Nucleated Red Blood Cells as Predictors of All-Cause Mortality in Cardiac Intensive Care Unit Patients: A Prospective Cohort Study.

BACKGROUND: The presence of nucleated red blood cells (NRBCs) in the peripheral blood of critically ill patients is associated with a poorer prognosis, though data on cardiovascular critical care patients is lacking. The aim of the present study was to assess the role of NRBCs as a predictor of intensive care unit (ICU) and in hospital all-cause mortality among cardiologic patients. METHODS: NRBCs were measured daily in consecutive cardiac ICU patients, including individuals with both coronary and non-coronary acute cardiac care. We excluded patients younger than 18 years, with cancer or hematological disease, on glucocorticoid therapy, those that were readmitted after hospital discharge and patients who died in the first 24 hours after admission. We performed a multiple logistic analysis to identify independent predictors of mortality. RESULTS: We included 152 patients (60.6 ± 16.8 years, 51.8% female, median ICU stay of 7 [4-11] days). The prevalence of NRBCs was 54.6% (83/152). The presence of NRBC was associated with a higher ICU mortality (49.4% vs 21.7%, P<0.001) as well as in-hospital mortality (61.4% vs 33.3%, p = 0.001). NRBC were equally associated with mortality among coronary disease (64.71% vs 32.5% [OR 3.80; 95%CI: 1.45-10.0; p = 0.007]) and non-coronary disease patients (61.45% vs 33.3% [OR 3.19; 95%CI: 1.63-6.21; p<0.001]). In a multivariable model, the inclusion of NRBC to the APACHE II score resulted in a significant improvement in the discrimination (p = 0.01). CONCLUSIONS: NRBC are predictors of all-cause in-hospital mortality in patients admitted to a cardiac ICU. This predictive value is independent and complementary to the well validated APACHE II score.

Caracterização dos usuários de substâncias psicoativas atendidos no ambulatório de transtorno aditivo com ênfase em dependência química / Caracterzación de los uuarios de sustancias psicoactivas atendidos en el ambulatorio de aditivo trastorno con un énfasis en dependencia química / Charactrization of users of psychoactive substances atthe clinic for addictive disorder with emphasis on chemical dependecee

O objetivo do presente estudo foi traçar o perfil dos usuários de substâncias psicoativas atendidos em ambulatório de dependência química. Trata-se de estudo observacional transversal realizado com usuários de substâncias psicoativas atendidos no Ambulatório de Transtorno Aditivo com Ênfase em Dependência Química da Cruz Vermelha Brasileira, filial do Estado do Rio Grande do Sul, abrangendo o período de 2005 a 2010. A coleta de dados ocorreu através da análise dos prontuários de pacientes (n=1.469), com levantamento de dados demográficos, socioeconômicos e de uso de drogas. Na análise estatística, foi utilizada frequência, média, desvio padrão e teste do ?2, com um nível de significância de p<0,05. O perfil predominante dos usuários de substâncias psicoativas foi de jovens, na faixa etária de 21 a 30 anos, sexo masculino, solteiros, cor branca, com baixo nível de escolaridade, baixa condição socioeconômica e sem vínculos empregatícios. Encontrou-se maior consumo de tabaco (86,0%) entre as substâncias lícitas, e de crack (83,3%) entre as ilícitas. O uso de tabaco, maconha e inalantes demonstrou-se significativamente associado aos jovens. Os resultados contribuem para a elaboração de programas de intervenção, que abordem uma articulação multidisciplinar, numa ofensiva contra a problemática do uso indevido de drogas.

