Consumo privado de ansiolíticos benzodiazepínicos e sua correlação com indicadores sociodemográficos nas capitais brasileiras

This work aims to analyze the distribution of anxiolytics and their frequency of consumption in the period of 2010 to 2012, on the Federal District and at other Brazilian cities, as well as evaluating the correlation between such consumption and its demographic, epidemiological, economic and social characteristics for each region of this study. Into the analysis, it was observed that social, economic and cultural factors seem to influence the over-consumption of these drugs in many countries. Based on this, the benzodiazepines (BDZs) have achieved great popularity among members of the medical community and among the general population, mainly because of its safety and effectiveness in controlling symptoms of anxiety, insomnia and convulsions. Concerning the methodology of this work, an ecological study was performed having as sampling Brazilian capitals and as data source the 2010 Population Census, as well as information from IBGE, DATASUS and ANVISA. Still in the case of the methodological procedure, a multiple linear regression was used. Through descriptive analysis, it was demonstrated that the Northern region has the lowest average on consumption of these drugs (being 0.24 DHD in Manaus); meanwhile in the capitals of the Southeast, higher means were identified (reaching 7.29 DHD in Belo Horizonte), with a national average of 3.04 DHD. Among the drugs analyzed, it was found that Alprazolam is the most dispensed by pharmacies and private drugstores, averaging 2.00 DHD for Brazilian capitals. A análise de regressão linear múltipla mostrou que 76% da variação no consumo foi explicada pela variação da densidade populacional (β = 0,310 p = 0,045) e pela percentagem de médicos (β = 0,507 p = 0,016). Therefore, it was concluded that the consumption of anxiolytics of short half-life has been increasing over the years, mainly in the cities of greater population density and with the highest concentration of doctors

Impacto da fibromialgia sobre a qualidade de vida e função sexual em mulheres no climatério

OBJETIVO: analisar o impacto da fibromialgia sobre os sinais e sintomas climatéricos, qualidade de vida, função sexual em mulheres na fase do climatério. MÉTODOS: Foi realizado estudo observacional analítico de corte transversal, envolvendo 161 mulheres na fase do climatério. As participantes foram divididas em dois grupos: grupo sem fibromialgia (83) e grupo com fibromialgia (78). As variáveis investigadas foram: Qualidade de vida medida através do questionário UQOL (Utian Quality of Life), Função sexual analisada através do questionário Quociente Sexual - versão feminina (QS-F) e sinais e sintomas climatéricos avaliados pelo Índice menopausal de Blatt & Kupperman (IMBK). No estudo estatístico, foi realizada análise inferencial através do método de modelos lineares generalizados. Para análise do UQOL e seus domínios assim como o QS-F e IMBK, foi utilizado uma função de ligação linear de Log Poisson com exposição de contrastes para os níveis dos fatores de exposição. O nível de significância adotado foi de 5%. RESULTADOS: No grupo fibromialgia foram observados escores significativamente inferiores para o domínio ocupacional UQOL (p 0,01) e UQOL total (p = 0,02), em comparação ao grupo sem fibromialgia. O grupo de mulheres com fibromialgia apresentou escores superiores em relação à intensidade dos sinais e sintomas climatéricos (p ˂0,01) e escores inferiores na avaliação da função sexual pelo QS-F (p = 0,01), quando comparado ao grupo sem fibromialgia. As mulheres mais jovens, com trabalhos extra domicílio, maior renda e maior grau de escolaridade apresentaram melhores escores na qualidade de vida em todos os domínios. Quanto aos sinais e sintomas climatéricos, a renda mais alta e maior tempo de escolaridade exerceram associação direta com sinais e sintomas mais leves, entretanto, quanto mais jovens, maior relação com sintomatologia mais intensa. Em relação à função sexual, melhores escores estiveram associados com idade entre 45 a 49 anos e trabalho extra domicílio. CONCLUSÃO: Os resultados obtidos no presente estudo permitem concluir que o diagnóstico de fibromialgia na fase do climatério apresentase como influência negativa no domínio ocupação da qualidade de vida, sinais e sintomas climatéricos e função sexual, sendo esta associação influenciada significativamente por diversos fatores sócio demográficos

