'Reversible cardiomyopathy' in patients with severe scorpion envenoming by Tityus serrulatus: evolution of enzymatic, electrocardiographic and echocardiographic alterations.

Severe scorpion envenoming is characterized by cardiocirculatory failure which may lead to pulmonary oedema. These are the major causes of death among victims of scorpion stings. Involvement of the heart has been attributed to the massive release of catecholamines and/or to a direct toxic effect of the venom on cardiac fibres, while pulmonary oedema has been considered to be of cardiogenic or non-cardiogenic origin. We present here the clinical, laboratory, electrocardiographic and echocardiographic data of 12 victims of severe Tityus serrulatus stings. These patients had important echocardiographic evidence of moderate to severe left ventricular (LV) dysfunction with diffuse LV hypokinesia and reduced ejection fraction. Seven developed pulmonary oedema. The clinical course of all the patients was satisfactory and the laboratory, electrocardiographic and echocardiographic changes returned to normal, usually within 1 week of the sting. The important alterations detected by echocardiography as early as during the 1st few hours after the sting, taken together with the enzymatic and electrocardiographic data, confirm that LV dysfunction is responsible, either alone or in combination with other factors, for the cardiac insufficiency and pulmonary oedema encountered in scorpion envenoming.

[Treatment of mild and moderate cardiac failure with captopril. A multicenter study]. / Tratamento da insuficiência cardíaca leve e moderada com captopril. Estudo multicêntrico.

PURPOSE: Evaluation of the clinical effects of captopril addition to the conventional therapy of functional class II and III (NYHA) congestive heart failure (CHF). METHODS: One hundred and fifteen patients with CHF, 46 (40%) class II and 69 (60%) class III, on conventional treatment (digitalis and diuretic) were the subject of this study. The age ranged from 22 to 75 years (mean 56.6 +/- 11); 67 were male and 66 were caucasians. The etiologies of the heart failure were: hypertensive heart disease 47 (40.9%), ischemic heart disease 27 (23.5%), Chagas cardiomyopathy 20 (17.4%), idiopathic cardiomyopathy 15 (13.0%), and other causes 6 (5.2%). Diuretic and digitalis were maintained in the same dosage during all the treatment. Captopril therapy was started with 6.25 mg b.i.d. or t.i.d., and the dosage was increased gradually to 25 mg b.i.d. or t.i.d. The duration of the study was 12 weeks. Clinical visits occurred every four weeks and laboratory tests were performed in the beginning and at the end of the study. RESULTS: The dosage of captopril ranged from 12.5 to 75 mg (mean 28.5 +/- 13.1 mg/day). The addition of captopril to the conventional therapy of CHF was associated with significant reduction (p < 0.01) of heart rate, systolic and diastolic blood pressure. In the end of the study 13 patients (11.3%) were in functional class III, 50 (43.5%) in class II and 52 (45.2%) in class I. Globally, functional class was improved in 98 (85.2%) patients and remained unchanged in 17 (14.8%) (p < 0.01). The side effects (dizziness, cough, hypotension and headache) were moderate and uncommon and did not need interruption of the treatment. CONCLUSION: The addition of captopril to the conventional therapy of class II and III CHF was associated with significant improvement of functional class and with good tolerability.

[Inequalities among hospitalized patients due to cardiac and cerebrovascular diseases in localities of the State of São Paulo (Brazil), 1986]. / Desigualdades entre pacientes hospitalizados por doenças cardíacas e vasculares-cerebrais em localidade do Estado de São Paulo (Brasil), 1986.

The clinical and epidemiological characteristics of hospitalizations due to cardiac and cerebral-vascular diseases (CCVD-ICD 390-438), which occurred in 1986, were studied on the basis of data from an information system relating to medical care in the City of Ribeirão Preto, State of S. Paulo, Brazil. These causes accounted for 4,673 of the annual total of 43,449 hospital admissions. Using the sources of payment of the hospitalization as an indicator of the patients' social strata, the following four study groups were defined: private, social insurance, non-paying and "others". These groups showed significant differences in relation to the following variables: hospitalization rates due to CCVD, mean and median age at admission and time of death, occupation, average length of stay in the hospital, mortality rates and relative frequencies of specific sub-group diagnosis. These differences are attributed to inequalities in the standard of living and in the working conditions of the groups, which determine diverse patterns of disease, medical care and mortality.

