Natural malaria infection in anophelines vectors and their incrimination in local malaria transmission in Darién, Panama.

BACKGROUND: More than 85% of the malaria cases in Panama occur in poor, rural and indigenous regions like Darien Province. Vector diversity, infection rate and spatial distribution are important entomological parameters of malaria transmission dynamics. Their understanding is crucial for the development of effective disease control strategies. The objective of this study was to determine the composition of Anopheles species, their natural infection rate and their geographic distribution to better understand the malaria transmission dynamics in Darién, Panama. METHODS: Anophelines mosquitoes were captured during the rainy and dry season of 2016. We selected five communities where adult anophelines were collected using CDC light-traps, and through protective human-baited traps. Detection of natural infection and Plasmodium genotype were detected via nested PCR through the amplification of ssrRNA and the circumsporozoite protein gene (csp), respectively. RESULTS: A total of 1,063 mosquitoes were collected mosquitoes were collected for the detection of natural infection with Plasmodium spp. Nine Anophelines species were identified, with the predominant species being: An. (Nys.) darlingi (45.0%) and An. (Nys.) albimanus (42.6%). Natural infection in An. (Nys.) albimanus with P. vivax was detected in one mosquito pool from the community Pueblo Tortuga (0.6%), three from Marraganti (1.7%), two from Bajo Chiquito (1.1%) and three pools from Alto Playona 3 (1.7%). For An. (Nys.) darlingi mosquitoes, we detected seven positive pools from the community Bajo Chiquito (4.0%), two pools from Marraganti (1.1%) and two pools from Alto Playona (1.1%). The P. vivax allelic variant VK210 was detected in infected mosquitoes. CONCLUSION: The results from this study provide new information on the transmission dynamics associated with anophelines vectors in the Darién region. This is the first report of natural P. vivax infection in An. (Nys.) darlingi and its incrimination as a potential malaria vector in this region of Panama. Additional studies are necessary to expand our knowledge and determine crucial parameters in malaria transmission in Darién, which in turn will aid the National Malaria Program in attaining an adequate malaria control strategy towards malaria elimination.

Study of the epidemiological behavior of malaria in the Darien Region, Panama. 2015-2017.

BACKGROUND: Malaria is endemic in Darién and an assessment of the different factors affecting its epidemiology is crucial for the development of adequate strategies of surveillance, prevention, and disease control. The objective of this study was to determine the main characteristics of the epidemiological behavior of malaria in the Darien region. METHODS: This research was comprised of a retrospective analysis to determine the incidence and malaria distribution in the Darien region from 2015 to 2017. We evaluated malaria indicators, disease distribution, incidence (by age group and sex), diagnostic methods, treatment, and control measures. In addition, we examined the cross-border migration activity and its possible contribution to the maintenance and distribution of malaria. RESULTS: During the period of 2015-2017, we examined 41,141 thick blood smear samples, out of which 501 tested positive for malaria. Plasmodium vivax was responsible for 92.2% of those infections. Males comprised 62.7% of the total diagnosed cases. Meanwhile, a similar percentage, 62.7%, of the total cases were registered in economically active ages. The more frequent symptoms included fever (99.4%) and chills (97.4%), with 53.1% of cases registering between 2,000 and 6,000 parasites/µl of blood. The annual parasitic incidence (API) average was 3.0/1,000 inhabitants, while the slide positivity rate (SPR) was 1.2% and the annual blood examination rate (ABER) 22.5%. In Darién there is a constant internal and cross-border migration movement between Panama and Colombia. Malaria control measures consisted of the active and passive search of suspected cases and of the application of vector control measures. CONCLUSION: This study provides an additional perspective on malaria epidemiology in Darién. Additional efforts are required to intensify malaria surveillance and to achieve an effective control, eventually moving closer to the objective of malaria elimination. At the same time, there is a need for more eco-epidemiological, entomological and migratory studies to determine how these factors contribute to the patterns of maintenance and dissemination of malaria.

Does salt addiction exist? / ¿Existe la adicción a la sal?

