Metabolic and immunological evaluation of patients with indeterminate and cardiac forms of Chagas disease.

ABSTRACT: Chagas disease affects approximately 7 million people, causing disability and mortality in the most productive life stages of infected individuals. Considering the lifestyle of the world population, metabolic syndrome is a synergistic factor for an increased cardiovascular risk of patients with Chagas disease.This study transversally evaluated the metabolic and immunological profiles of patients with indeterminate (IF) and cardiac (CF) forms of Chagas disease and their correlations with left ventricular dysfunction (LVD).Clinical and electrical bioimpedance analysis, levels of cytokines (interferon [IFN]-γ, tumor necrosis factor [TNF]-α, interleukin [IL]-17, IL-10, and IL-33) and adipocytokines (adiponectin, leptin, and resistin), metabolic syndrome components, and brain natriuretic peptide (BNP) levels were assessed in 57 patients (13 IF and 44 CF) with a mean age of 61.63 ±â€Š12.1 years. Chest x-ray, electrocardiogram, and echocardiogram were performed to classify the clinical forms.The CF group had a higher number of individuals with metabolic syndrome components blood pressure altered, while more participants in the CF group with LVD had low high-density lipoprotein (HDL) levels. The IF group had more participants with a higher waist-to-hip ratio (WHR). No significant difference was observed between metabolic syndrome, cytokine and adipocytokine level, and clinical forms of the disease or in relation to LVD.Individuals with the IF showed metabolic and immunological profiles compatible with increased disease control, whereas those with CF showed marked inflammatory immune response.

Rupture of the myocardium in autopsied MI hearts / Ruptura do miocárdio em corações com IM autopsiados

Summary Although myocardial rupture occurs in only 2% to 4% of cases of acute myocardial infarction (AMI), there is a high mortality rate due to acute cardiogenic shock. We present the anatomopathological findings of three cases of myocardial rupture in autopsied hearts in the last 30 years, with a diagnosis of cardiac rupture in acute myocardial infarction. In these 30 years the percentage of AMI with myocardial rupture was 0.2%. Risk factors for post-AMI myocardial rupture include older age, atherosclerosis, diabetes mellitus and systemic arterial hypertension.

Resumo Embora a ruptura do miocárdio ocorra em apenas 2 a 4% dos casos de infarto agudo do miocárdio (IAM), está associada a alta mortalidade, principalmente em decorrência do estado de choque cardiogênico agudo. São apresentados os achados anatomopatológicos de três casos de ruptura do miocárdio de pacientes autopsiados nos últimos 30 anos, com diagnóstico de ruptura cardíaca em decorrência de IAM. Nesse período, a porcentagem de IAM com ruptura do miocárdio foi de 0,2%. Os fatores de risco para ruptura do miocárdio pós-IAM incluem idade avançada, arteriosclerose, diabetes mellitus e hipertensão arterial sistêmica.

Rupture of the myocardium in autopsied MI hearts.

Although myocardial rupture occurs in only 2% to 4% of cases of acute myocardial infarction (AMI), there is a high mortality rate due to acute cardiogenic shock. We present the anatomopathological findings of three cases of myocardial rupture in autopsied hearts in the last 30 years, with a diagnosis of cardiac rupture in acute myocardial infarction. In these 30 years the percentage of AMI with myocardial rupture was 0.2%. Risk factors for post-AMI myocardial rupture include older age, atherosclerosis, diabetes mellitus and systemic arterial hypertension.

Aspectos clínicos e epidemiológicos de estomizados intestinais de um município de Minas Gerais / Aspectos clínicos y epidemiológicos de estomizados intestinales de un municipio de Minas Ge-rais / Clinical and epidemiological aspects of intestinal ostomy patients in a municipality of Minas Gerais

A estomia intestinal é a abertura cirúrgica de um orifício, na parede abdominal, a fim demudar o trajeto da saída das fezes. As principais razões para esse procedimento sãotraumatismos, doenças inflamatórias, tumores e câncer do intestino. Pacientes estomizadospassam por modificações fisiológicas e sociais, constituindo um desafio para os cuidadores daequipe multidisciplinar que o atendem. Este estudobuscou caracterizar pacientes estomizadosintestinais atendidos no Programa de Atenção Multiprofissional ao Paciente Estomizado domunicípio de Uberaba – MG quanto aos aspectos sociodemográficos e clínicos. Estudodescritivo, exploratório, quantitativo. A maioria era do sexo masculino, idosa, de escolaridadede nível fundamental, casada. O diagnóstico prevalente foi de neoplasia de cólon e reto,cirurgia relacionada ao estoma de hemicolectomia, apresentando colostomia descendente, decaráter permanente. Nenhum paciente apresentou alterações relacionadas ao estoma. Espera-se que esses achados possam subsidiar diretrizes deorientação multiprofissional com vistas aassegurar a qualidade de vida dessa população .