Padronização de testes para avaliação do estado de mania e potencial anti-maníaco de um agonista do receptor NOP

Bipolar disorder is characterized by mood impairment, alternating between mania/hypomania and depression, and its exact pathophysiology is already unknown. The treatment of bipolar disorder is based on prevention of the manic and depressive episodes using mood stabilizers. Nociceptin/orfanin FQ (N/OFQ) is an endogenous heptadecapeptide which binds as an agonist to NOP receptor, which is a G-coupled inhibitory receptor. N/OFQ and its receptor modulate a lot of functions in the organism, including emotional processes. It is known that the plasmatic concentration of N/OFQ is altered in patients in both phases depressive and manic of bipolar disorder and it is assumed that this system has a role on the etiology of this disorder. Concerning mania, the animal models used in research tend to focus in an unique aspect of the manic behavior, as hyperactivity or agressivity. In the 60’s, the hole board test was proposed, and it consists of an apparatus with holes where a behavior known as head-dippings is measured. High levels of head-dippings are suggestive of neophilia, while low levels can be characteristic of an anxious-like behavior. As the increase of exploratory and goal-directed behavior are characteristics of manic behavior, this test could help in mania research. Thus, this work was organized in 3 steps and aims to: (1) investigate the induction of a manic-like state promoted by ouabain, a Na+/K+-ATPase inhibitor, in the mouse open field test; (2) set up the hole board as a test to measure manic-like behaviors; and (3) investigate the N/OFQ effects in prevention of this kind of behavior on hole board. Male Swiss mice were used in this study, and they take part of only one of the described steps. Depending on the step performed, mice received one or more of the following treatments: (1) ouabain 10-6 , 10-5 , 10-4 , 10-3 or 10-2 M, intracerebroventricular (icv); (2) sodium valproate 300 mg/kg, intraperitoneal (ip); (3) sodium valproate 400 mg/kg, ip; (4) diazepam 1 mg/kg, ip; (5) methylphenidate 10 mg/kg, ip; and (6) N/OFQ 0,1 or 1 nmol, icv. The results suggest that hole board can be used to evaluate a manic state, through analysis of different animal behaviors. However, it was not possible to standard the model of Na+ /K+ -ATPase dysfunction through ouabain administration in mice. Moreover, the data suggest that N/OFQ, at the doses tested, has not affected the methylphenidate-induced mania-like behavior. Taken together, the results point to a new approach of manic research, through the hole board using. However, more studies are necessary in order to verify the role of N/OFQ system on bipolar disorder.

Efeitos da reabilitação vestibular em idosos com vertigem posicional paroxística benigna (VPPB): ensaio clínico controlado e randomizado