El objetivo de este estudio fue determinar el perfil de los usuarios de sustancias psicoactivas atendidos en consultas externas dependencia de sustancias químicas. Este es un estudio observacional transversal realizado con los usuarios de sustancias psicoactivas tratadas en el Ambulatorio de trastorno aditivo con énfasis en dependencia de sustancias químicas de Cruz Roja Brasileña, una filial del Estado de Río Grande do Sul, que abarca el período de 2005 a 2010. La recogida de datos se ha producido a través del análisis de los registros médicos de los pacientes (n=1.469), estudio de datos demográficos y socioeconómicos y el uso de drogas. En el análisis estadístico, se utilizan frecuencias, media, desviación estándar, y con el test de chi-cuadrado, con un nivel de significación de p<0,05. El perfil predominante de los usuarios de sustancias psicoactivas era joven, en el rango de edad de 21 a 30 años de edad, de sexo masculino, soltero, blanco, con bajo nivel de educación, el estado socioeconómico bajo y sin las relaciones de empleo. Encontramos que un mayor consumo de tabaco (86,0%) entre lo lícito y crack (83,3%) entre los ilícitos. El uso del tabaco, la marihuana y los inhalantes ha demostrado ser significativamente asociada con los jóvenes. Los resultados obtenidos contribuyen al desarrollo de los programas de intervención multidisciplinar que se dirigen a un link, una embestida contra el problema del uso indebido de drogas.

The objective of the present study was to outline the profile of psychoactive substance users treated at a clinic for chemical dependence. This is a transversal observational study developed with users of psychoactive substances treated at the Clinic for Addictive Disorder with Emphasis on Chemical Dependence of the Brazilian Red Cross, State of Rio Grande do Sul branch, from 2005 to 2010. Data collection was developed through the analysis of the patients? records (n=1,469), based on surveys on demographic, socio-economic and drug use data. Frequency, average, standard deviation and ?2 test were used in the statistical analysis, with a significance level of p<0.05. The predominant profile of psychoactive substance users was: young, in the age range between 21 and 30 years, male gender, single, Caucasian, low school and socioeconomic levels, as well as unemployed. Among the licit drugs, the main one was tobacco (86.0%); and for illicit drugs, the main one was crack (83.3%). The use of tobacco, marijuana and inhaled drugs has shown to be significantly related toyounger people. The results contribute for the development of intervention programs approaching a multidisciplinary articulation, as an offensive against the problem of drugs misuse.

New records of Mansonella ozzardi: a parasite that is spreading from the state of Amazonas to previously uninfected areas of the state of Acre in the Purus River region

Mansonella ozzardi infections are common in the riverside communities along the Solimões, Negro and Purus Rivers in the state of Amazonas (AM). However, little is known about the presence of this parasite in communities located in regions bordering AM and the state of Acre. The prevalence rate of M. ozzardi infections was determined in blood samples from volunteers according to the Knott method. A total of 355 volunteers from six riverine communities were enrolled in the study and 65 (18.3%) were found to be infected with M. ozzardi. As expected, most of the infections (25%) occurred in individuals involved in agriculture, cattle rearing and fishing and an age/sex group analysis revealed that the prevalence increased beginning in the 40-50-years-of-age group and reached 33% in both sexes in individuals over 50 years of age. Based on the described symptomatology, articular pain and headache were found to be significantly higher among infected individuals (56 and 65% prevalence, respectively, p < 0.05). Sera from volunteers were subjected to ELISA using a cocktail of recombinant proteins from Onchocerca volvulus to evaluate the specificity of the test in an endemic M. ozzardi region. No cross-reactions between M. ozzardi-infected individuals and recombinant O. volvulus proteins were detected, thus providing information on the secure use of this particular cocktail in areas where these parasites are sympatric.

New records of Mansonella ozzardi: a parasite that is spreading from the state of Amazonas to previously uninfected areas of the state of Acre in the Purus River region.

Mansonella ozzardi infections are common in the riverside communities along the Solimões, Negro and Purus Rivers in the state of Amazonas (AM). However, little is known about the presence of this parasite in communities located in regions bordering AM and the state of Acre. The prevalence rate of M. ozzardi infections was determined in blood samples from volunteers according to the Knott method. A total of 355 volunteers from six riverine communities were enrolled in the study and 65 (18.3%) were found to be infected with M. ozzardi. As expected, most of the infections (25%) occurred in individuals involved in agriculture, cattle rearing and fishing and an age/sex group analysis revealed that the prevalence increased beginning in the 40-50-years-of-age group and reached 33% in both sexes in individuals over 50 years of age. Based on the described symptomatology, articular pain and headache were found to be significantly higher among infected individuals (56 and 65% prevalence, respectively, p < 0.05). Sera from volunteers were subjected to ELISA using a cocktail of recombinant proteins from Onchocerca volvulus to evaluate the specificity of the test in an endemic M. ozzardi region. No cross-reactions between M. ozzardi-infected individuals and recombinant O. volvulus proteins were detected, thus providing information on the secure use of this particular cocktail in areas where these parasites are sympatric.