An intestinal ostomy is an opening in the abdominalwall surgically created in order to changethe trajectory of feces elimination. The main reasons for this procedure are trauma,inflammatory disease, tumors and intestinal cancer.Stomatized patients undergophysiological and social changes, which pose a challenge to multidisciplinary healthcareproviders. The objective was to analyze sociodemographic and clinical aspects of stomatizedpatients who are part of the Multiprofessional Carefor Stomatized Patients Program of themunicipality of Uberaba, state of Minas Gerais, Brazil. It was a descriptive, exploratory andquantitative study. Most patients were male, olderadults, had completed elementary school,and were married. Patients with colon and rectal neoplasm were most prevalent, withsurgeries related to hemicolectomy stomas, and whopresented a permanent descendantcolostomy. No participants presented alterations related to the stoma. These findings can helpcreate guidelines for multiprofessional teams to guarantee quality of life for this population .

La estomía intestinal es la apertura quirúrgica deun orificio en la pared abdominal, quecambia el trayecto de salida de las heces. Las principales razones para el procedimiento sontraumatismos, enfermedades inflamatorias, tumores ycáncer intestinal. El pacienteostomizado sufre cambios fisiológicos y sociales, constituyendo un desafío para loscuidadores del equipo multidisciplinario que lo atiende. Se objetivó caracterizar a pacientescon ostomía intestinal respecto de aspectos sociodemográficos y clínicos atendidos enPrograma de Atención Multiprofesional al Paciente Ostomizado de Uberaba-MG. Estudiodescriptivo, exploratorio, cuantitativo. Los resultados indican mayoría de sexo masculino,ancianos, escolarización primaria, casados. El diagnóstico prevalente fue neoplasia de colon yrecto, cirugía relacionada al estoma de hemicolectomía, y presentaban colostomíadescendente de carácter permanente. Ningún pacientepresentó alteraciones relativas alestoma. Se espera que estos hallazgos ayuden a implementar directivas de orientaciónmultiprofesional apuntando a asegurar la calidad devida de esta población .

Effects of reprocessing on chemical and morphological properties of guide wires used in angioplasty.

OBJECTIVE: To investigate the influence of the reprocessing technique of enzymatic bath with ultrasonic cleaning and ethylene oxide sterilization on the chemical properties and morphological structure of polymeric coatings of guide wire for regular guiding catheter. METHODS: These techniques simulated the routine of guide wire reprocessing in many hemodynamic services in Brazil and other countries. Samples from three different manufacturers were verified by scanning electron microscopy and X-ray photoelectron spectroscopy. RESULTS: A single or double sterilization of the catheters with ethylene oxide was not associated with morphological or chemical changes. However, scanning electron microscopy images showed that the washing method was associated with rough morphological changes, including superficial holes and bubbles, in addition to chemical changes of external atomic layers of polymeric coating surfaces, as detected by the X-ray photoelectron spectroscopy method, which is compatible with extended chemical changes on catheter surfaces. CONCLUSION: The reprocessing of the catheters with ethylene oxide was not associated with morphological or chemical changes, and it seemed appropriate to maintain guide wire coating integrity. However, the method combining chemical cleaning with mechanical vibration resulted in rough anatomical and chemical surface deterioration, suggesting that this reprocessing method should be discouraged.

Effects of reprocessing on chemical and morphological properties of guide wires used in angioplasty / Efeitos do reprocessamento nas propriedades químicas e morfológicas de fios-guia usados em angioplastia

OBJECTIVE: To investigate the influence of the reprocessing technique of enzymatic bath with ultrasonic cleaning and ethylene oxide sterilization on the chemical properties and morphological structure of polymeric coatings of guide wire for regular guiding catheter. METHODS: These techniques simulated the routine of guide wire reprocessing in many hemodynamic services in Brazil and other countries. Samples from three different manufacturers were verified by scanning electron microscopy and X-ray photoelectron spectroscopy. RESULTS: A single or double sterilization of the catheters with ethylene oxide was not associated with morphological or chemical changes. However, scanning electron microscopy images showed that the washing method was associated with rough morphological changes, including superficial holes and bubbles, in addition to chemical changes of external atomic layers of polymeric coating surfaces, as detected by the X-ray photoelectron spectroscopy method, which is compatible with extended chemical changes on catheter surfaces. CONCLUSION: The reprocessing of the catheters with ethylene oxide was not associated with morphological or chemical changes, and it seemed appropriate to maintain guide wire coating integrity. However, the method combining chemical cleaning with mechanical vibration resulted in rough anatomical and chemical surface deterioration, suggesting that this reprocessing method should be discouraged.

