Frequency of mental disturbances in HTLV-1 patients in the state of Bahia, Brazil.

Viral infections and chronic diseases have been associated with psychiatric disorders. Among these, increased depression has been reported in HTLV-1 patients. However, no studies on the prevalence of other mental disturbances have been carried out in these patients. Salvador is the city with the highest rate of infection with HTLV-1 in Brazil and it is estimated that approximately 40,000 inhabitants are infected. In our cross sectional study, we examined the frequency of mental disturbances in 50 HTLV-1 seropositive patients followed at the Centro Integrativo e Multidisciplinar de HTLV e Hepatites Virais (CHTLV) of the Escola Bahiana de Medicina e Saude Pública (EBMSP) in Salvador from January to November 2007. We used a questionnaire to collect clinical-epidemiologic data and the Mini International Neuropsychiatric Interview Brazilian Version 5.0.0 (M.I.N.I.) to evaluate the psychiatric disorders. The Statistical Package for Social Sciences (SPSS) was used for the analyses. Twenty-one (42%) HTLV-1 patients had a psychiatric co-morbidity; 17(34%) had mood disorders, 11 (22%) were anxious and one (2%) was an alcoholic. We found a high frequency of mental disturbances among HTLV-1 infected individuals, suggesting a possible association of this infection with psychiatric diseases.

Proinflammatory cytokines in patients with neuropathic pain treated with Tramadol.

BACKGROUND AND METHODS: Proinflammatory cytokines play an important role in the pathophysiology of neuropathic pain syndromes. The objective of this study was to evaluate plasma levels of proinflammatory cytokines before and after treatment with tramadol in patients with herniated intervertebral disks and carpal tunnel syndrome, and to compare them with normal individuals. METHODS: Thirty-eight patients with neuropathic pain secondary to herniated intervertebral disks or carpal tunnel syndrome participated in this study. All patients were treated with controlled release tramadol (100 mg every 12 hours) for 10 days. Venous blood (5 mL) was collected in the morning, before treatment and on the 11th day, and stored (-70 degrees C) until analysis. ELISA was used to determine the plasma levels of cytokines (TNF-+/-, IL-1, IL-6) and receptors sTNF-R1 (R & D Systems). Plasma levels of cytokines of 10 healthy volunteers were also determined. RESULTS: The concentration of TNF-+/- before (5.8 +/- 2.8 pg.mL-(1)) was significantly higher than after treatment with tramadol (4.8 +/- 2.1 pg.mL-1; p = 0.04, Mann-Whitney test). The levels of IL-1(2), IL-6, and sTNF-R1 before and after treatment with tramadol showed no significant differences. Plasma levels of TNF-+/- (healthy individuals: 1.4 +/- 0.5; pain patients: 5.8 +/- 2.8 pg.mL-1; p = 0.01) and IL-6 (healthy individuals: 1.2 +/- 0.8; pain patients: 3.5 +/- 2.6 pg.mL-1; p = 0.01) were significantly higher in patients with neuropathic pain, Mann-Whitney Test. CONCLUSIONS: In patients with herniated intervertebral disks and carpal tunnel syndrome, plasma levels of TNF-+/- and IL-6 were higher than in healthy volunteers, while differences in the concentrations of sTNF-R and IL-1(2) were not observed. Plasma levels of TNF-+/-, but not of IL-6, sTNF-R, and IL-1(2), decreased after treatment with tramadol (100 mg every 12 hours).

