Changes in land use affect anuran helminths in the South Brazilian grasslands.

Degradation and habitat loss of natural grasslands in Southern Brazil has a negative impact on native organisms, potentially including the composition of anuran helminth communities. Here, we characterized the richness, abundance, taxonomic composition, prevalence and intensity of helminth infection in four anuran species. Host anurans were collected in 34 ponds (19 in native grasslands with livestock and 15 in agricultural cultivation) from the highland grasslands in the Brazilian states of Santa Catarina and Paraná. Our results showed a significant difference between native grasslands with livestock and agricultural cultivation regarding the structure of helminth communities for the hosts Aplastodiscus perviridis and Pseudis cardosoi. We also found a greater prevalence and intensity of infection in anurans in areas of agricultural cultivation than in native grasslands with livestock. We found that the environmental descriptors (local and landscape) seem to explain most of the differences in anuran parasitism recorded between native grasslands with livestock and agricultural areas. Thus, we emphasized that the loss of grassy habitat due to conversion to agricultural cultivation can alter helminth communities in anurans, with further work needed to understand the mechanisms involved.

Predictors of short- and long-term recurrence of suicidal behavior in borderline personality disorder.

OBJECTIVE: To evaluate the incidence of suicidal outcomes and risk factors for short- and long-term recurrence of suicidal behavior (SB) among high-risk borderline personality disorder (BPD) patients during a 24-month prospective follow-up period. METHODS: A multicenter prospective cohort study was designed to compare data obtained from 136 patients admitted to the emergency department for current suicidal ideation (SI) or a recent suicide attempt (SA). Subjects were clinically evaluated and monitored for a new SA or suicide. RESULTS: The incidence of a new SA was 25.63 events/100 persons-year, and one patient died by suicide. Child sexual abuse (CSA) was the only significant predictor throughout the complete follow-up period. The absence of prior psychiatric treatment predicts the recurrence of SB in the first 6 months of follow-up. Patient age, poor psychosocial functioning before hospitalization, age at first SA, and having multiple suicide attempts increased risk of SB recurrence at the long-term period (24th months). In addition, there was an interaction between CSA and poor psychosocial functioning that increased risk of SB. CONCLUSION: The risk of recurrence was higher during the first 6 months. Risk factors at 6 and 24 months vary. These findings are important for implementing suicide strategies.

Effects of BMP-4 and FSH on growth, morphology and mRNA expression of oocyte-secreted factors in cultured bovine secondary follicles

This study evaluated the effect of different concentrations of bone morphogenetic protein-4 (BMP-4), as well as the interaction of BMP-4 and follicle stimulating hormone (FSH) on growth, ultrastructural integrity, and expression of mRNA for growth differentiation factor-9 (GDF-9), BMP-15, maternal antigen that the embryo requires (Mater) and nucleoplasmin-2 (Npm-2) in bovine secondary follicles cultured in vitro for 18 days. Follicles cultured in the presence of 50 ng/ml BMP-4 had a progressive increase in their diameters with the increase of culture period from 0 to 6 and 12 days, but no significant differences were observed among treatments. The presence of both FSH and BMP-4 in a culture medium did not stimulate follicle growth when compared to the control medium. After 12 days, the percentage of normal follicles was maintained similar to that of day 0 in the medium supplemented with both FSH and BMP-4, but no significant differences among treatments were observed after 18 days of culture. BMP-4 maintained the ultrastructural integrity of follicles after 18 days of culture, while follicles cultured in medium supplemented with FSH or both BMP-4 and FSH had oocyte with irregular zona pellucida, vesicular bodies, and an abundance of vacuoles. Follicles cultured in the presence of BMP-4 had an increase in the levels of BMP-15 mRNA, when compared to those cultured in medium supplemented with FSH alone. In conclusion, the addition of BMP-4 in culture medium contributes to preserve follicular ultrastructure, but BMP-4 did not interact positively with FSH. Regarding secondary follicles cultured in the presence of FSH, BMP-4 increases the expression of mRNA for BMP-15.(AU)

Effects of BMP-4 and FSH on growth, morphology and mRNA expression of oocyte-secreted factors in cultured bovine secondary follicles