OBJETIVO: Investigar a influência das técnicas de reprocessamento de banho enzimático com limpeza ultrassônica e a esterilização com óxido de etileno nas propriedades químicas e estruturas morfológicas de revestimentos poliméricos de fios-guia usados como guias em cateteres regulares. MÉTODOS: Estas técnicas simulam a rotina de processamento de fios-guia em muitos serviços de hemodinâmica do Brasil e de outros países. Amostras de três diferentes fabricantes foram verificadas por microscopia eletrônica de varredura e espectroscopia de fotoelétrons de raios-X. RESULTADOS: Uma única ou dupla esterilização dos cateteres com óxido de etileno não foi associada a mudanças químicas ou morfológicas. Contudo, imagens de microscopia eletrônica de varredura mostraram que o método de lavagem foi associado a intensas modificações morfológicas, incluindo bolhas e buracos superficiais, assim como mudanças nas ligações químicas das camadas atômicas externas do revestimento polimérico, conforme demonstrado por resultados de espectroscopia de fotoelétrons de raios-X, compatível com extensas modificações químicas induzidas por esse processo de lavagem. CONCLUSÃO: O reprocessamento dos fios-guia de cateteres com óxido de etileno não está associado a mudanças químicas e morfológicas dos mesmos e pode ser considerado adequado para manter a integridade destes materiais. Entretanto, o método que combina lavagem química com vibração mecânica resulta em intensas deteriorações anatômicas e químicas, sugerindo que esse método de processamento deve ser desencorajado.

Papillary atrophy of the tongue and nutritional status of hospitalized alcoholics.

BACKGROUND: Atrophy of the papillae, mucosa, and dorsum of the tongue are considered classical signs of nutritional deficiencies. OBJECTIVE: To assess the nutritional status of hospitalized alcoholics with or without papillary atrophy of the tongue. METHODS: This study was performed with 21 hospitalized alcoholics divided into Atrophic Glossitis Group (n=13) and Normal Tongue Group (n=8). Healthy, non-alcoholic volunteers composed the Control Group (n=8). Anthropometry and bioelectric impedance were performed, and serum vitamins A, E, and B12 were determined. RESULTS: There were no statistical differences in relation to age (46.7 ± 8.7 vs. 46.8 ± 15.8 years) or gender (92.3% vs. 87.5% male), respectively. Control Group volunteers were also paired in relation to age (47.5 ± 3.1 years) and male predominance (62.5%). In relation to hospitalized alcoholics without atrophic lesions of the tongue and Control Group, patients with papillary atrophy showed lower BMI (18.6 ± 2,5 vs 23.8 ± 3.5 vs 26.7 ± 3,6 kg/m(2)) and body fat content 7.6 ± 3.5 vs 13.3 ± 6.5 vs 19.5 ± 4,9 kg). When compared with the Control Group, alcoholic patients with or without papillary atrophy of the tongue showed lower values of red blood cells (10.8 ± 2.2 vs 11.8 ± 2.2 vs 14.5 ± 1,6g/dL) and albumin (3.6 ± 0.9 vs 3.6 ± 0.8 vs 4.4 ± 0.2g/dL). The seric levels of vitamins A, E, and B12 were similar amongst the groups. CONCLUSION: Hospitalized alcoholics with papillary atrophy of the tongue had lower BMI and fat body stores than controls, without associated hypovitaminosis.

Avaliação da dor crônica em idosos institucionalizados / Evaluacion del dolor cronico en ancianos institucionalizados / Evaluation of chronic pain in the institutionalized elderly

Objetiva-se com esta pesquisa avaliar a dor e caracterizar os idosos institucionalizados segundo as variáveissociodemográficas e clínicas. Trata-se de estudo descritivo realizado com 124 idosos residentes nas Instituiçõesde Longa Permanência para Idosos de Minas Gerais. Para a obtenção dos dados, realizou-se entrevista, bem comoavaliação clínica. Utilizou-se estatística descritiva com análise univariada dos dados. Verificou-se a predominânciado sexo feminino, com hipertensão arterial sistêmica referida, solteiros e com filhos, média de idade 76,2 anos eIMC médio 23,1 kg/m². A dor crônica, a adoção de tratamento medicamentoso e a não realização de atividade físicaregular foram referidas pela maioria dos idosos. Os principais fatores de melhora e piora referidos foram o repouso ea movimentação física, respectivamente. A dor crônica e a não realização de atividade física regular são vivenciadaspela maioria dos idosos institucionalizados. Espera-se que novas medidas de monitoramento, prevenção e controleda dor sejam implementadas nessas instituições.

This study objective was to evaluate the pain in institutionalized elderly as well as characterize this group accordingto socio-demographic and clinical variables. It is a descriptive study with 124 elderly people living in long-term carefacilities (LTCF) in the state of Minas Gerais, Brazil. Data were obtained via interview and clinical assessment. Descriptivestatistics with univariate data were used. There was predominance of women with systemic arterial hypertension, singleand with children. The mean age was 76.2 years, and the median BMI was 23.1 kg / m². Chronic pain, the medicationtreatment and the lack of physical activity were reported. Key fators for improvement and worsening of health were thephysical rest and physical activity, respectively. Results indicated that chronic pain and lack of regular physical activityare experienced by most of the institutionalized elderly. New measures for monitoring, preventing and controlling thepain should be implemented in these institutions.