Abstract: BACKGROUND: Salt consumption activates the brain reward system, inducing cravings and the search for salted food. Its excessive intake is associated with high blood pressure and obesity. The high quantity of salt in processed food is most likely a major cause of the global pandemic of hypertension (HT). OBJECTIVE: To review the current information on the topic of salt addiction and the health consequences this has. METHOD: A search in PubMed, ScienceDirect, and EBSCOhost databases was conducted with the keywords "salt", "salt addiction", and "food addiction". Articles with information relative to the topic of interest were checked, as were references of those articles and historical and culturally complementary information. RESULTS: We described the historical relationship between man and salt, the physiology of salty taste perception, its role in the reward system and the health consequences of a high sodium diet. DISCUSSION AND CONCLUSION: There is physiological and behavioural evidence that some people may develop a true addiction to food. Among these people, salt addiction seems to be of great importance in the development of obesity, HT and other diseases. Sodium is present in high quantities in processed food as salt and monosodium glutamate (MSG), used as flavour enhancers and food preservatives, including in non-salty foods like bread and soft drinks.

Resumen: ANTECEDENTES: El consumo de sal activa el sistema de recompensa cerebral, induciendo el deseo y búsqueda de alimentos salados. Su ingesta excesiva se asocia a presión arterial elevada y obesidad. La gran cantidad de sal en los alimentos procesados ha permitido que la hipertensión (HT) se instale hoy día como una pandemia. OBJETIVO: Revisar la bibliografía existente en el tema de adicción a la sal y sus consecuencias en la salud. MÉTODO: Se realizó una búsqueda en bases de datos PubMed, EBSCOhost y ScienceDirect con las palabras claves "salt", "salt addiction", "food addiction"; se revisaron los artículos que contuvieran información relativa al tema de interés así como referencias en estos mismos artículos e información histórica y cultural complementaria. RESULTADOS: Describimos la relación histórica entre el hombre y la sal, los mecanismos fisiológicos de percepción del sabor salado, su acción sobre el sistema de recompensa y las consecuencias en la salud de una dieta alta en sodio. DISCUSIÓN Y CONCLUSIÓN: Existe evidencia fisiológica y comportamental de que las personas pueden desarrollar una verdadera adicción a la ingestión de alimentos. Entre estas personas la adición a la sal juega un papel muy importante para el desarrollo de obesidad, hipertensión y otras enfermedades. El sodio está presente en altas cantidades en los alimentos procesados en forma de sal y glutamato monosódico (MSG), usados como conservadores o aditivos alimentarios, incluso en alimentos no salados como harinas y refrescos dulces.

Conocimientos, actitudes y prácticas sobre la malaria en la población indígena guna de la comarca de Madungandí, Panamá, 2012 / Knowledge, attitudes and practices regarding malaria in the indigenous Guna population of the Madungandí region, Panamá, 2012

Introducción. Las encuestas sobre comportamientos, actitudes y prácticas permiten determinar el grado de conocimiento de la población sobre la malaria o paludismo, así como las actitudes y prácticas que contribuyen a su transmisión. Objetivo. Identificar los conocimientos, actitudes y prácticas que favorecen la transmisión de la malaria en la población indígena guna de Madungandí. Materiales y métodos. Se hizo un estudio transversal mediante una encuesta a los jefes de familia de una muestra de 40 % de las viviendas en tres comunidades con alta incidencia de malaria. La encuesta se hizo con encuestadores gunas e integrantes del equipo de investigación, y con la ayuda de un traductor. El análisis se hizo en Epi-Info 6.04. Resultados. El rango de edad de los encuestados fluctuaba entre los 20 y los 70 años. Todos los encuestados indicaron pertenecer a la etnia guna y hablar su lengua; 64 % eran del sexo masculino y 30 % eran analfabetas. La mitad de los encuestados (51 %) manifestó haber enfermado de malaria, por lo menos, una vez en los últimos ocho años y 89 % reconoció la enfermedad como un problema de salud. El 63 % manifestó que el médico tradicional "inadule" curaba la malaria, y 78 % practicaba la "fuma de la pipa" y la "quema del cacao" para prevenirla. Conclusión. Dado el limitado conocimiento sobre la malaria y su vector, así como la actitud de colaboración de la población guna, es necesario iniciar programas educativos y de participación comunitaria para mejorar las prácticas de prevención y control en las comunidades, y disminuir así la incidencia de la enfermedad en la comarca de Madungandí.