This study evaluated the effect of different concentrations of bone morphogenetic protein-4 (BMP-4), as well as the interaction of BMP-4 and follicle stimulating hormone (FSH) on growth, ultrastructural integrity, and expression of mRNA for growth differentiation factor-9 (GDF-9), BMP-15, maternal antigen that the embryo requires (Mater) and nucleoplasmin-2 (Npm-2) in bovine secondary follicles cultured in vitro for 18 days. Follicles cultured in the presence of 50 ng/ml BMP-4 had a progressive increase in their diameters with the increase of culture period from 0 to 6 and 12 days, but no significant differences were observed among treatments. The presence of both FSH and BMP-4 in a culture medium did not stimulate follicle growth when compared to the control medium. After 12 days, the percentage of normal follicles was maintained similar to that of day 0 in the medium supplemented with both FSH and BMP-4, but no significant differences among treatments were observed after 18 days of culture. BMP-4 maintained the ultrastructural integrity of follicles after 18 days of culture, while follicles cultured in medium supplemented with FSH or both BMP-4 and FSH had oocyte with irregular zona pellucida, vesicular bodies, and an abundance of vacuoles. Follicles cultured in the presence of BMP-4 had an increase in the levels of BMP-15 mRNA, when compared to those cultured in medium supplemented with FSH alone. In conclusion, the addition of BMP-4 in culture medium contributes to preserve follicular ultrastructure, but BMP-4 did not interact positively with FSH. Regarding secondary follicles cultured in the presence of FSH, BMP-4 increases the expression of mRNA for BMP-15.

Estatinas x ácido lipóico na prevenção e tratamento das doenças cardiovasculares / Statins x lipoic acid in the prevention and treatment of cardiovascular diseases

Cardiovascular diseases (CVD) are the leading cause of death worldwide and atherosclerosis is the most important process underlying CVD. Statins are widely used in primary and secondary prevention of CVD, though their adverse side effects, such as myopathy and hepatotoxicity, justify the search for therapeutic alternatives. Alpha lipoic acid is a potent antioxidantand its potential use to combat various conditions, such as diabetic nephropathy, metal poisoning, Alzheimer's disease and CVD has been under intense study. The aim of this review was to gather information on the use of statins and alpha lipoic acid in the prevention and treatment of CVD. The literature suggests that inaddition to the known side effects most associated with the use of statins, they can also cause reduced levels of coenzyme Q10 (CoQ10), an important mitochondrial antioxidant and electron transport chain carrier that has the capacity to antagonize oxidation of plasma lowdensity lipoprotein (LDL). The loss of CoQ10 can reduce adenosine triphosphate (ATP) levels in cardiac cells, further worsening the overall state of the individual. Alpha lipoic acid produces favorable metabolic and endothelial anti-inflammatory effects, without adverse side effects, and thus may be an alternative treatment for the prevention of CVD. However, more controlled clinical studies are needed to establish definitively the prophylactic and therapeutic potential of alpha lipoic acid and to decide whether it might be more effective than statins for the prevention and treatment of CVD...

As doenças cardiovasculares (DCVs) são a principal causa de morte no mundo e tem a aterosclerose como componente mais importante. As estatinas são extensamente utilizadas na prevenção primária e secundária das DCVs, todavia seus efeitos adversos como miopatia e toxicidade hepática justificam a busca por alternativas terapêuticas. O ácido lipóico é um potente antioxidante e vem sendo intensamente investigado no combate de diversas condições tais como nefropatia diabética, intoxicação por metais, doença de Alzheimer e nas DCVs. O objetivo desta revisão foi reunir informações acerca da utilização das estatinas e do ácido lipóico na prevenção e tratamento das DCVs. A literatura aponta que além dos efeitos adversos mais conhecidos associados ao uso das estatinas, elas também podem ocasionar a redução dos níveis de Coenzima Q10 (CoQ10), um importante antioxidante mitocondrial e transportador de elétrons, que possui a capacidade de antagonizar a oxidação da Lipoproteína de Baixa Densidade (LDL) plasmática. Ainda, a deficiência da CoQ10, por sua vez, pode levar a diminuição da adenosina trifosfato (ATP) nas células cardíacas, comprometendo ainda mais o estado global do indivíduo. Enquanto isso, o ácido lipóico apresenta favoráveis efeitos antiinflamatórios, metabólicos e endoteliais, contudo sem a presença de efeitos adversos, podendo ser uma opção terapêutica na prevenção das DCVs. Entretanto, mais estudos clínicos controlados são necessários para estabelecer de maneira definitiva os potenciais terapêuticos e profiláticos do ácido lipóico, avaliando se ele pode ser mais efetivo para a prevenção e tratamento das DCVs do que as estatinas...