El objetivo del presente estudio fue evaluar el dolor y caracterizar ancianos institucionalizados en función de variablesdemográficas y clínicas. Se trata de un estudio descriptivo de 124 ancianos hospedados en establecimientos delarga permanencia de Minas Gerais. Llevamos a cabo entrevistas y evaluación clínica para obtener datos. Se utilizóestadística descriptiva con los datos de una variable. Los resultados indican que hay predominio de individuos delsexo femenino, hipertensos, solteros y con hijos. Edad promedio de 76,2 años y promedio de IMC de 23,1 kg / m².Dolor crónico, tratamiento con fármacos y falta de actividad física regular fueron mencionados por la mayoría de losancianos. Principales fatores de mejora y empeoramiento fueron reposo y actividad física, respectivamente. Llegamosa la conclusión que la mayoría de los ancianos vive con dolor crónico y falta de actividad física regular. Se espera quesean implementadas nuevas medidas de control, prevención y control del dolor en estas instituciones.

Papillary atrophy of the tongue and nutritional status of hospitalized alcoholics / Glossite atrófica e estado nutricional de alcoolistas hospitalizados

BACKGROUND: Atrophy of the papillae, mucosa, and dorsum of the tongue are considered classical signs of nutritional deficiencies. OBJECTIVE: To assess the nutritional status of hospitalized alcoholics with or without papillary atrophy of the tongue. METHODS: This study was performed with 21 hospitalized alcoholics divided into Atrophic Glossitis Group (n=13) and Normal Tongue Group (n=8). Healthy, non-alcoholic volunteers composed the Control Group (n=8). Anthropometry and bioelectric impedance were performed, and serum vitamins A, E, and B12 were determined. RESULTS: There were no statistical differences in relation to age (46.7±8.7 vs. 46.8±15.8 years) or gender (92.3% vs. 87.5% male), respectively. Control Group volunteers were also paired in relation to age (47.5±3.1 years) and male predominance (62.5%). In relation to hospitalized alcoholics without atrophic lesions of the tongue and Control Group, patients with papillary atrophy showed lower BMI (18.6 ± 2,5 vs 23.8 ± 3.5 vs 26.7 ± 3,6 kg/m² ) and body fat content 7.6 ± 3.5 vs 13.3 ± 6.5 vs 19.5 ± 4,9 kg). When compared with the Control Group, alcoholic patients with or without papillary atrophy of the tongue showed lower values of red blood cells (10.8 ± 2.2 vs 11.8 ± 2.2 vs 14.5 ± 1,6g/dL) and albumin (3.6 ± 0.9 vs 3.6 ± 0.8 vs 4.4 ± 0.2g/dL). The seric levels of vitamins A, E, and B12 were similar amongst the groups. CONCLUSION: Hospitalized alcoholics with papillary atrophy of the tongue had lower BMI and fat body stores than controls, without associated hypovitaminosis.

FUNDAMENTOS: A deficiência crônica de nutrientes pode levar à hipotrofia das papilas e da mucosa e do dorso da língua, considerada um sinal clássico de subnutrição protéico-energética. OBJETIVO: O objetivo do presente estudo é comparar o estado nutricional, incluindo as dosagens dos níveis séricos de vitaminas A, E e B12 em pacientes alcoolistas com ou sem alterações tróficas das papilas linguais. MÉTODOS: O estudo caso-controle incluiu 21 pacientes adultos alcoolistas internados em um hospital universitário. Utilizando-se de um sistema de fotografia da cavidade oral, dois clínicos independentes classificaram os indivíduos alcoolistas de acordo com a presença ou não de alterações tróficas na língua. Foram registrados os dados antropométricos, a composição corporal pela impedância bioelétrica e os exames laboratoriais para avaliação clínica e nutricional, incluindo dosagens das vitaminas A, E e B12. O estudo incluiu ainda voluntários saudáveis, não alcoolistas como Grupo Controle (n=8). A comparação entre os grupos foi feita por ANOYA-F ou pelo teste de Kruskal-Wallis, de acordo com a curva de normalidade dos resultados. Foram considerados significativos diferenças com p < 0,05. RESULTADOS: De acordo com a presença de alterações tróficas nas papilas linguais, os pacientes alcoolistas foram alocados no Grupo Língua Despapilada (n=13) e Grupo Língua Normal (n=8), sem diferença estatística quanto à idade (46,7 ± 8,7 vs 46,8 ± 15,8 anos) e gênero masculino (92,3 vs 87,5%). Os voluntários do Grupo Controle apresentaram 47,5 ±3,1 anos, sendo 62,5% do gênero masculino. Os pacientes alcoolistas com hipotrofia papilar apresentaram menor IMC (18,6 ± 2,5 vs 23,8 ± 3,5 vs 26,7 ± 3,6 kg/m2) e gordura corporal (7,6 ± 3,5 vs 13,3 ± 6,5 vs 19,5 ± 4,9 kg), quando comparados com os demais grupos. Em relação ao Grupo Controle, os alcoolistas apresentaram menores valores de hemoglobina (10,8 ± 2,2 vs 11,8 ± 2,2 vs 14,5 ± 1,6 g/dL) e albumina sérica (3,6 ± 0,9 vs 3,6 ± 0,8 vs 4,4 ± 0,2 g/dL). Os níveis plasmáticos de vitaminas A, E e B12 foram similares entres os grupos. CONCLUSÃO: Os pacientes alcoolistas com achados físicos de hipotrofia de papilas linguais apresentam menores valores em medidas antropométricas, de hemoglobina e albumina séricas que os grupos Controle ou de alcoolistas sem língua despapilada. Não houve evidências de hipovitaminoses associadas.

