed depending on the parental origin. Chromosome 11p15.5 has an imprinting control region (ICR2) that includes a differentially methylated region (KvDMR1) that guarantees parent-specific gene expression. The objective of the present study was to determine the presence of 5-hmC at the KvDMR1 in human placentas. We analyzed 16 third-trimester normal human placentas (chorionic villi). We compared two different methods based on real-time PCR after enzymatic digestion. The first method distinguished methylation from hydroxymethylation, while the other method did not. Unlike other methylation studies, subtle variations of methylation in ICRs could represent a drastic deregulation of the expression of imprinted genes, leading to important phenotypic consequences, and the presence of hydroxymethylation could interfere with the results of many studies. We observed agreement between the results of both methods, indicating the absence of hydroxymethylation at the KvDMR1 in third-trimester placentas. To the best of our knowledge, this is the first study describing the investigation of hydroxymethylation in human placenta using a genomic imprinting model.

Placental hydroxymethylation vs methylation at the imprinting control region 2 on chromosome 11p15.5

In addition to methylated cytosines (5-mCs), hydroxymethylcytosines (5-hmCs) are present in CpG dinucleotide-enriched regions and some transcription regulator binding sites. Unlike methylation, hydroxymethylation does not result in silencing of gene expression, and the most commonly used methods to study methylation, such as techniques based on restriction enzymatic digestion and/or bisulfite modification, are unable to distinguish between them. Genomic imprinting is a process of gene regulation where only one member of an allelic pair is expressed depending on the parental origin. Chromosome 11p15.5 has an imprinting control region (ICR2) that includes a differentially methylated region (KvDMR1) that guarantees parent-specific gene expression. The objective of the present study was to determine the presence of 5-hmC at the KvDMR1 in human placentas. We analyzed 16 third-trimester normal human placentas (chorionic villi). We compared two different methods based on real-time PCR after enzymatic digestion. The first method distinguished methylation from hydroxymethylation, while the other method did not. Unlike other methylation studies, subtle variations of methylation in ICRs could represent a drastic deregulation of the expression of imprinted genes, leading to important phenotypic consequences, and the presence of hydroxymethylation could interfere with the results of many studies. We observed agreement between the results of both methods, indicating the absence of hydroxymethylation at the KvDMR1 in third-trimester placentas. To the best of our knowledge, this is the first study describing the investigation of hydroxymethylation in human placenta using a genomic imprinting model.

Principais alterações no leite por agentes causadores de mastite no rebanho caprino dos estados de Minas Gerais e Rio de Janeiro / Major changes in milk by mastitis causative agents in goat herd from the states of Minas Gerais and Rio de Janeiro, Brazil

A mastite subclínica caprina ocasiona prejuízos econômicos em decorrência do descarte, dos gastos com medidas terapêuticas e da redução da quantidade e qualidade do leite e seus derivados.Nesse estudo, 129 amostras de leite de cabra in natura, provenientes de 11 propriedades foram avaliadas pelo teste da caneca telada, California Mastitis Test (CMT), exame bacteriológico, pesquisa de Mycoplasma spp. e pela determinação dos parâmetros físico-químicos. No teste da caneca telada e no CMT, 3,1% e 4,6% das amostras foram positivas, respectivamente. No exame bacteriológico, 57,4% das amostras foram positivas e o patógeno mais frequente foi Staphylococcus coagulase negativa com 56% das cepas resistentes à penicilina e 100% de sensíveis à gentamicina. Mycoplasma spp. não foi identificado nas amostras. O diagnóstico da mastite subclínica pelo CMT e pelo exame bacteriológico diferiu de forma significativa e não houve associação entre o número de UFC/mL obtidas no exame microbiológico e o resultado do CMT (Qui-quadrado p 0,05). Com base nos resultados obtidos, recomenda-se a associação do exame bacteriológico quando na utilização do CMT para diagnóstico da mastite subclínica caprina.

Major changes in milk by mastitis causative agents in goat herd from the states of Minas Gerais and Rio de Janeiro, Brazil. Goat mastitis causes significant economic losses due to the discarding of milk, costs of drugs and veterinary care, reducing the quantity and quality of milk and dairy products. In this study, 129 raw milk samples from 11 goat farms were investigated by the Tamis test, California mastitis test (CMT), bacteriological exam, presence of Mycoplasma spp. and physicochemical parameters. Seven (4.6%) and four samples (3.1%) were positive by CMT and Tamis test respectively. Bacteriological exam was positive from 57.4% of samples and coagulase-negative Staphylococcus was the most frequent bacteria isolated showing 56% of the strains resistant to penicillin and no resistance to gentamicin. Negative results were obtained from traditional culture as well as by PCR for Mycoplasma spp. The diagnosis of mastitis, the bacteriological exam and the CMT results differed significantly and no association was observed (chi squared, p 0.05). The physicochemical parameters differed significantly (ANOVA, Tukey-Kramer, p < 0.05) among the herds. These results indicate the need to associate microbiological exam when the CMT is used for the diagnosis of goat mastitis.