Marginal malnutrition and reduced physical work capacity of migrant adolescent boys in Southern Brazil.

We measured the effect of marginal malnutrition on physical work capacity of adolescent children of agricultural migrant workers in Southern Brazil. Nutritional status was evaluated using 24-h dietary recall. Body size was evaluated anthropometrically. Biochemical assessments were also made. Physical work capacity (PWC170) was assessed by measuring heart rate, blood lactic acid levels, and oxygen consumption during submaximal bicycle ergometer work. The same tests were also carried out on a comparable group of local well-to-do boys of the same age in the same community who served as controls. The dietary results suggest that adolescent boys of migrant families were marginally malnourished. Their physical growth and development were retarded by at least 1 yr. They had significantly lower reserves of body fat and less muscle mass when compared with controls. Their Hb levels were normal. At the submaximal work loads measured (0, 25, 50, 75 W) the migrant children exhibited similar oxygen consumption and gross exercise efficiency as the control children, but achieved this work at a higher percentage of their maximum work capacity as shown by significantly higher heart rates for the same oxygen consumption. Higher blood lactic acid levels in the migrant children suggest that the available muscle mass was under greater stress to accomplish the same task. PWC170 was reduced one-third in the migrant children (migrant 643 +/- 162 kpm/min, control 905 +/- 345 kpm/min; p less than 0.005). These differences were largely associated with weight (migrant 20.6 +/- 5.9 kpm/min; control 18.8 +/- 4.3 kpm/kg/min; p greater than 0.1). These observations suggest that marginal as well as severe malnutrition affect physical work capacity at levels low enough to affect growth and development.

Dietary supplementation and improvement in physical work performance of agricultural migrant workers of southern Brazil.

A three-month trial was carried out on 14 agricultural migrant workers (Bóias-Frias) residing on the periphery of Ribeirão Preto, an agricultural and industrial town in the interior of the State of São Paulo in southern Brazil. This group can be considered as marginally malnourished. Their nutritional status and physical work performance was measured before and after receiving a supplemented lunch over a three-month period. The main change in their nutritional status during this period was an increase in body weight. Their physical work performance, as measured by a bicycle ergometer test, improved significantly after the supplementation of their traditional diet.

Dietary supplementation and improvement in physical work performance of agricultural migrant workers of Southern Brazil.

Se llevo a cabo un ensayo de tres meses de duracion en l4 peones agricolas migrantes (Boias-Frias) residentes en la periferia de Ribeirao Preto, ciudad agricola e industrial situada en el interior del Estado de Sao Paulo en el sur del Brasil. Este grupo se puede considerar como marginalmente malnutrido. Su estado nutricional y rendimiento en el trabajo fisico se midio antes y despues de recibir un almuerzo suplementado durante el periodo mencionado.En ese lapso, el principal cambio observado en su estado nutricional fue un incremento del peso corporal. Segun mediciones practicadas utilizando la prueba de bicicleta con ergometro, su rendimiento en el trabajo fisico mejoro en forma significativa despues de la suplementacion de su dieta tradicional

Capacidade física de trabalhadores migrantes antes e após nutrição balanceada. Análise por cicloergometria / Physical capacity of migrant workers before and after formulated diet.Analysis by cycloergometry