Análise da vitamina C sérica e ingerida e estresse oxidativo em crianças e adolescentes infectados pelo vírus da imunodeficiência humana / Analysis of serum and supplemented vitamin C and oxidative stress in HIV-infected children and adolescents

OBJETIVOS: Verificar adequação do consumo de vitamina C em crianças e adolescentes infectados pelo vírus da imunodeficiência humana (HIV), avaliar níveis séricos da vitamina e indicadores de estresse oxidativo, comparar ao grupo não infectado, correlacionar a vitamina sérica ao estresse oxidativo e associá-los segundo os valores de referência. MÉTODOS: Estudo seccional transversal comparativo. Dois grupos com 27 crianças e adolescentes cada, de 3 a 19 anos, sendo G1 infectados pelo HIV por transmissão vertical atendidos em ambulatório regional e G2 indivíduos convidados sem histórico de infecção pelo HIV. Foram pareados por sexo, idade e condição socioeconômica. Avaliou-se: antropometria (índice de massa corporal para idade), ingestão e consumo do micronutriente, análise sérica da vitamina C, proteína C reativa e albumina. RESULTADOS: Idade média encontrada de 12 anos, prevalência do sexo feminino (17 - 63%) e da classe econômica C (27 - 50%). Diagnóstico nutricional prevalente foi eutrofia em 20 (74,1%) em G1 e 21 (77,8%) em G2. O consumo de vitamina C foi significativamente maior em G1 (p = 0,006; t = 2,987) pelo método recordatório 24 horas. Houve diferença significativa da dosagem sérica de vitamina C, sendo menor em G1 (p = 0,000; t = -7,309). Em relação ao estresse oxidativo, os valores da proteína C reativa em G1 foram significativamente maiores (p = 0,007; t = 2,958). Não houve relação entre deficiência da vitamina, proteína C reativa e albumina. CONCLUSÃO: Os resultados encontrados mostram que indivíduos infectados pelo HIV apresentam baixos valores da vitamina C, não relacionados à alimentação, uma vez que o consumo desse micronutriente foi superior ao grupo comparativo, que não apresentou essa depleção. Existem peculiaridades nos indivíduos infectados que aumentam o estresse oxidativo, evidenciado pelo aumento da proteína C reativa.

OBJECTIVES: To assess adequacy of vitamin C intake in HIV-infected children and adolescents; to evaluate serum levels of vitamin C and indicators of oxidative stress; to compare with the uninfected group; to correlate serum vitamin C with oxidative stress and associate them according to the reference values. METHODS: Comparative cross-sectional study. Two groups of 27 children and adolescents each, aged between 3 to 19 years. Group 1 (G1) comprised individuals vertically infected with HIV seen at a regional outpatient clinic. Group 2 (G2) comprised invited individuals without history of HIV infection. The groups were matched for age, sex, and socioeconomic status. The following variables were analyzed: body mass index for age; micronutrient intake and consumption; and serum vitamin C, C-reactive protein (CRP), and albumin. RESULTS: The mean age was 12 years old. Most subjects were female (17, 63%), and there was prevalence of the economic class C (27, 50%). The most prevalent nutritional status was normal weight in 20 individuals (74.1%) in G1 and 21 (77.8%) in G2. The intake of vitamin C was significantly higher in G1 (p = 0.006; t = 2.987) according to the 24-hour dietary recall method. There were significant differences in serum vitamin C concentration between the groups, with a lower level in G1 (p = 0.000; t = -7.309). In relation to oxidative stress, values of CRP in G1 were significantly higher (p = 0.007; t = 2.958). There was no association between deficiency of vitamin, CRP, and albumin. CONCLUSION: Our findings show that HIV-infected individuals have low levels of vitamin C; however, this deficiency is not related to eating habits, since the intake of this nutrient was higher in this group than in the control group. HIV-infected individuals have specific characteristics that increase their oxidative stress, which is evidenced by increased CRP.