Impact of 3 years ivermectin treatment on onchocerciasis in Yanomami communities in the Brazilian Amazon.

In the current study, it was assessed, for the first time, the effect of ivermectin treatment administered twice a year on the prevalence and morbidity of onchocerciasis in the hyperendemic Yanomami communities of the Roraima State (Brazil). Physical and parasitological examinations were carried out every 6 months until six drug rounds of treatment were completed. The coverage during the six rounds of ivermectin treatment ranged from 89% to 92% of the eligible Yanomami population. Overall, comparison of results at pre-treatment with results after six rounds of treatment, the prevalence of infection had declined from 87% to 42% (P<0.0001, CI 95%=0.05-0.22); the community microfilarial load (CMFL) fell from 1.17 to 0.53Mf/mg of skin; and the crude intensity of infection (MFL-Total) decreased from 18.95 to 1.96Mf/mg of skin during the same period (P<0.0001, for both microfilarial loads). Although no significant difference was observed between microfilarial densities in skin snips from iliac crest and scapula after the 6th round of ivermectin treatment it was observed that the prevalence of positive skin snips was significantly higher when skin snips were taken from iliac crest (42%) than from scapula (8%) (P=0.001, CI 95%=3.41-22.67). After six rounds of ivermectin treatments, no significant differences were observed in the prevalences of palpable nodules and of onchodermatitis in relation to pre-treatment prevalences, from 45% to 41% and from 17% to 20% (P>0.05, for both). These findings suggest that mass population treatment should continue without interruption and achieve higher levels of drug coverage in order to alleviate disease manifestations and interrupt infection transmission to hasten the elimination of onchocerciasis in Yanomami communities. In addition, the sensitivity of iliac crest snips for parasitological assessment in epidemiological surveillance of Yanomami communities may increase the acceptance of the population in biopsy sampling and seems to be a good choice for assessing the success of control programs.

Effect of lysophosphatidylcholine on the surface hydration of phospholipid vesicles.

The interfacial properties of the negatively charged dimyristoyl-phosphatidylglycerol (DMPG) and the zwitterionic dimyristoyl-phosphatidylcholine (DMPC) vesicles mixed with the fusion inhibitor lysomyristoylphosphatidylcholine (LMPC) are investigated by electron paramagnetic resonance (EPR). At 35 degrees C, addition of 20 mol% of LMPC to the DMPG vesicles increases the effective concentration of water in the interfacial layer of DMPG vesicles from 19.3 M to 27.7 M, whereas in the case of mixed DMPC-LMPC vesicle the effective water concentration in the interfacial layer of DMPC vesicles only changes from 15.1 M to 18.4 M. The hydrogen bonding structure in both mixed DMPG-LMPC and mixed DMPC-LMPC vesicles becomes stronger with an increasing fraction of LMPC in the vesicles. The average area per phospholipid decreases in mixed DMPC-LMPC vesicles, while it increases in mixed DMPG-LMPC vesicles as the proportion of LMPC in the vesicle increases. The inhibitory nature of LMPC in both vesicle and biological fusion comes from the increase in surface hydration, as well as from the dynamic cone shape of LMPC in the phospholipid bilayer.