Citocinas pró-inflamatórias em pacientes com dor neuropática submetidos a tratamento com Tramadol / Proinflammatory cytokines in patients with neuropathic pain treated with Tramadol / Interleucinas proinflamatorias en pacientes con dolor neuropático sometidos a tratamiento con Tramadol

JUSTIFICATIVA E OBJETIVOS: As citocinas pró-inflamatórias têm função importante na fisiopatologia das síndromes dolorosas neuropáticas. O objetivo desse estudo foi avaliar os níveis plasmáticos de citocinas pró-inflamatórias antes e após o tratamentocom tramadol em pacientes com hérnia discal e síndrome do túnel do carpo e compará-los com indivíduos normais.MÉTODO: Investigou-se 38 pacientes com dor neuropática por hérnia discal ou síndrome do túnel do carpo. Todos os pacientes foram tratados com tramadol de liberação controlada (100 mg em 12h) durante 10 dias. Realizaram-se coletas de sangue venoso (5 mL), no período matutino, antes do tratamento e no 11º dia e as amostras foram armazenadas até análise (-70ºC). Foram utilizados testes enzimáticos ELISA para dosagem de citocinas plasmáticas (TNF-α, IL-1, IL-6) e receptores sTNF-R1, (R & D Systems). Realizou-se dosagem de citocinas em soro de 10 voluntários sadios. RESULTADOS: A concentração de TNF-α antes (5,8 ± 2,8 pg.mL-1) foi significativamente maior que após o tramadol (4,8 ± 2,1 pg.mL-1; p = 0,04, Teste Mann-Whitney). Não houve diferença significativa de IL-1β, IL-6 e sTNF-R1 antes e após o tratamento. As concentrações plasmáticas de TNF-α (sadios: 1,4 ± 0,5; pacientes com dor: 5,8 ± 2,8 pg.mL-1; p = 0.01) e IL-6 (sadios: 1,2 ± 0,8; pacientes com dor: 3,5 ± 2,6 pg.mL-1; p = 0,01) foram significativamente maiores nos pacientes com dor neuropática que nos voluntários, Teste de Mann-Whitney. CONCLUSÕES: Nos pacientes com hérnia discal e síndrome do túnel do carpo as concentrações plasmáticas de TNF-α e IL-6 foram maiores que em voluntários sadios, não havendo diferença das concentrações de sTNF-R e IL-1β. Houve redução da concentraçãoplasmática de TNF-α após tratamento com tramadol (100 mg em 12h), mas não de IL-6, sTNF-R e IL-1β.

BACKGROUND AND METHODS: Proinflammatory cytokines play an important role in the pathophysiology of neuropathic pain syndromes. The objective of this study was to evaluate plasma levels of proinflammatory cytokines before and after treatment with tramadol in patients with herniated intervertebral disks and carpal tunnel syndrome, and to compare them with normal individuals. METHODS: Thirty-eight patients with neuropathic pain secondary to herniated intervertebral disks or carpal tunnel syndrome participated in this study. All patients were treated with controlled release tramadol (100 mg every 12 hours) for 10 days. Venous blood (5 mL) was collected in the morning, before treatment and on the 11th day, and stored (-70º C) until analysis. ELISA was used to determine the plasma levels of cytokines (TNF-α, IL-1, IL-6) andreceptors sTNF-R1 (R & D Systems). Plasma levels of cytokines of 10 healthy volunteers were also determined. RESULTS: The concentration of TNF-α before (5.8 ± 2.8 pg.mL-1) was significantly higher than after treatment with tramadol (4.8 ± 2.1 pg.mL-1; p = 0.04, Mann-Whitney test). The levels of IL-1β, IL-6, and sTNF-R1 before and after treatment with tramadol showed nosignificant differences. Plasma levels of TNF-α (healthy individuals: 1.4 ± 0.5; pain patients: 5.8 ± 2.8 pg.mL-1; p = 0.01) and IL-6 (healthy individuals: 1.2 ± 0.8; pain patients: 3.5 ± 2.6 pg.mL-1; p = 0.01) were significantly higher in patients with neuropathic pain, Mann-Whitney Test. CONCLUSIONS: In patients with herniated intervertebral disks and carpal tunnel syndrome, plasma levels of TNF-α and IL-6 werehigher than in healthy volunteers, while differences in the concentrations of sTNF-R and IL-1β were not observed. Plasma levels of TNF-α, but not of IL-6, sTNF-R, and IL-1β, decreased after treatment with tramadol (100 mg every 12 hours).