Introdução: a Vertigem Posicional Paroxística Benigna (VPPB) é uma das principais causas de tontura em idosos. O tratamento mais empregado para essa afecção é a Manobra de Reposicionamento Canalítico (MRC). Apesar de útil na resolução clínica da sintomatologia vertiginosa e do nistagmo, os pacientes podem continuar demonstrando prejuízo na estabilidade postural após serem submetidos à MRC. Outra opção não farmacológica disponível são os exercícios de Reabilitação Vestibular (RV) que podem ser direcionados à melhora do equilíbrio postural dos idosos, porém há escassez de estudos que avaliem a efetividade da RV no equilíbrio postural de idosos com VPPB. Objetivo: analisar a efetividade da Terapia de Reabilitação Vestibular associada às Manobras de Reposicionamento Canalítico em comparação às Manobras de Reposicionamento Canalítico no tratamento de idosos com Vertigem Posicional Paroxística Benigna (VPPB) crônica. Métodos: participaram do presente ensaio clínico controlado, randomizado e cego 14 idosos de ambos os sexos e idade igual ou superior a 65 anos e com diagnóstico de VPPB crônica. Os idosos foram randomizados em dois grupos, sendo sete (mediana: 69 anos, 65-78) para o grupo experimental e sete (mediana: 73 anos, 65-76) para o grupo controle. Ambos os grupos foram submetidos a Manobras de Reposicionamento Canalítico (MRC) para VPPB e somente o grupo experimental à Terapia de Reabilitação Vestibular (TRV) associada às MRC. Os efeitos da TRV foram mensurados em relação à conversão do teste de Dix-Hallpike de positivo para negativo, recorrência da VPPB, número de manobras para obter a negativação do teste de Dix-Hallpike, sintomatologia da tontura, qualidade de vida e ao equilíbrio estático e dinâmico. Os idosos foram submetidos a uma avaliação inicial (T0), em uma semana (T1), cinco (T5), nove (T9) e treze semanas (T13). Em todas as avaliações o teste de Dix-Hallpike foi realizado com o auxílio do sistema de Videonistagmoscopia (SVNC) da Contronic - Brasil, e em caso positivo, nova MRC foi empregada. As diferenças entre os grupos foram analisadas pelos testes de Mann Whitney e exato de Fisher e para elucidar as diferenças intra-grupo os testes não paramétricos de Friedman e Wilcoxon foram usados. Resultados: nenhuma diferença significativa foi encontrada na conversão do teste de Dix-Hallpike de positivo para negativo, na recorrência da VPPB e no número de manobras para a negativação do teste de Dix-Hallpike, entre os grupos ao longo do ensaio. Também não foram encontradas diferenças entre os grupos na sintomatologia da tontura, qualidade de vida e equilíbrio estático. Contudo, diferenças significativas foram observadas nos aspectos do equilíbrio dinâmico entre os grupos (p< 0,05). Na análise intra-grupo ambos os grupos obtiveram melhora em todas as medidas de desfecho, porém o grupo controle não obteve melhora no equilíbrio dinâmico. Conclusões: a TRV adicional não influenciou na conversão do teste de Dix-Hallpike de positivo para negativo, na recorrência da VPPB, no número de manobras para a negativação do teste de Dix-Hallpike, na redução da sintomatologia da tontura e na qualidade de vida dos idosos com VPPB crônica. Porém, os participantes que receberam a TRV adicional demonstraram melhores resultados no equilíbrio dinâmico do que aqueles que foram submetidos somente às MRC. Os resultados desse estudo deverão repercutir nas estratégias de reabilitação baseadas em evidências nos pacientes idosos com disfunções otoneurológicas.

Correlação entre força muscular do assoalho pélvico, função sexual e qualidade de vida em mulheres de meia idade

Introduction: Menopause is characterized by the depletion of ovarian follicles and the gradual decline in estradiol levels, which ends with the definitive cessation of menstrual periods (menopause). As a result of hypoestrogenism, characteristic symptoms, such as hot flashes, night sweats, vaginal dryness, dyspareunia, insomnia, mood swings and depression can be observed. There is also the weakening of the pelvic floor muscles (MAP) as a result of progressive muscle-aponeurotic and connective atrophy with consequent decreased sexual function. Objective: To evaluate the strength of MAP, sexual function and quality of life of menopausal women. Methodology: This is an observational, analytical, cross-sectional design. The sample consisted of 55 women (35 postmenopausal and 20 perimenopausal), aged between 40 and 65, who were assessed by muscle strength and perineometry test. For the assessment of sexual function and quality of life, used the Female Sexual Function Index (FSFI) and Utian Quality of Life (UQOL), respectively. Statistical analysis was performed using Pearson's correlation and multivariate analysis. Results: The mean age was 52.78 (± 6.47 years). Sexual dysfunction presented, 61.8% of participants (43.62% of postmenopausal and perimenopausal 18.17%). Muscle strength test and the maximum perineometry had a median of 3.00 (Q25: 2 e Q75: 4) and 33,50 cmH20 (Q25: 33,5 e Q75: 46,6), respectively. No correlation was found between sexual function and muscle strength (r = 0.035; p = 0.802) and between sexual function and perineometry (r = 0.126; p = 0.358). The mean total score of UQOL was 74.45 (± 12.23). Weak positive correlation was found between sexual function and quality of life (r = +0.422 p = 0.001). Multivariate analysis identified associations between sexual function and variables: quality of life, climacteric symptoms, physical activity and education level. Conclusions: These results suggest that the climacteric symptoms, quality of life, physical activity and level of education are associated with sexual function in menopausal women. However, the muscular component of sexual function needs to be further investigated in this context.