Introduction: Knowledge, attitudes and practices surveys allow to determine the degree of knowledge on the management of malaria in a given population, as well as the attitudes and practices that contribute or not to its transmission. Objective: To identify the knowledge, attitudes and practices that favor or not the transmission of malaria in the indigenous Guna population of Madungandí. Materials and methods: A cross-sectional study was conducted by applying a survey to the heads of the families in a sample of 40% of households in three communities with high malaria incidence. Local Guna residents and translators were part of the research team that applied the questionnaires. The statistical analysis was performed in Epi-Info 6.04. Results: The age range of those surveyed was between 20 and 70 years. All responders indicated that they belonged to and spoke the language of the Guna ethnic group, 64% were male and 30% were illiterate. Half (51%) of the responders declared they had suffered malaria at least once in the last eight years, and 89% accepted that malaria was a health problem. Sixty-three per cent responded that their traditional doctors, “inadule”, cured malaria and 7.0 % practiced the “pipe smoking” and “cocoa burn” rituals to prevent the disease. Conclusion: Considering the limited knowledge about malaria and its vector, as well as the willingness to collaborate shown by the Guna population, it is essential to initiate educational and participative programs to improve control and prevention activities in the communities aimed at achieving a reduction in malaria incidence in the Madungandí indigenous region.

Characterization of a recent malaria outbreak in the autonomous indigenous region of Guna Yala, Panama.

BACKGROUND: This study aims to describe the epidemiological and entomological factors associated with a recent malaria outbreak that occurred in 2012 in a socially marginalized population from Guna Yala Comarca in Panama. METHODS: A descriptive and observational study was conducted by analysing demographic and epidemiological data from all malaria cases registered during 2012 in the Comarca Guna Yala, Panama. Malaria intensity indicators were calculated during the study period. Entomological evaluations were performed monthly, from October to December 2012, in the three communities that presented the most intense malaria transmission during the first semester of 2012. Anopheles breeding habitats were also characterized. RESULTS: During the studied period, 6754 blood smears were examined (17.8 % of the total population), and 143 were confirmed as positive for Plasmodium vivax. A significant increase of malaria transmission risk indicators (API: 3.8/1000, SPR: 2.1 %) was observed in Guna Yula, when compared with previous years, and also in comparison with estimates from the whole country. Anopheles albimanus was the most abundant and widespread (877; 72.0 %) vector species found in the three localities, followed by Anopheles punctimacula (231; 19.0 %) and Anopheles aquasalis (110; 9.0 %). Three An. albimanus pools were positive for P. vivax, showing an overall pooled prevalence estimate of 0.014. CONCLUSIONS: Data analysis confirmed that during 2012 a malaria epidemic occurred in Guna Yala. Panama. This study provides baseline data on the local epidemiology of malaria in this vulnerable region of Panamá. This information will be useful for targeting control strategies by the National Malaria Control Programme.

[Knowledge, attitudes and practices regarding malaria in the indigenous Guna population of the Madungandí region, Panamá, 2012]. / Conocimientos, actitudes y prácticas sobre la malaria en la población indígena guna de la comarca de Madungandí, Panamá, 2012.