Erosão dental em pacientes com doença do refluxo gastroesofágico / Dental erosion in patients with gastroesophagic reflux disease

A doença do refluxo gastroesofágico consiste num conjunto de manifestações orgânicas causadas pelo fluxo retrógrado do conteúdo gástrico para o esôfago. A associação entre doença do refluxo gastroesofágico e erosão dental sinaliza uma conseqüência da ação do refluxo ácido. A erosão dental define-se como perda irreversível da estrutura dental causada por um processo químico não envolvendo a ação bacteriana. Este estudo avaliou a associação Erosão Dental com a doença do Refluxo Gastroesofágico, faixa etária, gênero e nível de escolaridade em pacientes com diagnóstico endoscópico de esofagite por refluxo gastroesofágico, conforme Savary-Miller modificada, grupo (E), em comparação aos pacientes sem este diagnóstico (endoscopicamente normais), grupo normal (N), atendidos no Centro de Endoscopia Digestiva do Hospital Sírio-Libanês de São Paulo. Foram examinados 120 pacientes com idade variando entre 20 e 80 anos (média de 46,76 anos), de ambos os gêneros, com diagnóstico endoscópico de esofagite por refluxo gastroesofágico, e 60 pacientes com idade variando entre 20 e 80 anos (média de 39,97 anos), de ambos os gêneros, sem diagnóstico de esofagite por refluxo gastroesofágico. O protocolo específico foi respondido pelo paciente ou por seu representante legal. A metodologia adotada envolveu, numa primeira etapa, exame de endoscopia digestiva alta e esofagite por refluxo gastroesofágica diagnosticada segundo a classificação de Savary-Miller modificada. Em seguida, o exame oral foi realizado e a erosão dental foi classificada, quando presente, segundo a escala de graduação de ED proposta por Eccles e Jenkins. Para análise estatística, os...

Gastroesophagic reflux disease is a set of organic manifestations caused by gastric reflux to the esophagus. The association between Gastroesophagic reflux diseaseand dental erosion demonstrates the result of acid reflux. Dental erosion is defined as the irreversible loss of dental structure caused by a chemical process that does not involve bacterial action. This study evaluated Dental Erosion associated with Gastroesophagic reflux disease, according to age, sex and educational level in patients with an endoscopic diagnosis of esophagitis caused by gastroesophagic reflux using modified Savary-Miller classification, group (E) compared to patients without this diagnosis (endoscopically normal), a normal group (N), treated at Centro de Endoscopia Digestiva do Hospital Sírio-Libanês de São Paulo. 120 patients were examined, with ages ranging from 20 to 80 (average age 46.76), of both sexes presenting with an endoscopic diagnosis of esophagitis caused by gastroesophagic reflux, and a further 60 patients aged between 20 and 80 (average age 39.97) of both sexes not diagnosed with esophagitis caused by gastroesophagic reflux. Specific protocol was answered by the patient or their legal representative. The methodology adopted involved, in the first stage, an endoscopic examination of the upper digestive tract and a test for esophagitis caused by gastroesophagic reflux, diagnosed according to modified Savary-Miller classification. This was followed by an oral examination and dental erosion was classified when present in accordance with the Eccles and Jenkins Scale. For statistical analysis the results were tested for each...

Cationic latex formation by ionic modification.

Stable cationic latices were prepared by charge inversion of anionic styrene-acrylic copolymer latices upon binding Al3+ and Fe3+ ions. This is achieved by stabilizing the latices with a high-HLB (hydrophile-lypophile balance) nonionic surfactant that imparts strong steric stability to the latex, even in the presence of high concentrations of multivalent counterions while these are bound to the latex anionic sites. The cationic latices thus prepared have good stability properties, and the same procedure should be applicable to essentially any latex-carrying anionic sites. Analytical ESI-TEM images show that particle-bound iron is concentrated at the particle borders, but it is also found in the particle bulk.

Combining precision spin-probe partitioning with time-resolved fluorescence quenching to study micelles. Application to micelles of pure lysomyristoylphosphatidylcholine (LMPC) and LMPC mixed with sodium dodecyl sulfate.