Diagnóstico e tratamento do TDA/H: investigação dos critérios utilizados por diferentes categorias profissionais da cidade de Natal-RN

TDA/H is usually considered among the most frequent psychological malfunctions in both childhood and adolescence. It covers a complex combination of neurocognitive deficits leading to developmental troubles linked to attention failure, hyperactivity and impulsivity. On the other hand, diagnosis of TDA/H is frequently a hard task, since sociocultural aspects concerning the evaluation of symptoms lead to some etiologic vagueness. Additionally, the large extent of evaluation tools, together with the diversity of therapeutic approaches referred by specialized literature justify the interest of investigating the diverse ways of diagnosing and treating TDA/H by medical doctors, psychologists and psycho-pedagogues developing professional activities in Natal-RN (Brazil) in the assistance of children and teenagers with TDA/H diagnosis hypothesis. A sample of thirty-four professionals participated in this study in a convenience-basis, and submitted to a semi-directed interview. Information from this procedure was analyzed, categorized and submitted to a multidimensional descriptive analysis (cluster analysis procedure), allowing to verify the partition of the sample in two groups: Group 1, basically composed by medical professionals, and Group 2, composed by psychologists and psycho-pedagogues. The categorized variable “Number of sessions” – average time used for arriving to a diagnosis – was the partition-variable showing the larger amount of statistical contribution for the partition, followed by the variables “Professional formation” and “Use of diagnostic tools”. Variables such “Comorbidity”, “TDA/H Definition” and Modalities of Intervention” also showed contribution to the partition obtained, even though their lesser amount of statistical contribution. Despite some similarity between these two groups, data allowed to demonstrate specific association between academic source-formation of the professional concerned and diagnosis and intervention modalities shown by these professionals when dealing with TDA/H. These data confirm relevant heterogeneity in dealing with TDA/H due to professional formation of professionals involved in diagnosis and treatment tasks.

Diagnóstico e tratamento do TDA/H: investigação dos critérios utilizados por diferentes categorias profissionais da cidade de Natal-RN

TDA/H is usually considered among the most frequent psychological malfunctions in both childhood and adolescence. It covers a complex combination of neurocognitive deficits leading to developmental troubles linked to attention failure, hyperactivity and impulsivity. On the other hand, diagnosis of TDA/H is frequently a hard task, since sociocultural aspects concerning the evaluation of symptoms lead to some etiologic vagueness. Additionally, the large extent of evaluation tools, together with the diversity of therapeutic approaches referred by specialized literature justify the interest of investigating the diverse ways of diagnosing and treating TDA/H by medical doctors, psychologists and psycho-pedagogues developing professional activities in Natal-RN (Brazil) in the assistance of children and teenagers with TDA/H diagnosis hypothesis. A sample of thirty-four professionals participated in this study in a convenience-basis, and submitted to a semi-directed interview. Information from this procedure was analyzed, categorized and submitted to a multidimensional descriptive analysis (cluster analysis procedure), allowing to verify the partition of the sample in two groups: Group 1, basically composed by medical professionals, and Group 2, composed by psychologists and psycho-pedagogues. The categorized variable “Number of sessions” – average time used for arriving to a diagnosis – was the partition-variable showing the larger amount of statistical contribution for the partition, followed by the variables “Professional formation” and “Use of diagnostic tools”. Variables such “Comorbidity”, “TDA/H Definition” and Modalities of Intervention” also showed contribution to the partition obtained, even though their lesser amount of statistical contribution. Despite some similarity between these two groups, data allowed to demonstrate specific association between academic source-formation of the professional concerned and diagnosis and intervention modalities shown by these professionals when dealing with TDA/H. These data confirm relevant heterogeneity in dealing with TDA/H due to professional formation of professionals involved in diagnosis and treatment tasks.