JUSTIFICATIVA Y OBJETIVOS: Las interleucinas proinflamatorias tienen una función importante en la fisiopatología de los síndromes dolorosos neuropáticos. El objetivo de este estudio, fue evaluar los niveles plasmáticos de interleucinas proinflamatorias antes y después del tratamiento con tramadol en pacientes con hernia de disco y síndromedel túnel del carpo, y compararlos con individuos normales. MÉTODO: Se investigaron 38 pacientes con dolor neuropático por hernia de disco o síndrome del túnel del carpo. Todos los pacientes fueron tratados con tramadol de liberación controlada (100 mg en 12h) durante 10 días. Se realizaron muestras de sangre venosa (5 mL), por la mañana, antes del tratamiento y en el 11º día, y las mismas se almacenaron para ser analizadas (-70ºC). Se utilizaron test enzimáticos ELISA para la dosificación de las interleucinas plasmáticas (TNF-α, IL-1, IL-6) y receptores sTNFR1, (R & D Systems). Se realizó la dosificación de interleucinasen suero de 10 voluntarios sanos. RESULTADOS: La concentración de TNF-α antes (5,8 ± 2,8 pg.mL-1) fue significativamente mayor que después del tramadol (4,8 ± 2,1 pg.mL-1; p = 0,04, Test de Mann-Whitney). No hubo diferencia significativa de IL-1β, IL-6 y sTNF-R1 antes y después del tratamiento. Las concentraciones plasmáticas de TNF-α (sanos: 1,4 ± 0,5; pacientes con dolor: 5,8 ± 2,8 pg.mL-1; p = 0.01) y IL-6 (sanos: 1,2 ± 0,8; pacientes con dolor: 3.5 ± 2,6 pg.mL-1; p = 0,01) fueron significativamente mayores en los pacientes con dolor neuropático que en los voluntarios, test de Mann-Whitney. CONCLUSIONES: En los pacientes con hernia discal y síndrome del túnel del carpo, las concentraciones plasmáticas de TNF-α yIL-6, fueron más elevadas que en los voluntarios sanos, no habiendo ninguna diferencia en las concentraciones de sTNF-R y IL-1β...

Frequency of mental disturbances in HTLV-1 patients in the state of Bahia, Brazil

Viral infections and chronic diseases have been associated with psychiatric disorders. Among these, increased depression has been reported in HTLV-1 patients. However, no studies on the prevalence of other mental disturbances have been carried out in these patients. Salvador is the city with the highest rate of infection with HTLV-1 in Brazil and it is estimated that approximately 40,000 inhabitants are infected. In our cross sectional study, we examined the frequency of mental disturbances in 50 HTLV-1 seropositive patients followed at the Centro Integrativo e Multidisciplinar de HTLV e Hepatites Virais (CHTLV) of the Escola Bahiana de Medicina e Saude Pública (EBMSP) in Salvador from January to November 2007. We used a questionnaire to collect clinical-epidemiologic data and the Mini International Neuropsychiatric Interview Brazilian Version 5.0.0 (M.I.N.I.) to evaluate the psychiatric disorders. The Statistical Package for Social Sciences (SPSS) was used for the analyses. Twenty-one (42 percent) HTLV-1 patients had a psychiatric co-morbidity; 17(34 percent) had mood disorders, 11 (22 percent) were anxious and one (2 percent) was an alcoholic. We found a high frequency of mental disturbances among HTLV-1 infected individuals, suggesting a possible association of this infection with psychiatric diseases.