Micelles of lysomyristoylphosphatidylcholine (LMPC) and mixed micelles of LMPC with anionic detergent sodium dodecyl sulfate (SDS) have been characterized by spin-probe-partitioning electron paramagnetic resonance (SPPEPR) and time-resolved fluorescence quenching (TRFQ) experiments. SPPEPR is a novel new method to study structure and dynamics in lipid assemblies successfully applied here for the first time to micelles. Several improvements to the computer program used to analyze SPPEPR spectra have been incorporated that increase the precision in the extracted parameters considerably from which micelle properties such as effective water concentration and microviscosity may be estimated. In addition, with this increased precision, it is shown that it is feasible to study the rate of transfer of a small spin probe between micelles and the surrounding aqueous phase by SPPEPR. The rate of transfer of the spin probe di-tert-butyl nitroxide (DTBN) and the activation energy of the transfer process in LMPC and LMPC-SDS micelles have been determined with high precision. The rate of transfer increases with temperature and SDS molar fraction in mixed micelles, while it remains constant with LMPC concentration in pure LMPC micelles. The activation energy of DTBN transfer in pure lysophospholipid micelles does not change with LMPC concentration while it decreases with the increasing molar fraction of SDS in mixed LMPC-SDS micelles. Both this decrease in activation energy and the increase in the rate of transfer are rationalized in terms of an increasing micelle surface area per molecule (decreasing compactness) as SDS molecules are added. This decreasing compactness as a function of SDS content is confirmed by TRFQ measurements showing an aggregation number that decreases from 122 molecules for pure LMPC micelles to 80 molecules for pure SDS micelles. The same increase in surface area per molecule is predicted to increase the effective water concentration in the polar shell of the micelles. This increase in hydration with SDS molar fraction is confirmed by measuring the effective water concentration in the polar shell of the micelles from the hyperfine spacing of DTBN. This work demonstrates the potential to design mixed lysophospholipid surfactant micelles with variable physicochemical properties. Well-defined micellar substrates, in terms of their physicochemical properties, may improve the studies of protein structure and enzyme kinetics.

An EPR study of the interfacial properties of phosphatidylcholine vesicles with different lipid chain lengths.

The hydrophobic spin probe 2,2,6,6-tetramethyl-piperidin-1-oxyl-4-yl octadecanoate (TEMPO-stearate) is used to study the interfacial properties of a variety of phosphatidylcholine vesicles. Since the spin probe exhibits a fast motional electron paramagnetic resonance (EPR) spectrum above the phase transition, the EPR spectrum of the spin probe is analyzed by nonlinear least-squares spectral fitting. EPR spectral line fitting provides high precision spectral parameters, which can be used to construct a detailed picture of the dynamics of the probe and its environment. The hyperfine coupling spacing is used to estimate the effective water concentration in the polar shell of vesicles, while the rotational correlation times give the information on the motion of the spin probe. The effective water concentration of the polar shell of dimyristoyl-phosphatidylglycerol (DMPG) vesicles is greater on average by about 4.0M than the effective water concentration of the polar shell of dimyristoyl-phosphatidylcholine (DMPC) vesicles. The effective water concentration decreases by about 0.5M for an increase of two carbons in the chain, and increases noticeably with hydrocarbon chain unsaturation, which is in good agreement with literature values. The nitroxide moiety rotates preferentially along the N-O bond, that is, parallel to its hydrocarbon chain.

Trypanosoma saimirii Rodhain, a junior synonym of Trypanosoma rangeli Tejera.

In the present study, we used sodium dodecyl sulfate-polyacrylamide gel electrophoresis to compare polypeptides of trypanosomes isolated by hemoculture of squirrel monkeys displaying Trypanosoma saimirii blood trypomastigotes, with other trypanosomes that infect primates to evaluate the validity of T. saimirii. The polypeptide profiles of trypanosomes isolated directly from squirrel monkeys or after their passage in mice were identical to those of 3 standard strains of T. rangeli, but they were distinct from those of T. cruzi, T. conorhini, and T. minasense. These results strengthen previous morphological and biological findings by Rodhain on trypanosomes of the squirrel monkey and lead to the conclusion that T. saimirii is indeed a junior synonym of T. rangeli.

Precision parameters from spin-probe studies of membranes using a partitioning technique. application to two model membrane vesicles.