Frequency of metabolic syndrome and the food intake patterns in adults living in a rural area of Brazil.

INTRODUCTION: Metabolic syndrome (MetS), a risk factor for atherosclerosis and coronary heart disease, is related to an inadequate food intake pattern. Its incidence is increasing among Brazilian adults, including those living in rural areas. Our aim was not only to describe the frequency of MetS in adults with or without MetS but also to compare their food intake pattern as assessed by the healthy eating index (HEI) and serum albumin and C reactive protein (CRP) levels. METHODS: Men and women (n = 246) living in a small village in Brazil were included. MetS was characterized according to the adult treatment panel (ATP III) criteria. Groups were compared by chi-square, student t or Mann-Whitney tests. RESULTS: MetS was diagnosed in 15.4% of the cases. The MetS group showed higher CRP (1.8±1.2 vs. 1.0±0.9 mg/dl) and lower albumin (4.3±0.3 vs. 4.4±0.3 g/dl) serum levels compared to the control group. Additionally, the MetS group showed lower scores (median[range]) in the HEI compared to the control group (53.5[31.2-78.1] vs 58[29.7-89.5], respectively). The MetS group also had decreased scores for total fat and daily variety of food intake. CONCLUSIONS: The results suggest that adults with MetS displayed chronic mild inflammation and a poorer food intake pattern than the control group.

Frequency of metabolic syndrome and the food intake patterns in adults living in a rural area of Brazil / Frequência de síndrome metabólica e padrão de ingestão alimentar de adultos vivendo em uma área rural do Brasil

INTRODUCTION: Metabolic syndrome (MetS), a risk factor for atherosclerosis and coronary heart disease, is related to an inadequate food intake pattern. Its incidence is increasing among Brazilian adults, including those living in rural areas. Our aim was not only to describe the frequency of MetS in adults with or without MetS but also to compare their food intake pattern as assessed by the healthy eating index (HEI) and serum albumin and C reactive protein (CRP) levels. METHODS: Men and women (n = 246) living in a small village in Brazil were included. MetS was characterized according to the adult treatment panel (ATP III) criteria. Groups were compared by chi-square, student t or Mann-Whitney tests. RESULTS: MetS was diagnosed in 15.4% of the cases. The MetS group showed higher CRP (1.8±1.2 vs. 1.0±0.9 mg/dl) and lower albumin (4.3±0.3 vs. 4.4±0.3 g/dl) serum levels compared to the control group. Additionally, the MetS group showed lower scores (median[range]) in the HEI compared to the control group (53.5[31.2-78.1] vs 58[29.7-89.5], respectively). The MetS group also had decreased scores for total fat and daily variety of food intake. CONCLUSIONS: The results suggest that adults with MetS displayed chronic mild inflammation and a poorer food intake pattern than the control group.

INTRODUÇÃO: A síndrome metabólica (SM), fator de risco para aterosclerose e cardiopatia isquêmica, está relacionada a uma alimentação inadequada, e sua incidência está aumentando no Brasil, incluindo entre populações rurais. O objetivo deste estudo foi descrever a frequência de síndrome metabólica, e comparar o padrão de ingestão alimentar, avaliado pelo índice de alimentação saudável (healthy eating index - HEI), e níveis séricos de albumina e proteina C reativa (PCR) entre adultos com ou sem SM. MÉTODOS: Homens e mulheres (n = 246) morando em Inhaumas, pequeno vilarejo do interior da Bahia foram incluídos. SM foi caracterizada de acordo com os critérios do adult treatment panel (ATP III). Os grupos foram comparados pelos testes qui-quadrado, teste t de student ou Mann-Whitney. RESULTADOS: SM foi diagnosticada em 15,4% dos casos. O grupo SM mostrou maiores níveis séricos de PCR (1.8±1.2 vs. 1.0±0.9mg/dl) e menores valores de albumina (4.3±0.3 vs. 4.4±0.3g/dl). O grupo SM apresentou menores notas (mediana [faixa de variação]) do HEI (53.5[31.2-78.1] vs 58[29.7-89.5]), com menores notas para a ingestão de gordura total e variedade de alimentos ingeridos. CONCLUSÕES: Adultos com SM mostraram resultados compatíveis com diagnóstico de inflamação crônica, e um padrão de ingestão alimentar inadequado em relação ao controle.

Scurvy in a patient with AIDS: case report.

We report the case of a 35-year-old homeless alcoholic and illicit drug user, with AIDS, who was admitted to the emergency unit complaining of asthenia and a weight loss of 30 kg over the preceding three months. Clinical and laboratory data confirmed a diagnosis of marasmus, bacterial pneumonia, chorioretinitis caused by Toxoplasma gondii and oral Candida infection. The patient also presented loss of tongue papillae, gingival hypertrophy, perifollicular hyperkeratosis and hemorrhage, coiled, corkscrew-like hair, anemia, hypoalbuminemia, increased C-reactive protein levels and low serum vitamin C levels. The patient developed severe gastric hemorrhage, with hemodynamic instability and terminal disseminated intravascular coagulopathy.