INTRODUCTION: Knowledge, attitudes and practices surveys allow to determine the degree of knowledge on the management of malaria in a given population, as well as the attitudes and practices that contribute or not to its transmission. OBJECTIVE: To identify the knowledge, attitudes and practices that favor or not the transmission of malaria in the indigenous Guna population of Madungandí. MATERIALS AND METHODS: A cross-sectional study was conducted by applying a survey to the heads of the families in a sample of 40% of households in three communities with high malaria incidence. Local Guna residents and translators were part of the research team that applied the questionnaires. The statistical analysis was performed in Epi-Info 6.04. RESULTS: The age range of those surveyed was between 20 and 70 years. All responders indicated that they belonged to and spoke the language of the Guna ethnic group, 64% were male and 30% were illiterate. Half (51%) of the responders declared they had suffered malaria at least once in the last eight years, and 89% accepted that malaria was a health problem. Sixty-three per cent responded that their traditional doctors, “inadule”, cured malaria and 7.0 % practiced the “pipe smoking” and “cocoa burn” rituals to prevent the disease. CONCLUSION: Considering the limited knowledge about malaria and its vector, as well as the willingness to collaborate shown by the Guna population, it is essential to initiate educational and participative programs to improve control and prevention activities in the communities aimed at achieving a reduction in malaria incidence in the Madungandí indigenous region.

High prevalence of aggregative adherent Escherichia coli strains in the mucosa-associated microbiota of patients with inflammatory bowel diseases.

The intestinal population of Escherichia coli is increased in patients with inflammatory bowel disease (IBD), but the reason for this elevation, the particular features of these bacteria and their potential role in the pathogenesis of the disease are not known. The present study was undertaken to investigate the adherence abilities and some virulence properties of a collection of 131 E. coli isolates cultured from rectal biopsies of 23 subjects diagnosed with ulcerative colitis (UC), 8 with Crohn's disease (CD) and 23 control patients from southern Brazil. The adherence abilities of the bacteria were investigated in vitro, using HEp-2 epithelial cells in assays of 3 and 6h of bacteria-cell contact. The isolates were screened by PCR with primers for the following virulence genetic markers: plasmid of aggregative adhesion (pAA) and the aggregative adherence fimbriae R (aggR), E. coli attaching and effacing (eae), invasion-associated locus (ial), invasion plasmid antigen H (ipaH) and Shiga citotoxin-encoding (stx) genes. HEp-2 cells aggregative adherent E. coli strains, as detected in the 3h adherence assay, were found in 14/23 (60.9%) patients with UC, 7/8 (87.5%) with CD and in 7/23 (30.4%) controls (p=0.011). Virulence genetic markers were detected in strains of 9 patients with UC (39.1%), but in none of CD or control group. Two of these UC patients had strains harboring both pAA and aggR, one had strains positive for aggR, four had strains positive for eae and two had strains positive for stx. These results suggest that the augmented population of E. coli on the rectal mucosa of IBD patients, particularly of those diagnosed with UC, is mostly comprised of aggregative adherent strains, some of which possessing classical virulence markers of E. coli.

Incidence and prevalence rates of inflammatory bowel diseases, in midwestern of São Paulo State, Brazil.

CONTEXT: The incidence and populational prevalence of inflammatory bowel diseases, hitherto unknown in Brazil, were estimated for a region in the Midwest of São Paulo State, Brazil. METHODS: Using a sequential registry of 115 adult patients (>15 years old) with inflammatory bowel diseases - exclusively residing in the studied region with 533,508 inhabitants (2005) and attended at the reference hospital during a 20 year interval (1986-2005) - were estimated, in four consecutives periods of 5 years each, the incidences according to gender, type of the disease and the prevalence of these diseases, and its inner-relations evaluated by the Poisson regression model. RESULTS: The inflammatory bowel diseases in the studied region predominated among young, white race and people living in urban area, and the incidence on the female population rose during this period. The incidence of ulcerative colitis were higher than Crohn's disease and non-classified colitis, and showed a progressive increase in the first three periods with a decrease in the last one (2001-2005), where the observed rates of ulcerative colitis, Crohn's disease and non-classified colitis were 4.48, 3.50 and 1.75 cases/100,000 inhabitants, with prevalence of 22.61, 14.81, 5.65, 2.14 cases/100,000 inhabitants for total inflammatory bowel diseases. CONCLUSION: The inflammatory bowel diseases incidence in the studied area was as low as in other countries of Latin America and smaller than that found in countries of South Europe. The crescent prevalence justifies the policies to adequate medical cares for inflammatory bowel diseases patients in this area.