Phytohemagglutinin improves the development and ultrastructure of in vitro-cultured goat (Capra hircus) preantral follicles.

The objective this study was to determine the effect of phytohemagglutinin (PHA) on survival, growth and gene expression in caprine secondary follicles cultured in vitro. Secondary follicles (∼0.2 mm) were isolated from the cortex of caprine ovaries and cultured individually for 6 days in α-MEM+ supplemented with PHA (0, 1, 10, 50, 100, or 200 µg/mL). After 6 days of culture, follicle diameter and survival, antrum formation, ultrastructure and expression of mRNA for FSH receptors (FSH-R), proliferating cell nuclear antigen (PCNA), and neuronal nitric oxide synthase were determined. All treatments maintained follicular survival [α-MEM+ (94.59%); 1 µg/mL PHA (96.43%); 10 µg/mL PHA (84.85%); 50 µg/mL PHA (85.29%); 100 µg/mL PHA (88.57%), and 200 µg/mL PHA (87.50)], but the presence of 10 µg/mL PHA in the culture medium increased the antrum formation rate (21.21%) when compared with control (5.41%, P < 0.05) and ensured the maintenance of oocyte and granulosa cell ultrastructures after 6 days of culture. The expression of mRNA for FSH-R (2.7 ± 0.1) and PCNA (4.4 ± 0.2) was also significantly increased in follicles cultured with 10 µg/mL PHA in relation to those cultured in α-MEM+ (1.0 ± 0.1). In conclusion, supplementation of culture medium with 10 µg/mL PHA maintains the follicular viability and ultrastructure, and promotes the formation of antral cavity after 6 days of culture in vitro.

Phytohemagglutinin improves the development and ultrastructure of in vitro-cultured goat (Capra hircus) preantral follicles

The objective this study was to determine the effect of phytohemagglutinin (PHA) on survival, growth and gene expression in caprine secondary follicles cultured in vitro. Secondary follicles (∼0.2 mm) were isolated from the cortex of caprine ovaries and cultured individually for 6 days in α-MEM+ supplemented with PHA (0, 1, 10, 50, 100, or 200 µg/mL). After 6 days of culture, follicle diameter and survival, antrum formation, ultrastructure and expression of mRNA for FSH receptors (FSH-R), proliferating cell nuclear antigen (PCNA), and neuronal nitric oxide synthase were determined. All treatments maintained follicular survival [α-MEM+ (94.59%); 1 µg/mL PHA (96.43%); 10 µg/mL PHA (84.85%); 50 µg/mL PHA (85.29%); 100 µg/mL PHA (88.57%), and 200 µg/mL PHA (87.50)], but the presence of 10 µg/mL PHA in the culture medium increased the antrum formation rate (21.21%) when compared with control (5.41%, P < 0.05) and ensured the maintenance of oocyte and granulosa cell ultrastructures after 6 days of culture. The expression of mRNA for FSH-R (2.7 ± 0.1) and PCNA (4.4 ± 0.2) was also significantly increased in follicles cultured with 10 µg/mL PHA in relation to those cultured in α-MEM+ (1.0 ± 0.1). In conclusion, supplementation of culture medium with 10 µg/mL PHA maintains the follicular viability and ultrastructure, and promotes the formation of antral cavity after 6 days of culture in vitro.

Effects of growth differentiation factor-9 and FSH on in vitro development, viability and mRNA expression in bovine preantral follicles.