Scurvy in a patient with AIDS: case report / Escorbuto em paciente com AIDS: relato de caso

We report the case of a 35-year-old homeless alcoholic and illicit drug user, with AIDS, who was admitted to the emergency unit complaining of asthenia and a weight loss of 30kg over the preceding three months. Clinical and laboratory data confirmed a diagnosis of marasmus, bacterial pneumonia, chorioretinitis caused by Toxoplasma gondii and oral Candida infection. The patient also presented loss of tongue papillae, gingival hypertrophy, perifollicular hyperkeratosis and hemorrhage, coiled, corkscrew-like hair, anemia, hypoalbuminemia, increased C-reactive protein levels and low serum vitamin C levels. The patient developed severe gastric hemorrhage, with hemodynamic instability and terminal disseminated intravascular coagulopathy.

Relatamos o caso de um paciente alcoólatra e usuário de drogas ilícitas com 35 anos de idade, morador de rua com AIDS, admitido na Unidade de Emergência referindo astenia e perda ponderal de trinta quilos nos últimos três meses. Dados clínicos e laboratoriais confirmaram o diagnóstico de marasmo, pneumonia, corioretinite por Toxoplasma gondii e candidíase oral. Apresentava ainda: língua despapilada com hipertrofia gengival, hiperqueratose e hemorragia folicular associada a pêlos tipo saca-rolhas, anemia, hipoalbuminemia, aumento dos níveis de proteína C reativa com baixos níveis séricos de vitamina C. O paciente desenvolveu hemorragia gástrica grave, com instabilidade hemodinâmica e coagulação intravascular disseminada terminal.

Implantação de um sistema de telecardiologia em Minas Gerais: projeto Minas Telecardio / Implementation of a telecardiology system in the state of Minas Gerais: the Minas Telecardio Project

FUNDAMENTO: Embora as doenças cardiovasculares sejam a maior causa de morbimortalidade em todo Brasil, o acesso das populações de cidades pequenas à eletrocardiografia e à avaliação cardiológica é limitado. O uso da telecardiologia para facilitar o acesso da população de municípios remotos à eletrocardiografia e à segunda opinião em cardiologia é promissora, entretanto não foi formalmente testada. OBJETIVO: Avaliar a viabilidade de se implantar o sistema público de telecardiologia de baixo custo em pequenas cidades brasileiras. MÉTODOS: Foram selecionadas 82 cidades do Estado de Minas Gerais, com população < 10.500 habitantes, > 70 por cento de cobertura pelo Programa Saúde da Família (PSF), com interesse do gestor e acesso pela internet. Em cada município foi instalado um aparelho de eletrocardiógrafo (ECG) digital, com subsequente treinamento da equipe. A implantação foi coordenada pelo HC/UFMG, em conjunto com outros quatro hospitais universitários mineiros (UFU, UFTM, UFJF e UNIMONTES). Os ECGs foram realizados nos municípios e enviados pela internet para análise imediata em plantão de telecardiologia. Realizaram-se discussões de casos médicos on-line e off-line e cursos de atualização via web. RESULTADOS: No período de implantação, foram treinados 253 profissionais de saúde. De julho de 2006 a novembro de 2008, o projeto atendeu 42.664 pacientes, realizando 62.865 ECGs. Foram efetuados 2.148 atendimentos de urgência e 420 teleconsultorias. A avaliação intermediária apontou boa aceitação da tecnologia implantada e uma diminuição de 70 por cento de encaminhamentos de pacientes para outros centros de referência. CONCLUSÃO: É factível a utilização de recursos habituais de informática para facilitar o acesso de populações de cidades pequenas à eletrocardiografia e avaliação cardiológica especializada.

BACKGROUND: Although cardiovascular diseases are the main cause of morbimortality in Brazil, the access of small-town populations to electrocardiography and cardiology assessment is limited. The use of telecardiology to assist the access of distant towns to electrocardiography and a second opinion in cardiology is promising; however, it has not been formally assessed. OBJECTIVE: To assess the feasibility of implementing a low-cost public telecardiology system in small Brazilian towns. METHODS: A total of 82 towns in the state of Minas Gerais, with a population < 10,500 inhabitants, presenting > 70 percent coverage by the Family Health Program (Programa Saude da Familia - PSF), local government compliance and internet access, were selected. Each town was supplied with digital electrocardiography (ECG) device and a team was trained. The implementation was coordinated by HC/UFMG, together with four university hospitals in the state of Minas Gerais (UFU, UFTM, UFJF and UNIMONTES). The ECG assessments were carried out in the towns and sent through the Internet for prompt analysis by an on-duty telecardiology team. Online and offline discussions on the medical cases were carried out through the Internet, as well as refreshment courses. RESULTS: During the implementation period, a total of 253 health professionals were trained. From July 2006 to November 2008, the project assisted 42,664 patients, with a total of 62,865 ECG assessments being performed. A total of 2,148 emergency cases were treated, as well as 420 teleconsultations. The intermediate evaluation showed good acceptance of the implemented technology and a 70 percent decrease in patient referrals to other reference centers. CONCLUSION: The use of the customary resources in informatics to assist the access of small-town populations to electrocardiography and specialized cardiology assessment is feasible.