Renal failure as a determinant of mortality after cardiac transplantation.

INTRODUCTION: Patients with heart failure frequently develop renal failure, which increases the mortality rate among patients undergoing cardiac transplantation. PURPOSE: To determine whether preoperative renal function influenced postoperative mortality in cardiac transplantation recipients. MATERIALS AND METHODS: The measurements of plasma urea, plasma creatinine, and 24-hour creatinine clearance in patients who underwent cardiac transplantation were correlated with mortality at 30, 90, and 365 days after the procedure, using Student t test for continuous variables and the chi-square test for categorical variables. RESULTS: All variables correlated with mortality, particularly plasma creatinine at 30, 90, and 365 days (P =.029,.003, and.0029, respectively). CONCLUSION: Preoperative renal failure is a mortality indicator in cardiac transplantation recipients.

Renal Failure as a Determinant of Mortality After Cardiac Transplantation

Introduction. Patients with heart failure frequently develop renal failure, which increasesthe mortality rate among patients undergoing cardiac transplantation.Purpose. To determine whether preoperative renal function influenced postoperativemortality in cardiac transplantation recipients.Materials and Methods. The measurements of plasma urea, plasma creatinine, and 24-hour creatinine clearance in patients who underwent cardiac transplantation werecorrelated with mortality at 30, 90, and 365 days after the procedure, using Student t test for continuous variables and the chi-square test for categorical variables.Results. All variables correlated with mortality, particularly plasma creatinine at 30, 90,and 365 days (P .029, .003, and .0029, respectively).Conclusion. Preoperative renal failure is a mortality indicator in cardiac transplantation recipients.

[Activities of the Brazilian Senate in the area of public health, 1995 and 1996]. / Atividades do Senado Federal brasileiro na área de saúde pública, 1995 e 1996.

The objective of this study was to identify and describe the actions of Brazilian senators in the field of public health in 1995 and 1996. We also sought to determine if profession, regional background, or political party influenced the senators' actions. The actions were divided into three types: legislative (proposal and review of bills and petitions); supervisory (information requests to the executive branch and the establishment of inquiry committees and other special committees); and parliamentary (speeches). The data were collected from two databases maintained by the Senate, namely MATE and DISC. Of the 89 senators who were in office during the study period, 76 were involved with public health issues. Of the total of 667 actions studied, there was a predominance of speeches (43% of all actions), most of them responding to news reported by regional or national media. Supervisory activities were limited (5% of all actions were information requests). The subjects dealt with most frequently were health policies (30%), drugs (9%), regulation of health professions (8%), disease control (7%), and worker health (6%). Concerning the professions of the senators, the most frequent categories were physicians, teachers, and journalists. The senators representing the North and Northeast regions performed 62% of the actions and were involved with almost all the health subjects. Although 43% of the actions were carried out by liberal and right-wing senators, the senators from socialist and labor parties had a stronger proportional participation (both in terms of senators involved and actions performed). It is interesting to note that socialist and labor senators showed minimal involvement in the issue of worker health. The predominance of speeches as a prevalent type of action, the limited and disjointed scope of legislative actions, and, especially, the poor monitoring and control show the need for deep changes in the work process of the Senate's technical committees and, therefore, of the Senate's technical support unit.

Thrombin-like enzyme from Lachesis muta muta venom: isolation and topographical analysis of its active site structure by means of the binding of amidines and guanidines as competitive inhibitors.