The present study investigated the role of growth differentiation factor (GDF)-9 and FSH, alone or in combination, on the growth, viability and mRNA expression of FSH receptor, proliferating cell nuclear antigen (PCNA) and proteoglycan-related factors (i.e., hyaluronan synthase (HAS) 1, HAS2, versican, perlecan) in bovine secondary follicles before and after in vitro culture. After 12 days culture, sequential FSH (100 ng mL⁻¹) from Days 0 to 6 and 500 ng mL⁻¹ from Days 7 to 12) increased follicular diameter and resulted in increased antrum formation (P<0.05). Alone, 200 ng mL⁻¹ GDF-9 significantly reduced HAS1 mRNA levels, but increased versican and perlecan mRNA levels in whole follicles, which included the oocyte, theca and granulosa cells. Together, FSH and GDF-9 increased HAS2 and versican (VCAN) mRNA levels, but decreased PCNA mRNA expression, compared with levels in follicles cultured in α-minimum essential medium supplemented with 3.0 mg mL⁻¹ bovine serum albumin, 10 µg mL⁻¹ insulin, 5.5 µg mL⁻¹ transferrin, 5 ng mL⁻¹ selenium, 2 mM glutamine, 2mM hypoxanthine and 50 µg mL⁻¹ ascorbic acid (α-MEM⁺). Comparisons of uncultured (0.2 mm) and α-MEM⁺ cultured follicles revealed that HAS1 mRNA expression was higher, whereas VCAN expression was lower, in cultured follicles (P<0.05). Expression of HAS1, VCAN and perlecan (HSPG2) was higher in cultured than in vivo-grown (0.3 mm) follicles. In conclusion, FSH and/or GDF-9 promote follicular growth and antrum formation. Moreover, GDF-9 stimulates expression of versican and perlecan and interacts positively with FSH to increase HAS2 expression.

Virulência e aspectos biológicos de Isaria javanica (Frieder & Bally) Samson & Hywell-jones sobre Coptotermes gestroi (Wasmann) (Isoptera: Rhinotermitidae) / Virulence and biological aspects of Isaria javanica (Frieder & Bally) Samson & Hywell-jones in Coptotermes gestroi (Wasmann) (Isoptera: Rhinotermitidae)

O cupim asiático Coptotermes gestroi é considerado praga em áreas urbanas, causando danos expressivos em casas, edifícios e árvores. Esta pesquisa avaliou a eficiência de Isaria javanica URM4993 e I. javanica URM4995 sobre operários de C. gestroi. Os insetos foram pulverizados nas concentrações de 104 a 108 conídios/mL e mantidos em incubadora a 25 ± 1º C e 80 ± 10% de umidade relativa. Determinou-se a Concentração Letal (CL50) e o Tempo Letal (TL50), bem como foi quantificada a produção de conídios sobre os insetos mortos. Os aspectos biológicos referentes à germinação e esporulação, antes e após a infecção em C. gestroi, foram avaliados. O fungo foi virulento ao cupim, causando infecção em todas as concentrações utilizadas, sendo que I. javanica URM4993 foi mais eficiente, por causar mortalidade de 100%, após o 6º dia de inoculação (CL50 de 4,86 conídios/mL e TL50 de 2,26 dias). A esporulação nos insetos mortos não diferiu entre as linhagens. Foi observado que o percentual de germinação foi maior nas linhagens reisoladas do que nas linhagens padrão. Contudo, I. javanica URM4993 apresentou maior potencial de esporulação. Esses resultados mostram o fungo como um candidato ao controle biológico desse cupim.

The Asiatic termite Coptotermes gestroi is considered a pest in urban areas causing extensive damage to houses, buildings and trees. The present study evaluated the effectiveness of Isaria javanica URM4993 and URM4995 on workers of C. gestroi. Insects were sprayed with concentrations of 104 at 108 conidia/mL and kept in an incubator at 25 ± 1º C and 80 ± 10% relative humidity. Results were used to determine the lethal concentration (LC50) and lethal time (LT50). Conidia production on dead insects was assessed. Biological aspects related to germination and sporulation, before and after infection with C. gestroi were also assessed. The fungus was virulent to termites, causing infection at all tested concentrations, with I. javanica URM4993 being the most virulent, causing 100% mortality after six days of inoculation (LC50 of 4.86 x 10 conidia/mL and LT50 of 2.26 days). Sporulation on dead insects did not differ between strains. The percentage of germination was greater for reisolated strains than for standard strains. However, I. javanica URM4993 showed greater sporulation. These results show that the fungus is a candidate for the biological control of termites.