Quarenta e um trabalhadores migrantes (regiao de Ribeirao Preto - SP) foram submetidos a exame fisico, dosagens bioquimicas e hematimetricas. Responderam a rigoroso inquerito alimentar que evidenciou ingestao calorica subnormal. Utilizando prova cicloergometrica, determinou-se a capacidade fisica. A comparacao dos resultados com outros grupos profissionais demonstrou que os trabalhadores migrantes tem desempenho fisico muito baixo. Durante 3 meses consecutivos, foi formecida uma refeicao balanceada, quente e normocalorica (media de 1388 cal), ingerida no local do trabalho, no periodo do almoco. Ao final desta fase, novos exames antropometrico, bioquimico e cicloergometrico foram realizados em 14 trabalhadores. Estes ganharam peso e apresentaram aumento dos periometros braquial e cefalico. Os resultados ergometricos igualmente evidenciaram melhora na capacidade fisica do grupo. Cinco trabalhadores, sem suplementacao serviram para controle. Concluiu-se que estes trabalhadores migrantes sao fisicamente limitados, mas quando recebem alimentacao adequada, em condicoes nutritivas normais, aumentam seu desempenho na producao de trabalho

Área valvar mitral e capacidade física determinada pelo teste cicloergométrico em pacientes portadores de estenose mitral / Mitral valve area and physical capacity determined by cycloergometric test in patients with mitral stenosis

Os autores estudaram 18 pacientes portadores de estenose mitral, relacionando a capacidade fisica determinada pelo teste cicloergometrico com a area valvar medida durante a cirurgia e com parametros hemodinamicos obtidos pelo cateterismo cardiaco realizado em 8 pacientes. Todos valvopatas apresentaram baixos valores para a capacidade fisica independente da area valvar mitral, da atividade profissional e do uso terapeutico de digoxina. Sugere-se, como conclusao, que o teste cicloergometrico, para os pacientes com estenose mitral estudados, nao trouxe contribuicao para a indicacao da correcao cirurgica da estenose valvar, uma vez que nao foram obtidas relacoes entre a area util valvar mitral, a capacidade funcional, e, entre esta e os dados hemodinamicos obtidos pelo cateterismo cardiaco venoso

Prevalência de bloqueios de ramos e fasciculares esquerdos do feixe de His na cardiopatia chagásica / Prevalence of bundle-branch and left fascicular blocks in the bunde of His in Chagas' cardiomyopathy

Trezentos eletrocardiogramas de portadores de cardiopatia chagasica, registrados no Hospital das Clinicas da Faculdade de Medicina de Riberao Preto da USP foram examinados. Em 174 foi observado disturbio intraventricular da conducao do estimulo. Destes, 72 apresentavam bloqueio isolado de ramo direito do feixe de His. A associacao de bloqueio de ramo direito e divisional, foi visto em 19 casos. O bloqueio divisional postero-inferior esquerdo foi encontrado em 3 casos e o completo do ramo esquerdo, isoladamente, em 11 pacientes.Usando-se a classificacao funcional das cardiopatias e o indice cardiotoracico, foi possivel verificar que os disturbios da conducao predominam em situacoes mais graves e em coracoes de maiores dimensoes. Ha forte sugestao de que o bloqueio divisional anterosuperior e a forma mais grave destas alteracoes, representando prognostico mais serico

Anthropometric and cycloergometric assessment of the nutritional status of the children of agricultural migrant workers in Southern Brazil.

In our survey of the food habits and nutritional status of "Boia-Fria" agricultural migrant workers in Southern Brazil, a special project was undertaken to assess the influence of socioeconomic and dietary deprivation on the physical growth and development and physical performance of their children. Four hundred fifty-five children in Boia-Fria families from Vila Recreio, a periurban slum of Ribeirao Preto located in the interior of the state of Sao Paulo, were examined for body weight, standing height, mid-upper arm muscle circumference, and head circumference. For comparison, 475 children from "Vita et Pax", a private school attended primarily by children of well-to-do families from the city of Ribeirao Preto, were also examined using similar anthropometric procedures. A small group of selected Boia-Fria children and their well-to-do counterparts were subjected to ergometric-cum-electrocardiographic testing for submaximal physical work performance. The overall results of this comparative study indicate that the physical growth and development and the physical performance of the Boia-Fria children are significantly lower than their well-to-do counterparts. It is suggested that the poor anthropometric and ergometric status of the Boia-Fria children is a reflection of poor dietary habits and socioeconomic deprivation prevalent among the agricultural migrant workers and poor periurban populations of Brazil.