A serine protease enzyme was purified from Lachesis muta muta venom, with 40% yield, by gel filtration on Sephadex G-100 and affinity chromatography on Sepharose-agmatin. Homogeneity of the enzyme preparation was demonstrated by sodium dodecyl sulfate polyacrylamide gel electrophoresis and the enzyme had a relative mol. wt of 45,000. The molar extinction coefficient at 280 nm was 62,127 (M x cm)-1. The enzyme hydrolysed Bz-Arg-Nan with Ks = 0.233 +/- 0.08 mM and kcat = 2.80 +/- 0.07 sec-1. All the amidines and guanidines tested for their inhibitory effect on thrombin-like enzyme behaved as competitive inhibitors of the enzyme with Ki values in the range 6.2 microM to 42.3 mM for amidines and 0.19 mM to 9.31 mM for guanidines. Dissociation constant values were analyzed in terms of the binding of the inhibitors with the subsite S1, the specificity pocket of the enzyme, Ki values were discussed in accordance with those for trypsin inhibition. beta-Naphthamidine was the strongest inhibitor, while guanidine was the weakest. The differences among the Ki values were interpreted in terms of the shape of the enzyme active site. For meta- and para-substituted benzamidinium ions a good correlation was found between log l/Ki and sigma Hammett values of the substituents. The substituent effects in the pi-electrons of the benzamidine ring were considered in the frame of Hückel molecular orbital theory. A model for the binding of p-benzamidine derivatives with the primary specificity S1 subsite of the enzyme active site was proposed.

Programas supervisionados em reabilitaçào cardiovascular - abordagem de prescriçäo de exercício / Supervised programs in cardiovascular rehabilitation - approach to exercise prescription

Nas últimas décadas, a prática de exercícios físicos tem sido estimulada entre sadios e pacientes cardíacos. Os programas de reabilitaçäo cardíaca têm objetivos profiláticos e terapêuticos. Classicamente, esses programas säo divididos em 3 fases. A Fase I é dirigida para pacientes hospitalizados, convalescendo de infarto agudo do miocárdio ou pós-cirurgia cardiovascular visando evitar os efeitos negativos do repouso prolongado no leito, o retorno mais breve às atividades cotidianas, diminuir o impao psicológico e evitar complicaçöes pulmonares; os tipos de exercício para essa fase säo leves, graduais e individualizados. na Fase II é feita a estratificaçäo de risco (alto, médio e baixo): os de alto risco seräo orientados como os de Fase I e os demais fazem exercícios acima de 5 METs, 3 a 4 vezes por semana, em sessöes de 30 a 60 minutos. Os programas podem ser supervisionados ou näo. As contra-indicaçöes devem ser observadas. Na Fase III procede-se à avaliaçäo do consumo de oxigênio pelo teste caripulmonar para estabelecer o limiar anaeróbico e programa a instensidade de exercício, que deve ficar a 70 por cento da capacidade aeróbia máxima. como há linearidade entre o consumo de oxigênio e a frequência cardíaca, a contagem do pulso serve para determinar o limite de exercício. Cada sessäo deve durar de 30 a 60 minutos, 3 a 4 vezes por semana, observando-se o aquecimento, o estímulo e o desaquecimento. As reavaliaçöes devem ser feitas a cada 6 meses, quando poderäo ser reprogramados os exercícios.

Seleçäo de candidato a receptor: indicaçöes e contra-indicaçöes do transplante cardíaco / Heart transplantation recipients selection: indication and contraindication criteria

A crescente demanda por transplantes do coraçäo e a escassez de órgäos, a par dos bons resultados que vêm sendo obtido, exigem cada vez maior critério na seleçäo dos candidatos. O procedimento está indicado em pacientes com insuficiência cardíaca grave, refratária à terapêutica otimizada, em portadores de cardiopatia näo-suscetível de cirurgia conservadora. Säo contra-indicaçöes absolutas: infecçäo ativa, sorologia positiva para HIV, neoplasia atual ou passada näo seguramente controlada, hipertensäpulmonar grave, úlcera péptica ativa, diabete melito dependente de insulina com lesäo em órgäos-alvo, embolia ou infarto pulmonar recente (menos de 3 meses), disfunçäo renal e/ou hepática irreversível, perfil psicológico/psiquiátrico desfavorável, condiçäo associada que limite a expectativa de vida, alcoolismo ou toxicomania e condiçäo socioeconômica inadequada. Säo contra-indicaçöes relativas: idade igual ou superior a 70 amos, diabete melito sem lesäo de órgäo-alvo, moradia distante do centro de translnte, disfunçäo renal e/ou hepática transitória, peso corporal elevado, doença crônica incurável, doença neurológica ou vascular central ou periférica, amiloidose, diverticulose. A priorizaçäo de pacientes na lista de espera deve obedecer aos críterios de justiça e potencial de benefícios.