Síndromes coronarianas agudas na ausência de doença arterial coronariana significativa / Acute coronary syndromes in the absence of significant coronary artery disease

OBJETIVO: Avaliar as características clínicas, a evolução e as complicações intra-hospitalares de pacientes com síndromes coronarianas agudas (SCA) na ausência de doença arterial coronariana (DAC) obstrutiva significativa. MÉTODOS: Estudo transversal envolvendo pacientes internados, de agosto/96 a março/02, com síndromes coronarianas agudas, com e sem supradesnivelamento ST, analisando as características clinicas, demográficas e complicações intra-hospitalares nos casos com (>50 por cento) e sem (< 50 por cento) estenose coronariana significativa. RESULTADOS: Dos 1351 pacientes admitidos com síndrome coronariana aguda, 28 por cento apresentavam supradesnivelamento ST e 72 por cento não o demonstravam. Os pacientes com a síndrome coronariana aguda sem supradesnivelamento do segmento ST, na ausência de obstrução coronariana significativa, eram mais jovens, predominantemente mulheres, e apresentavam menor freqüência de dislipidemia, doença arterial coronariana prévia, diabetes mellitus, tabagismo e hipertensão arterial sistêmica, quando comparados àqueles com lesão obstrutiva significativa. Entre os indivíduos com síndrome coronariana aguda e supradesnivelamento ST, tabagismo foi o fator de risco com maior prevalência nos pacientes com lesão obstrutiva não significativa. Quanto às complicações, houve menor freqüência de isquemia recorrente, insuficiência cardíaca congestiva e arritmias em pacientes com síndrome coronariana aguda sem supradesnivelamento ST na ausência de lesão coronariana obstrutiva significativa. CONCLUSÃO: Pacientes com síndrome coronariana aguda sem supradesnivelamento ST com lesões coronarianas obstrutivas não significativas são mais jovens, predominantemente mulheres, com menor freqüência de fatores de risco para doença arterial coronariana e menor incidência de complicações, em relação aos pacientes com lesão coronariana obstrutiva significativa.

Freqüência e implicaçöes dos auto-anticorpos em hepatites agudas virais / Frequency and implications of autoantibodies in acute viral hepatitis

Existem interaçöes entre viroses hepatotrópicas e o sistema imunológico do hospedeiro que podem influenciar na patogenicidade da agressäo hepática. O objetivo deste trabalho foi investigar a freqüência de auto-anticorpos na fase aguda da hepatite viral, sua relaçäo com atividade bioquímica, gravidade da doença e cronicidade. Foram estudados 156 pacientes com hepatite aguda viral de 1992 a 2000. Destes, 32 por cento tiveram infecçäo por vírus A, 31 por cento por vírus B, 8 por cento por vírus C, 3 por cento tiveram hepatite E e 24 por cento näo A-E. Na fase aguda, 20,5 por cento apresentaram FAN e 14,8 por cento antimúsculo liso positivos. Na convalescença, 6,4 por cento persistiram com FAN e 3,9 por cento com antimúsculo liso positivos. Pacientes que persistiam com anticorpos detectáveis näo apresentavam níveis de transaminases e bilirrubinas significativamente diferentes daqueles com auto-anticorpos negativos. Concluindo, os anticorpos que aparecem na fase inicial da infecçäo säo transitórios e näo têm implicaçäo prognóstica

[Frequency and implications of autoantibodies in acute viral hepatitis]. / Freqüência e implicações dos auto-anticorpos em hepatites agudas virais.

There are interactions between hepatotropic viruses and the host immune system, which could contribute to liver damage in viral hepatitis. The aim of this study was to investigate the frequency of autoantibodies in patients with acute viral hepatitis and their relationship with biochemical activity, severity of acute illness and chronicity rate. From 1992 to 2000, 156 patients with acute viral hepatitis were enrolled in a prospective study. Among these, hepatitis A was detected in 32%, hepatitis B in 31%, hepatitis C in 8%, hepatitis E in 3% and 24% were considered non A-E hepatitis. During the acute phase, 20.5% of patients presented ANA and 14.8% anti-smooth muscle antibody positive. During convalescence, 6.4% of patients showed ANA and 3.9% anti-smooth muscle positive. Comparison between autoantibodies-positive and negative groups showed no differences regarding ALT and bilirubin levels. In conclusion, autoantibodies can occur in acute viral hepatitis but there are no prognostic consequences.