Incidence and prevalence rates of inflammatory bowel diseases, in midwestern of São Paulo State, Brazil / Incidência e prevalência das doenças inflamatórias intestinais na região centro-oeste do Estado de São Paulo

CONTEXT:The incidence and populational prevalence of inflammatory bowel diseases, hitherto unknown in Brazil, were estimated for a region in the Midwest of São Paulo State, Brazil. METHODS: Using a sequential registry of 115 adult patients (>15 years old) with inflammatory bowel diseases - exclusively residing in the studied region with 533,508 inhabitants (2005) and attended at the reference hospital during a 20 year interval (1986-2005) - were estimated, in four consecutives periods of 5 years each, the incidences according to gender, type of the disease and the prevalence of these diseases, and its inner-relations evaluated by the Poisson regression model. RESULTS: The inflammatory bowel diseases in the studied region predominated among young, white race and people living in urban area, and the incidence on the female population rose during this period. The incidence of ulcerative colitis were higher than Crohn's disease and non-classified colitis, and showed a progressive increase in the first three periods with a decrease in the last one (2001-2005), where the observed rates of ulcerative colitis, Crohn's disease and non-classified colitis were 4.48, 3.50 and 1.75 cases/100,000 inhabitants, with prevalence of 22.61, 14.81, 5.65, 2.14 cases/100,000 inhabitants for total inflammatory bowel diseases. CONCLUSION: The inflammatory bowel diseases incidence in the studied area was as low as in other countries of Latin America and smaller than that found in countries of South Europe. The crescent prevalence justifies the policies to adequate medical cares for inflammatory bowel diseases patients in this area.

CONTEXTO: No Brasil, a incidência e prevalência populacionais das doenças inflamatórias intestinais são desconhecidas. OBJETIVO: Neste trabalho, estimou-se esses parâmetros na área que abrange a antiga região de saúde DIR 11, no centro-oeste do Estado de São Paulo. MÉTODOS: Usou-se um registro sequencial de 115 pacientes (>15 anos de idade) com doenças inflamatórias intestinais, residindo na área de estudo, atendidos durante período de 20 anos (1986-2005) em hospital de referência. Estimou-se, para quatro períodos consecutivos de 5 anos, as incidências e prevalências de acordo com os tipos de doença e do sexo de doentes. As suas inter-relações foram analisadas utilizando o modelo de regressão linear de Poisson. RESULTADOS: Na região, as doenças inflamatórias intestinais foram predominantes em mulheres jovens, da raça branca, residindo na zona urbana.A incidência da retocolite foi maior que a da doença de Crohn e das colites não classificadas, e diferentemente dessas duas ultimas, mostrou decréscimo no último período (2001-2005). Neste mesmo período, a taxa da incidência para a retocolite foi de 4,48 casos/100.000 habitantes, para a doença de Crohn atingiu 3,50 casos/100.000 habitantes e a das colites não classificadas foi de 1,75 casos/100.000 habitantes. As prevalências atingiram os valores de 14,81 casos/100.000 habitantes para a retocolite, 5,65 casos/100.000 habitantes para a doenças de Crohn e 2,14 casos/100.000 habitantes. Considerando todas as doenças inflamatórias a prevalência atingiu o valor de 22,61 casos/100.000 habitantes. CONCLUSÃO:A incidência dessas doenças inflamatórias intestinais nessa região é baixa, igualando-se aos países da América Latina e do sul da Europa e sua crescente prevalência justifica políticas de saúde para as suas abordagens.

[Fiber intake and colonic transit time in functional constipated patients]. / Ingestão de fibra alimentar e tempo de trânsito colônico em pacientes com constipação funcional.