VIRULÊNCIA E ASPECTOS BIOLÓGICOS DE ISARIA JAVANICA (FRIEDER & BALLY) SAMSON & HYWELL-JONES SOBRE COPTOTERMES GESTROI (WASMANN) (ISOPTERA: RHINOTERMITIDAE)

ABSTRACT The Asiatic termite Coptotermes gestroi is considered a pest in urban areas causing extensive damage to houses, buildings and trees. The present study evaluated the effectiveness of Isaria javanica URM4993 and URM4995 on workers of C. gestroi. Insects were sprayed with concentrations of 104 at 108 conidia/mL and kept in an incubator at 25 ± 1º C and 80 ± 10% relative humidity. Results were used to determine the lethal concentration (LC50) and lethal time (LT50). Conidia production on dead insects was assessed. Biological aspects related to germination and sporulation, before and after infection with C. gestroi were also assessed. The fungus was virulent to termites, causing infection at all tested concentrations, with I. javanica URM4993 being the most virulent, causing 100% mortality after six days of inoculation (LC50 of 4.86 x 10 conidia/mL and LT50 of 2.26 days). Sporulation on dead insects did not differ between strains. The percentage of germination was greater for reisolated strains than for standard strains. However, I. javanica URM4993 showed greater sporulation. These results show that the fungus is a candidate for the biological control of termites.

RESUMO O cupim asiático Coptotermes gestroi é considerado praga em áreas urbanas, causando danos expressivos em casas, edifícios e árvores. Esta pesquisa avaliou a eficiência de Isaria javanica URM4993 e I. javanica URM4995 sobre operários de C. gestroi. Os insetos foram pulverizados nas concentrações de 104 a 108 conídios/mL e mantidos em incubadora a 25 ± 1º C e 80 ± 10% de umidade relativa. Determinou-se a Concentração Letal (CL50) e o Tempo Letal (TL50), bem como foi quantificada a produção de conídios sobre os insetos mortos. Os aspectos biológicos referentes à germinação e esporulação, antes e após a infecção em C. gestroi, foram avaliados. O fungo foi virulento ao cupim, causando infecção em todas as concentrações utilizadas, sendo que I. javanica URM4993 foi mais eficiente, por causar mortalidade de 100%, após o 6º dia de inoculação (CL50 de 4,86 conídios/mL e TL50 de 2,26 dias). A esporulação nos insetos mortos não diferiu entre as linhagens. Foi observado que o percentual de germinação foi maior nas linhagens reisoladas do que nas linhagens padrão. Contudo, I. javanica URM4993 apresentou maior potencial de esporulação. Esses resultados mostram o fungo como um candidato ao controle biológico desse cupim.

Análise sobre a fitoterapia como prática integrativa no Sistema Único de Saúde / Analysis about phytotherapy as an integrating practice in the Brazilian Unified Health System (UHS)

É notável o crescente uso da fitoterapia como prática médica integrativa em diversos países. A utilização de plantas medicinais no Brasil tem como facilitadores a grande diversidade vegetal e o baixo custo associado à terapêutica, o que vem despertando a atenção dos programas de assistência à saúde e profissionais. O Ministério da Saúde, com a finalidade de evitar o uso inadequado desta prática medicinal, tem demonstrado interesse por meio do incentivo de pesquisas relacionadas ao assunto, favorecendo a implantação de programas de saúde visando à distribuição e utilização destes medicamentos de forma racional. Baseado neste contexto foi realizado levantamento de como esta temática vem sendo abordada e implementada no Sistema Único de Saúde (SUS). Trata-se de estudo descritivo com abordagem qualitativa, realizado através de levantamento bibliográfico em bases de dados relacionado ao tema "medicamentos fitoterápicos no sistema único de saúde". Os descritores utilizados durante toda a pesquisa foram fitoterapia, medicamentos fitoterápicos, medicina integrativa, medicamentos, medicina herbária, fitoterapia no SUS, medicina integrativa e sistemas públicos de saúde. Observou-se que o governo tem demonstrado interesse no desenvolvimento de políticas que associem o avanço tecnológico ao conhecimento popular em prol de procedimentos assistenciais em saúde que apresentem eficácia, abrangência, humanização e menor dependência com relação à indústria farmacêutica. Nas duas últimas décadas, alguns estados e municípios brasileiros vêm realizando a implantação de Programas de Fitoterapia na atenção primária à saúde, com o intuito de suprir as carências medicamentosas de suas comunidades. Apesar da crescente busca por integrativas medicamentosas, os estudos acerca da fitoterapia ainda são precários no Brasil, fazendo-se ainda necessárias pesquisas nesta área, de modo a ampliar o conhecimento dos profissionais e estudantes da saúde, auxiliando e tornando mais sólidas as bases de segurança e eficácia para implementação das praticas fitoterápicas no SUS.