Cuidados com o candidato a doador e critérios de seleçäo / Care with the donor candidate and selection criteria

O sucesso do transplante cardíaco depende, fundamentalmente, do receptor bem selecionado e do doador em bom estado orgânico. Além dos cuidados iniciais, a orientaçäo é para que, sempre que possível, seja realizada a operaçäo com receptor e doador em salas contíguas (lado a lado), seja evitado doador em peso inferior (até 10 por cento) ao do receptor, sejam evitadas pressöes elevadas e cirurgia cardíaca prévia no receptor. A busca de órgäos à distância fica para recptor com regime pressórico baixo artéria pulmonar. O diagnóstico de coma encefálico dever ser feito por meio de carotidoangiografia, demostrando ausência de fluxo sanguíneo encefálico; provas sorológicas negativas säo imprescindíveis para a realizaçäo do transplante, assim como a identidade ABO com o recptor. De rpreferência, näo usar drogas vasoativas (dopamina) no doador; se necessário, näo ultrapassar a dose de 10 ug/kg/min, mantendo adquados parâmetros de oxigenaçäo pela ventilaçäo mecânica. É necessária administraçäo generosa d íquidos por via endovenosa para evitar a ocorrência de hipovolemia/hipotensäo decorrentes de polúria desencadeada pelo diabete insípido. Quando o doador tem mais de 50 anos de idade ou nos casos em que o doador é do sexo feminino, é importante evitar-se o uso de agentes inotrópicos e que a cirurgia seja realizada no menor tempo isquêmico possível.

Molecular basis of alpha-thalassemia in Portugal.

We have estimated the incidence and molecular basis of alpha-thalassemia in a Portuguese population, mostly from the Greater Lisbon area. In a group of 100 consecutive cord blood samples, the gene frequency of the rightward deletion (-alpha 3.7) was 0.035, and the leftward deletion (-alpha 4.2) was 0.015. In this group, we have also found four heterozygotes for the triple alpha-globin gene rearrangement (alpha alpha alpha anti 3.7. gene frequency 0.020). We have characterized the subtypes of -alpha 3.7 and alpha alpha alpha anti 3.7 rearrangements. On the whole, these results give an incidence of 10% for deletional alpha-thalassemia carriers in the studied Portuguese population. In a group of 342 subjects presenting beta-thalassemia, or Hb S trait, beta-thalassemia major sickle cell disease or low red blood cell indices, the -alpha 3.7, -alpha 4.2, -SEA, -MED, (alpha alpha)MM, and alpha alpha alpha anti 3.7 haplotypes were found in different combinations. Only one nondeletional alpha-thalassemia determinant (a 5 nucleotide deletion in the alpha 2-globin gene in the second intervening sequence donor site) was detected, which might suggest a low incidence of these defects in the Portuguese population.

[Infective endocarditis in children and adolescents]. / Endocardite infecciosa na infância e adolescência.

PURPOSE: To assess infective endocarditis (IE) predisposing factors, etiologic agents and hospital course in infants and adolescents. METHODS: We Studied 222 patients admitted under compatible IE diagnosis, from 1985 to 1990. The population of this study is fifty patients (23%) under 16 years of age. RESULTS: Rheumatic valvular disease, as predisposing cardiopathy was proeminent within 9 to 16 years of age, markedly Statistical difference when compared to age range of 0 to 8 years (p < 0.05). Among congenital cardiopathies, the most frequent were: interventricular septal defect (26.0%) and tetralogy of Fallot (21.7%). Blood cultures, surgical material or emboli cultures were positive in 35 (70.0%) assessed patients. Streptococcus viridans (45.7%) and Staphylococcus aureus (42.8%) were the etiologic agents most often isolated. It was found that endocarditis by Staphylococcus aureus had mortality rate of 53.3% [(clinical (66.6%) and surgical (44.4%)], (p < 0.05) when compared to those by Streptococcus viridans; with total mortality of 6.2% (no clinical death and 16.6% in the surgical group). Total in-hospital mortality (clinical and surgical) was 26.0% (13 deaths). CONCLUSION: IE in infants and adolescents in this studied population presented Streptococcus viridans responsible for 46.7% of patients with endocarditis and the Staphylococcus aureus for 42.8% were the etiologic agents most often found. Total, clinical and surgical mortality was greater in patients with endocarditis by Staphylococcus aureus when compared with those by Streptococcus viridans. Among the congenital cardiopathies, whether operated on or not, ventricular septal defect and of Fallot's tetralogy were the most involved ones; rheumatic cardiopathy Still remains a significant predisposing factor to infective IE in our country.