BACKGROUND: Patients with functional constipation presenting no response to treatment using fibers supplement represents important clinical issue. AIMS: To evaluate the relations among the amount of ingested fiber, the constipation intensity and the colonic transit time in patients with functional constipation. METHODS: We evaluated 30 patients, presenting no response to treatment using fibers supplement, and 18 healthy volunteers conducting individual inquiry into fibers intake, constipation intensity and the total and segmental colonic transit evaluation using radiopaque markers. RESULTS: In the constipated, despite the good level of fiber intake (26.3 +/- 12.9 g, constipated x 9.3 +/- 5,2 g, control), the symptoms of constipation was serious (score = 21.3 +/- 4.07). Mean total colonic transit was 58.8h. The colonic transit was slower in the constipated group (41.0 +/- 22.8 hours, constipated x 21.8 +/- 18.5h, control). In constipated patients with slow colonic transit (>58.8h) there were colonic inertia (eight), outlet constipation (one) and slow transit in left colon (one), and among constipated patients with normal colonic transit (<58.8h), there were isolated slow transit, in the right colon (nine), left colon (three) and in the rectosigmoid segment (eight). There were no relation among the amount of ingested fiber, constipation intensity and the colon transit. CONCLUSIONS: In the functional constipation the gravity of symptoms does not depend only on the dietary fibers intake, which is not the only responsible for the differences in the colonic transit. The colonic transit can differentiate normal from constipated patients and, among them, those with altered transit that demand approaches distinct of fiber supplementation.

Ingestão de fibra alimentar e tempo de trânsito colônico em pacientes com constipação funcional / Fiber intake and colonic transit time in functional constipated patients

RACIONAL: Pacientes com constipação funcional que não melhoram com suplementação de fibras dietéticas, representam importante problema clínico. OBJETIVOS: Avaliar as relações entre as quantidades de fibras ingeridas, intensidade da constipação e o tempo de trânsito colônico em pacientes com constipação funcional. MÉTODOS: Foram avaliados 30 pacientes constipados funcionais, sem melhoras após suplementação dietética com fibras e 18 pessoas controle, sadias, sem queixas digestivas, utilizando inquéritos individuais quanto à ingestão de fibras e a intensidade da constipação e, por meio da técnica dos marcadores radiopaco, o tempo de trânsito colônico, total e segmentar. RESULTADOS: Apesar da maior ingestão diária de fibras (26,3 ± 12,9 g, constipados x 9,3 ± 5,2 g, controles), os sintomas da constipação mostraram-se intensos nos constipados (escore médio = 21,3 ± 4,07). O tempo normal para o trânsito colônico foi de 58,8h. O trânsito colônico total, em média, foi mais lento nos constipados (41,0 ± 22,8h, constipados x 21,8 ± 18,5h, controles). Constipados com trânsito lento (>58,8h) apresentaram inércia colônica (oito), obstrução de saída (um) e lentificação no cólon esquerdo (um). Constipados com trânsito normal (<58,8h), apresentaram lentificações isoladas no cólon direito (nove), no cólon esquerdo (três) e no segmento retossigmoideano (oito). Não houve correlação entre a quantidade ingerida de fibra, intensidade da constipação e tempo de trânsito colônico nos constipados funcionais. CONCLUSÕES: Em constipados funcionais a gravidade da constipação não depende apenas da ingestão de fibras, que, também não é a única contributiva para as variações no tempo de trânsito colônico. Este diferencia os pacientes normais dos constipados e nestes, aqueles com trânsito alterado que exigem abordagens diferentes da suplementação de fibras.