Implementation of a telecardiology system in the state of Minas Gerais: the Minas Telecardio Project.

BACKGROUND: Although cardiovascular diseases are the main cause of morbimortality in Brazil, the access of small-town populations to electrocardiography and cardiology assessment is limited. The use of telecardiology to assist the access of distant towns to electrocardiography and a second opinion in cardiology is promising; however, it has not been formally assessed. OBJECTIVE: To assess the feasibility of implementing a low-cost public telecardiology system in small Brazilian towns. METHODS: A total of 82 towns in the state of Minas Gerais, with a population < 10,500 inhabitants, presenting > 70% coverage by the Family Health Program (Programa Saude da Familia-PSF), local government compliance and internet access, were selected. Each town was supplied with digital electrocardiography (ECG) device and a team was trained. The implementation was coordinated by HC/UFMG, together with four university hospitals in the state of Minas Gerais (UFU, UFTM, UFJF and UNIMONTES). The ECG assessments were carried out in the towns and sent through the Internet for prompt analysis by an on-duty telecardiology team. Online and offline discussions on the medical cases were carried out through the Internet, as well as refreshment courses. RESULTS: During the implementation period, a total of 253 health professionals were trained. From July 2006 to November 2008, the project assisted 42,664 patients, with a total of 62,865 ECG assessments being performed. A total of 2,148 emergency cases were treated, as well as 420 teleconsultations. The intermediate evaluation showed good acceptance of the implemented technology and a 70% decrease in patient referrals to other reference centers. CONCLUSION: The use of the customary resources in informatics to assist the access of small-town populations to electrocardiography and specialized cardiology assessment is feasible.

Is an increased body mass index associated with a risk of cutaneous leishmaniasis?

All adults (n = 334) living in Brejo do Mutambal, an endemic area for cutaneous leishmaniasis, were included in this study. Contrary to our initial hypothesis, it was observed that men (23.7 +/- 3.2 vs. 22.1 +/- 2.6 kg/m(2)) and women (24.1 +/- 4.7 vs. 22.5 +/- 3.4 kg/m(2)) with cutaneous leishmaniasis presented higher body mass index than the controls.

Is an increased body mass index associated with a risk of cutaneous leishmaniasis? / O índice de massa corporal aumentado é associado a risco de leishmaniose cutânea?

All adults (n = 334) living in Brejo do Mutambal, an endemic area for cutaneous leishmaniasis, were included in this study. Contrary to our initial hypothesis, it was observed that men (23.7 ± 3.2 vs. 22.1 ± 2.6 kg/m²) and women (24.1 ± 4.7 vs. 22.5 ± 3.4 kg/m²) with cutaneous leishmaniasis presented higher body mass index than the controls.

Neste estudo, foram incluídos todos (nº =334) os adultos morando em Brejo do Mutambal, região endêmica para leishmaniose cutânea. Contrário à hipótese inicial, observou-se que homens (23,7 ± 3,2 vs. 22,1 ± 2,6kg/m²) e mulheres (24,1±4,7 vs. 22,5±3,4kg/m2) com leishmaniose cutânea apresentaram maior índice de massa corporal que os controles.

Frequency of pneumonitis among malnourished autopsied adults / Frequência de pneumonite em adultos subnutridos autopsiados

The objective of this study was to investigate whether malnourished autopsied adults would present higher frequency of pneumonitis than non-malnourished ones would. All of the autopsied adults (n = 175; age > 18 years) with complete records, including weight and height data, were included. Pneumonitis was observed more frequently in malnourished individuals (59.1 percent) than in non-malnourished individuals (41.3 percent). This study showed that the percentage of pneumonitis among autopsied adults was high, in addition to an increased risk of pneumonitis among these individuals.

O objetivo deste estudo foi verificar se adultos subnutridos autopsiados teriam maior freqüência de pneumonite que adultos não-subnutridos. Todos os adultos autopsiados ((nº = 175); idade > 18 anos) com dados completos, incluindo peso e estatura, foram incluídos. Pneumonite foi observada com maior frequência em subnutridos (59,1 por cento) do que em não-subnutridos (41,3 por cento). Este estudo mostrou uma alta porcentagem de pneumonite entre os adultos autopsiados, além do aumento do risco de pneumonite entre estes.