The growing use of phytotherapy as an integrating medical practice in several countries has been remarkable. The use of medicinal plants in Brazil is facilitated by the plant diversity and low cost associated with therapeutics, which has called the attention of health assistance programs and professionals. The Brazilian Ministry of Health, in order to avoid misuse of this medical practice, has demonstrated interest, developing policies that encourage research related to this issue and favoring the establishment of health programs focused on the distribution and use of these drugs in a rational way. Based on this context, a survey about how this issue has been addressed and implemented in the Unified Health System (UHS) was carried out. This was a descriptive study of qualitative approach, performed through a literature review in databases, related to the theme "phytotherapic medicines in the unified health system". The key words used throughout the study were: phytotherapy, phytomedicines, integrating medicine, medicines, herbal medicine, phytotherapy in the UHS, integrating medicine and public health systems. The government has shown interest in developing policies which combine technological advances with common knowledge for the sake of assistance health procedures that show effectiveness, coverage, humanization and less dependence on the pharmaceutical industry. In the last two decades, some Brazilian states and municipalities have implemented Phytotherapy Programs in primary health care in order to meet the drug needs of their communities. Despite the growing search for integrating drugs, studies about phytotherapy are still limited in Brazil, with the need of research in this area in order to increase the knowledge of health professionals and students, helping and making more solid the safety and efficacy bases for the implementation of phytotherapic practices in the UHS.

Políticas públicas de medicamentos: trajetória e desafios / Public policies for medicines: trajectory and challenges

Por meio de um levantamento bibliográfico sobre as políticas públicas no setor de medicamentos brasileiro, o artigo examina as principais características das ações aplicadas na área, ressaltando seus resultados e deficiências, bem como as dificuldades encontradas para consolidar uma política de medicamentos no Brasil. O estudo realizado se fundamentou na análise de artigos por meio das bases de dados Scielo e Lilacs e de outras fontes. Desde a extinta Central de Medicamentos (CEME) até a aprovação da Política Nacional de Medicamentos (PNM), todas as ações e projetos foram voltados principalmente para a reorientação da Assistência Farmacêutica na atenção básica, garantindo, por conseguinte, o acesso e o uso racional dos medicamentos essenciais.

Through a bibliography review of public policies in Brazilian medicine sector, this paper examines the main characteristics of actions implemented in this area, lighting their results and deficiencies, as well as the difficulties to consolidate a policy for medicines in Brazil. The study is based on analysis of articles searched in the Scielo and Lilacs databases and other sources. Since the extinct Medicine Center to the approval of the National Medicine Policy, all the actions and programs aimed mainly at the reorientation of Pharmaceutical Assistance in primary health are, to guarantee access and rational use of essential medicines essential.

Do intrauterine growth restriction and overweight at primary school age increase the risk of elevated body mass index in young adults?