BACKGROUND: Patients with functional constipation presenting no response to treatment using fibers supplement represents important clinical issue. AIMS: To evaluate the relations among the amount of ingested fiber, the constipation intensity and the colonic transit time in patients with functional constipation. METHODS: We evaluated 30 patients, presenting no response to treatment using fibers supplement, and 18 healthy volunteers conducting individual inquiry into fibers intake, constipation intensity and the total and segmental colonic transit evaluation using radiopaque markers. RESULTS: In the constipated, despite the good level of fiber intake (26.3 ± 12.9 g, constipated x 9.3 ± 5,2 g, control), the symptoms of constipation was serious (score = 21.3 ± 4.07). Mean total colonic transit was 58.8h. The colonic transit was slower in the constipated group (41.0 ± 22.8 hours, constipated x 21.8 ± 18.5h, control). In constipated patients with slow colonic transit (>58.8h) there were colonic inertia (eight), outlet constipation (one) and slow transit in left colon (one), and among constipated patients with normal colonic transit (<58.8h), there were isolated slow transit, in the right colon (nine), left colon (three) and in the rectosigmoid segment (eight). There were no relation among the amount of ingested fiber, constipation intensity and the colon transit. CONCLUSIONS: In the functional constipation the gravity of symptoms does not depend only on the dietary fibers intake, which is not the only responsible for the differences in the colonic transit. The colonic transit can differentiate normal from constipated patients and, among them, those with altered transit that demand approaches distinct of fiber supplementation.

Reconstrução do Ligamento Cruzado Anterior com Tendão Patelar e Tendões dos Músculos Semitendinoso e Grácil: Avaliação Clinicofuncional Comparativa pelo Protocolo do IKDC

Avaliar comparativamente os resultados clinicofuncionais das reconstruções do ligamento cruzado anterior(LCA)com o tendão patelar (TP) e tendões dos músculos semitendinoso (ST) e grácil(GR)

Avaliação dos Mecanismos de Lesão do Ligamento Cruzado Anterior no Futebol / Evaluation of Mechanisms of Anterior Cruciate Ligament Injuries In Soccer

Definir os principais mecanismos de lesão do ligamento cruzado anterior durante a prática do futebol

Análise Epidemiológica das Rupturas do Ligamento Cruzado Anterior em Pacientes Atendidos no Instituto Nacional de Tráumato-Ortopedia / Epidemiology of Anterior Cruciate Ligament Ruptures in Patients Treated at the National Institute of Orthopaedic and Trauma

A lesão do ligamento cruzado anterior permance como assunto de controvérsia no que diz respeito aos seus fatores de risco, história natural e opções de tratamento.Para elaborar estratégias de prevenção e melhoria no atendimento desses pacientes é fundamental a obtenção de informações sobre essa população

Curso Tópicos de Medicina Interna - aula 14 Molho de Tomate: boas notícias sobre um velho amigo / Course: topics in internal Medicine, 14th lesson: Tomato souce: good news about a old friend

O lycopene é um dos carotenóides mais ingeridos nas dietas dos países ocidentais, sendo o tomate (Solanum lycopersicum) cozido sua principal origem. Dentre os carotenóides, é o que tem maior capacidade quelante contra o singlet oxigêncio. Estudos experijentais e epidemiológicos sugerem efeitos protetores do lycopene em doenças cardiiovasculares e vários tipos de câncer, em especial no câncer de próstata

Curso: tópicos de medicina interna, aula 9: padronização da técnica de PCR para detecção da t(14; 18) em materiais de arquivo / Course: topics in internal medicine, 9th lesson: PCR technique`s standardization on t(14; 18) detection in fixed materials

Os linfomas não-Hodgkin (LNH) são caracterizados pela proliferação de células linfocíticas. O protooncogene BCL-2 codifica uma proteína de membrana mitocondrial interna que bloqueia a apoptose. Cerca de oitenta e cinco por cento dos linfomas foliculares e trinta por cento dos difusos tê como evento inicial a t(14; 18). A translocação justapõe o BCL-2 localizado no cromossomo 18 à região codificadora da cadeia pesada da imunoglobulina (IgH) no cromossomo 14. Em decorrência desse rearranjo, a expressão do BCL-2 é exacerbada e a apoptose inibida, prolongando o tempo de vida dos linfócitos B. O objetivo deste trabalho foi a padronização da técnicde PCR para detecção da t(14; 18) em materiais de arquivo. O método foi considerado sensível, podendo ser utilizado na investigação da doença residual mínima