A new version of the ESR spin probe partitioning method is developed and applied to the study of hydration properties of dimyristoyl-phosphatidylglycerol (DMPG) and dimyristoyl-phosphatidylcholine (DMPC) vesicles as functions of salt concentration and temperature above the lipid phase transition. The small spin probe di-tert-butyl nitroxide (DTBN) is used in order to achieve motionally narrowed Electron Spin Resonance (ESR) spectra which may be analyzed with high precision. The new method relies on the use of the second harmonic display of the ESR spectrum followed by spectral line fitting. Spectral fitting yields precise ESR parameters giving detailed information on the surroundings of the spin probe in both phospholipid and aqueous phases. The nitrogen hyperfine coupling constant of DTBN arising from those probes occupying the vesicles is used to study the hydration of the vesicle surface. The hydration properties of the negatively charged vesicle surface of DMPG vesicles are affected by the addition of salt at all temperatures. In contrast, the hydration of DMPC vesicles does not change with salt concentration at the low temperatures. However, at higher temperatures the hydration properties of DMPC vesicle are affected by salt which is interpreted to be due to the faster motion of the phospholipid molecules. The partitioning of the spin probe increases with salt concentration for both DMPG and DMPC vesicles, while water penetration decreases simultaneously. The spin probe in the phospholipid bilayer exhibits anisotropic motion and the extent of the anisotropy is increased at the higher salt concentrations.

Saliva substitute in xerostomic patients with primary Sjögren's syndrome: a single-blind trial.

OBJECTIVE: To evaluate the efficacy of oral moisturizing gel (Oral Balance) in xerostomic patients with primary Sjögren's syndrome (SS). METHOD AND MATERIALS: Twenty-one xerostomic patients with primary SS were subjected to a single-blind trial in which the efficacy of Oral Balance gel in reducing xerostomia and xerostomia-related oral symptoms was compared with that of a placebo. Both gels were packaged identically and were indiscernible in appearance and taste. Xerostomia was confirmed for all the patients through measurement of stimulated whole saliva. Patients began using the Oral Balance gel three times a day for 90 days, and were then switched to a gel placebo to be used in the same way for the same length of time. Clinical response was evaluated through the patients' subjective assessment (improved, worsened, or unaltered) of both gels. RESULTS: Neither the Oral Balance gel nor the gel placebo affected the salivary output of the patients. The Oral Balance gel presented a substantial statistically significant advantage in the control of burning mouth, mastication, and swallowing. No statistically significant relief of the isolated sensation of oral dryness was established. CONCLUSION: Oral Balance is a useful tool in the management of dryness-related oral symptoms in primary SS, but there is room for enhancing the overall properties of topical preparations designed to reduce oral complaints in xerostomic patients.

Leiomyosarcoma of the buccal mucosa: a case report / Leiomyosarcoma da mucosa bucal: relato de caso

Leiomyosarcomas account for 6 per cent to 7 per cent of soft tissues sarcomas. Their main site of occurrence is in the uterus, gastrointestinal tract, and retroperitoneum; they are extremely rare in the oral and maxillofacial region. In 1995, Izumi et al reviewed 60 examples of oral leiomyosarcoma, of which only six (10 per cent) cases occurred in the buccal mucosa. The definitive histologic diagnosis of oral leiomyosarcoma is difficult because of the similarity with other sarcomas that are composed of fascicles of moderately differentiated spindle cells. Immunohistochemical analysis for cytoskeletal proteins such as actin, vimentin, myosin, and desmin has been widely used for the diagnosis of leiomyosarcoma. The purpose of this report is to describe a case of leiomyosarcoma of the buccal mucosa and its immunohistochemical features that were useful in arriving at the final diagnosis

Colecistite aguda alitiásica: aspectos ultra-sonográficos / Acalculous acute cholecistitis: ultra-sonographic aspects

Foram examinados, por meio de ultra-sonografia, 14 pacientes com colecistite aguda alitiásica, com o objetivo de avaliar a forma de apresentaçäo mais característica. Os achados ultrasonográficos dessa patologia analisados isoladamente näo säo específicos, mas quando em conjunto, e associados à história clínica, podem ser diagnósticos. Em nosso trabalho, os achados ultra-sonográficos mais freqüentes foram: o sinal de Murphy ecográfico positivo e o espessamento descontínuo da parede da vesícula biliar. O diagnóstico precoce de colecistite aguda alitiásica é importante, a fim de evitar complicaçöes potenciais, reduzindo assim as taxas de morbidade e mortalidade, que säo mais altas nessa forma de colecistite aguda