Obesity is one of the rising public health problems characterized as a risk factor for many chronic diseases in adulthood. Early life events such as intrauterine growth restriction, as well as life style, are associated with an increased prevalence of this disease. The present study was performed to determine if intrauterine growth restriction interacts with overweight at primary school age to affect body mass index (BMI) in young adults. From June 1, 1978 to May 31, 1979, 6827 singleton liveborns from Ribeirão Preto, São Paulo State, Brazil, corresponding to 98% of all births at the 8 maternity hospitals, were examined and their mothers were interviewed. Samples from the initial cohort were examined again at primary school age (8 to 11 years of age) and at the time of military service (18 years of age). There were 519 male individuals with complete measurements taken in the three surveys. Intrauterine growth-restricted individuals had a BMI 0.68 kg/m(2) lower than that of individuals who were not restricted (95%CI = -1.34 to -0.03) and overweight at primary school age showed a positive and strong effect on BMI at 18 years of age (coefficient 5.03, 95%CI = 4.27 to 5.79). However, the increase in BMI was much higher--6.90 kg/m(2)--when the conscript had been born with intrauterine growth restriction and presented overweight at primary school age (95%CI = 4.55 to 9.26). These findings indicate that the effect of intrauterine growth restriction on BMI at 18 years of age is modified by later weight gain during school age.

Do intrauterine growth restriction and overweight at primary school age increase the risk of elevated body mass index in young adults?

Obesity is one of the rising public health problems characterized as a risk factor for many chronic diseases in adulthood. Early life events such as intrauterine growth restriction, as well as life style, are associated with an increased prevalence of this disease. The present study was performed to determine if intrauterine growth restriction interacts with overweight at primary school age to affect body mass index (BMI) in young adults. From June 1, 1978 to May 31, 1979, 6827 singleton liveborns from Ribeirão Preto, São Paulo State, Brazil, corresponding to 98 percent of all births at the 8 maternity hospitals, were examined and their mothers were interviewed. Samples from the initial cohort were examined again at primary school age (8 to 11 years of age) and at the time of military service (18 years of age). There were 519 male individuals with complete measurements taken in the three surveys. Intrauterine growth-restricted individuals had a BMI 0.68 kg/m² lower than that of individuals who were not restricted (95 percentCI = -1.34 to -0.03) and overweight at primary school age showed a positive and strong effect on BMI at 18 years of age (coefficient 5.03, 95 percentCI = 4.27 to 5.79). However, the increase in BMI was much higher - 6.90 kg/m² - when the conscript had been born with intrauterine growth restriction and presented overweight at primary school age (95 percentCI = 4.55 to 9.26). These findings indicate that the effect of intrauterine growth restrictionon BMI at 18 years of age is modified by later weight gain during school age.

Adaptador intercambiable para desfibrilación en pacientes pediátricos

En la actualidad, una de las principales causas de muerte a nivel mundial es el paro cardiaco, producido en muchas ocasiones debido a una fibrilación ventricular que requiere la aplicación de una descarga eléctrica a través del tórax del paciente. En términos generales, atendiendo a la edad, pueden identificarse dos tipos de pacientes: los pacientes adultos y los pacientes pediátricos, ambos susceptibles de aplicárseles desfibriladores externos. Entre las diferencias técnicas más importantes en ambos casos se encuentran los valores de la energía utilizada en el tratamiento y el área de los electrodos (paletas) con los que se aplica la descarga. En el presente trabajo se propone una solución para la detección de la presencia de un adaptador pediátrico y el cambio de las escalas de energía de desfibrilación para un desfibrilador-monitor diseñado por un grupo de trabajo multidisciplinario con la participación de los autores. Se presenta, además, unalgoritmo que facilita el diseño mecánico en 3D y su ulterior aplicación a la obtención de prototipos rápidos, como un medio de lograr una comprobación rápida y eficaz de los ajustes entre distintas piezas(AU)

Nowadays cardiac arrest constitutes one of the major death causes worldwide. Cardiac arrest is frequently produced by a ventricular fibrillation, which can be eliminated applying an electrical discharge to the thorax of the patient. Generally speaking, two patient types may be identified: adult and paediatric patients, both prone to develop ventricular fibrillation that can be eliminated with an external defibrillator. Among the main differences in both cases are the energy values of thedischarge and the area of the metallic electrode in contact with the skin. In this paper a new solution for detecting the presence of the paediatric adapter is presented that allows to limit the maximum selectable energy value, when used in conjunction with a biphasic defibrillator-monitordeveloped by a multidisciplinary work group with participation of the authors. An algorithm that eases the 3D mechanical design and its later application in rapad prototyping as a means to verify a fast and efficient coincidence of fittings among different pieces is presented(AU)