Utilizaçäo do metabolismo protéico (15N-glicina) na detecçäo precoce de agravamento da atividade da doença em pacientes portadores de retocolite ulcerativa inespecífica / Utilization of the proteic metabolism (15N-glycine) in the precocious detection of disease exacerbation in patients with unespecific ulcerative colitis

Dez pacientes portadores de retocolite ulcerativa inespecífica em atividade leve e moderada foram acompanhados por um período de quatro meses. Foram avaliados os seguintes indicadores de atividade da doença: clínicos (número de evacuaçoes e presença de sangue nas fezes), laboratoriais (hemoglobina, contagem de plaquetas, VHS, mucoproteínas, alpha1-glicoproteína ácida e PCR), escore retossigmoidoscópico e histopatológico. Avaliou-se também o metabolismo protéico dos pacientes mediante (15)N-glicina e amônia como produto final. Apenas um paciente teve exacerbaçao acentuada da atividade da doença durante o período de estudo. Esse paciente apresentava no início do estudo valores de síntese e catabolismo protéicos superiores aos de todos os outros pacientes, ou seja, 4,51 e 3,47 g de proteína/Kg/dia, respectivamente, mostrando estado de hipermetabolismo, compatível com aumento da atividade da doença. Esse aumento de atividade nao foi, entretanto, detectado pelos demais indicadores utilizados, possibilitando aventar a hipótese de que a avaliaçao do metabolismo protéico consegue detectar precocemente o agravamento da atividade da doença em pacientes com retocolite ulcerativa.

Título Hipertensão no idoso: tratamento / Elderly hipertension: treatment

A expectativa de vida da população tem aumentado. Como conseqüência, o contingente de hipertensos idosos vem aumentando gradativamente. Estimando-se que prevalência de hipertensão em indivíduos acima de 50 anos seja de 50 por cento, aproximadamente 6 milhões de brasileiros idosos são portadores desta doença. O risco cardiovascular do idoso hipertenso é maior, confrontado com o do normotenso de idade comparável. A capacidade de recuperação satisfatória após um evento cardiovascular grave também é menor no idoso, confrontando com hipertensos de menor idade. Os grandes estudos de tratamento de hipertensão arterial mostraram que o benefício é maior e mais rápido de ser obtido que no hipertenso jovem. O tratamento, constituído por mudança do estilo de vida e drogas anti-hipertensivas, pode prevenir estas complicações. Isto representa economia para o sistema de saúde e pode evitar grande parte de eventos incapacitantes e mutilantes desta população. A presente revisão pretende esclarecer alguns aspectos do tratamento da hipertensão no paciente idoso

Ascite: aspectos clínicos / Ascites: clinical aspects

Ascite é uma complicação que ocorre com relativa frequência nas doenças crônicas do fígado, particularmente na cirrose. Sua presenτa é um sinal que indica mau prognóstico no processo instalado, predispondo o indivíduo a várias complicações que aumentam a morbimortalidade. É importante enfatizar que além do diagnóstico clínico da ascite é necessário procurar sua etiologia e, para tal, usa-se o cálculo do gradiente de lbumina sérico-ascótico. Este método é uma maneira efetiva para diferenciar a ascite causada pela hipertensão portal de outras etiologias. Na patogênese da ascite existem dois fatores a serem considerados: a hemodinâmica portal e a retenτπo de sódio e água, sendo estes secundários αs alterações circulatórias encontradas nos cirróticos. Recentemente, a teoria que explica a formação da ascite e as alterações hemodinâmicas na cirrose é a da vasodilataτπo periférica. Possivelmente esta vasodilatação é secundária ás altas concentrações séricas de certas substâncias, incluindo o óxido nítrico, glucagon, sais biliares e outras. O tratamento da ascite no cirrótico inclui procedimentos clénicos e cirúrgicos, como restrição salina, repouso no leito, diuréticos, paracentese abdominal, derivação peritoniovenosa, bomba de Paris, TIPS e o transplante hepático