Comparative study of bacterial infection prevalence between cirrhotic patients with and without upper gastrointestional bleeding

Bacterial infection is a frequent complication in patients with chronic liver disease, mainly during the advanced stages. There is evidence that the main factors that contribute to a predisposition to infection in cirrhotic patients are related to hepatic failure with consequent immunodeficiency. Invasive procedures (diagnostic or therapeutic) can predispose to baceterial infections, and upper gastrointestinal bleeding (UGB) is considered a potentially important risk factor. A group of cirrhotic patients (child B and C Pugh groups) were evaluated retrospectively by chart reviews regarding the prevalence of bacterial infection during hospitalization to determine whether UGB was a risk factor. An infection was considered present if a specific organ system was identified or if fever (>38§C) persisted for more than 24 hours with associated leukocytosis. Spontaneous bacterial peritonitis was based on classical criteria. Eighty-nine patients were evaluated. Fourty-six patients presented with UGB, and 43 patients had no UGB (control). There were infections recorded in 25/46 (54 percent) patients with UGB, and 15/43 (35 percent) in those without UGB (p=0.065). The ratio of the number of infections/admitted patients, was significantly larger in the group with UGB (0.78 ñ 0.89 vs. 0.39 ñ 0.62; p=0.028) since patients had more than one infection. In the UGB group compared to non UGB group, ascites was more frequent (67 percent vs. 42 percent; p=0.027); they were more likely to have undergone endoscopic procedures (p<0.001) and the mean ñ SD for platelets count was smaller (96,114 ñ 57,563 vs. 145,674 ñ 104,083; p=0.007). The results show that UGB is an important contribution to bacterial infection among Child B and C cirrhotic patients.

Tendência da mortalidade por infarto agudo do miocárdio (1981-1996) na cidade de Salvador, Brasil / Mortality attribute to myocardial infarction in the male and female population of Salvador, BA, between 1981 and 1996

OBJECTIVE: To describe according to gender the trend in mortality attributed to myocardial infarction (MI) in the population of Salvador, Bahia between 1981 and 1996. METHODS: This study was on mortality due to MI estimates by period and gender of the city of Salvador, Bahia. Data from 1981 to 1996 were stratified by quadrienia, and the percentage reduction in death rate due to MI relative to the preceding period (PRR) was determined. Comparisons between genders were expressed by the male/female death ratio (DR) based on the gender-related PPR. RESULTS: An overall increase of approximately 8 percent was observed in the death rate attributed to MI for the period 1985-1988 (89.2/10 5 individuals / year) versus the period 1981-1984 (82.1/105/ year). In the subsequent periods, overall reductions of 10 percent and 20.3 percent were observed for the periods 1989-1992 and 1993-1996, respectively. For men, the PPRs were 11.1in the period 1989-1992 and 22.7 percent in the period 1993-1996. The PPRs in women were lower: 8.6 percent and 17.4 percent between 1989 and 1992, and 1993 and 1996, respectively. Death rate reduction was greater for men than women, then the male/female DR decreased from 1.66 in 1981-1984 to 1.35 in 1993-1996. CONCLUSION: The results indicate a trend towards a reduction in the death rate attributed to myocardial infarction in the city of Salvador from the second half of the 1980s onwards, striking in men.

Use of carbamazepine-buspirone combination in alcohol dependence / Uso da associação carbamazepina-buspirona na dependência do álcool

Setenta e quatro dentre os 117 pacientes atendidos no ambulatório para alcoolistas de um hospital universitário, apresentaram os critérios do DSM-III-R para dependência do álcool e foram tratados com a associaçäo carbamazepina-buspirona durante seis meses. Aqueles que näo completaram esse período foram considerados como insucesso terapêutico, de acordo com o princípio de intençäo-de tratar. Verificou-se que 47,3 por cento apresentaram remissäo parcial (8,1 por cento) ou total (39,2 por cento). Tanto a carbamazepina quanto a buspirona foram bem toleradas pelos pacientes em doses que variam entre 400 a 800 mg/dia e 10 a 40 mg/dia, respectivamente