Un desfibrilador bifásico cubano portátil: características y resultados / A portable Cuban two-phase equipment: characteristics and results

En el trabajo se presentan las principales características de diseño del primer desfibrilador externo bifásico cubano, desarrollado por los autores. Se describen la arquitectura, los principales requisitos de seguridad y los resultados de los principalesensayos realizados durante la etapa de diseño. Finalmente se hace referencia al ensayo del desfibrilador en un modelo porcino y a los resultados obtenidos en la prueba de uso en humanos y a su subsiguiente aplicación, discutiéndose ambos ensayos. Se concluye que el equipo, que está dirigido al tratamientodel paro cardiaco por fibrilación ventricular y a la cardioversión sincronizada, puede ser aplicado con elevada seguridad tanto para el paciente como para el operador, logrando una eficacia semejante a la de equipos similares del mercado internacional(AU)

Un desfibrilador bifásico cubano: características fundamentales

En el trabajo se presentan las principales características de diseño de un desfibrilador externo bifásico cubano, que se desarrolla por los autores. Se describen la arquitectura, los principales requisitos de seguridad y las pruebas realizadas al equipo. Finalmente se hace referencia al ensayo del prototipo de desfibrilador en un modelo porcino. Se presentan los resultados y se concluye que el equipo, que está dirigido al tratamiento del paro cardiaco por fibrilación ventricular, puede ser también aplicado con elevada seguridad a la cardioversión de pacientes con determinadas patologías(AU)

Remission of heart failure through endoluminal repair of femoral arteriovenous fistula with the use of a covered stent.

We report the case of a 21-year-old male with high-output heart failure due to a femoral arteriovenous fistula caused by a firearm wound. A new balloon expandable stent covered with polytetrafluorethylene was implanted in the artery to occlude the arteriovenous fistula. The fistula was immediately occluded and the artery remained patent. On the following day, the patient felt much better, with no symptoms of heart failure. Additional follow-up is required to assure the usefulness of this less invasive procedure in the treatment of arteriovenous fistulas.

[Coronary intervention at a general hospital in the State of Piauí, Brazil]. / Intervenção coronária em hospital geral no Piauí.

PURPOSE: To evaluate retrospectively success and complication rates of coronary interventions performed in a general hospital with no digital equipment in the State of Piauí with a small annual number of procedures. METHODS: From August/91 to January/98, 122 patients underwent 146 procedures using a fluoroscope with camera and TV monitor of 525 lines. The variables analyzed included the initial success of procedures (residual stenosis less than fifty percent and TIMI III flow) and more serious complications (acute occlusion, infarcts, emergency surgeries and death). The clinical data and the morphological characteristics of the lesions (ACC/AHA Task Force) were also analyzed. RESULTS: Eighty five percent of the patients presented with an acute ischemic syndrome (acute myocardial infarction, post infarction angina, rest angina), 5% were in cardiogenic shock and 88% had type B lesions. The initial success rate was 93% while the more serious complications occurred in 3.5% of the cases. CONCLUSION: In spite of the small annual procedural volume and the use of conventional equipment, the initial success rate in our institution was excellent in a diverse and complex patient population while the complication rates were similar to that of the literature.

[Chronobiology in medicine and surgery]. / Cronobiología en medicina y cirugía.

Chronobiology studies predictable variations, rhythms and trends in all forms of life. Each physiologic variable or system in an organism has a time structure which is genetically anchored and capable of being expressed in the absence of external cycles. However, it is normally adjusted by geophysical changes. Chronobiology quantifies rhythms by providing measures of amplitude and timing (phase and period), and a mean more precise than the arithmetic mean. The correct measurement of biological rhythms has led to considerable advances in the understanding of their underlying mechanisms of generation and expression. The use of information on rhythms is opening new opportunities in the prevention, diagnosis and treatment of disease. Chronobiology is also effective in the improvement of the quality of life by teaching self-help to the healthy individual.