Variabilidade genética de Leishmania spp. circulantes entre seres humanos e cães e infecção de flebotomíneos em áreas endêmicas para as leishmanioses no Rio Grande do Norte

Leishmania infantum is the main etiologic agent of visceral leishmaniasis in the New World. The pattern of distribution of leishmaniasis has changed substantially and has presented an emerging profile within the periphery of the Large Urban Centers. Leishmania infection can compromise skin, mucosa and viscera. Only 10% of the individuals infected develop the disease and 90% of human infection is asymptomatic. The main factors involved in the development of the disease are the host immune response, the vector’s species and the parasite’s genetic content. The sequencing of Leishmania isolated seeks to increase the understanding of the symptoms of individuals. The aim of this study was to evaluate the genetic diversity of circulating Leishmania strains among humans, and symptomatic and asymptomatic, and dogs from endemic areas of Rio Grande do Norte State and analyze sandflies from endemic areas for cutaneous and visceral disease. The genetic variability was evaluated by the use of markers hsp70 , ITS1 and a whole genome sequencing was also carried out. The amplified hsp70 and ITS1 of samples were analyzed and assembled using a Phred / Phrap package. The dendograms were constructed using the same methodology, but adding 500 bootstraps, followed by inferences on the relationships between Leishmania variants. The sequences of the 20 Brazilian isolates were mapped to the reference genome L. infantum JPCM5, using the Bowtie2 program and the identification of 36 contigs. The information of the valid SNPs were used in the PCA. SNPs were visualized by Geneious 7.1 and IGV. The genome annotations were transferred to their respective chromosomes and displayed on Geneious. The matching sequences of all chromosomes were aligned using Mauve. The phylogenetic trees were calculated according to maximum likelihood and JTT models. Sandflies were analyzed by PCR for the identification of Leishmania infection, a blood meal source and GAPDH sand fly. As a result, hsp70 and ITS1 were not capable of identifying genetic variability among human isolates from symptomatic and asymptomatic, and dogs. The complete sequencing of the 20 Brazilian isolates revealed a strong similarity between the circulating Leishmania strains in Rio Grande do Norte. The isolates collected in the city of Natal from humans and canines remained grouped in all analyzes, suggesting that there is genotypic and geographic proximity among the isolates. The isolated samples in the 1990s had a higher genotypic diversity when compared to freshly isolated samples. All isolates presented 36 chromosomes with variable ploidy among them, no correlation was found between the number of amastina genes copies, gp63, A2 and SSG with such clinic forms. In general, we did not find correlation between symptomatic and asymptomatic clinical forms and the gene content of the Brazilian isolates of Leishmania. 34,28% of the sandflies collected in the upper west region were L. longipalpis and the main sources of blood meal were humans, dogs and chickens.

Variabilidade genética de Leishmania spp. circulantes entre seres humanos e cães e infecção de flebotomíneos em áreas endêmicas para as leishmanioses no Rio Grande do Norte

Leishmania infantum is the main etiologic agent of visceral leishmaniasis in the New World. The pattern of distribution of leishmaniasis has changed substantially and has presented an emerging profile within the periphery of the Large Urban Centers. Leishmania infection can compromise skin, mucosa and viscera. Only 10% of the individuals infected develop the disease and 90% of human infection is asymptomatic. The main factors involved in the development of the disease are the host immune response, the vector’s species and the parasite’s genetic content. The sequencing of Leishmania isolated seeks to increase the understanding of the symptoms of individuals. The aim of this study was to evaluate the genetic diversity of circulating Leishmania strains among humans, and symptomatic and asymptomatic, and dogs from endemic areas of Rio Grande do Norte State and analyze sandflies from endemic areas for cutaneous and visceral disease. The genetic variability was evaluated by the use of markers hsp70 , ITS1 and a whole genome sequencing was also carried out. The amplified hsp70 and ITS1 of samples were analyzed and assembled using a Phred / Phrap package. The dendograms were constructed using the same methodology, but adding 500 bootstraps, followed by inferences on the relationships between Leishmania variants. The sequences of the 20 Brazilian isolates were mapped to the reference genome L. infantum JPCM5, using the Bowtie2 program and the identification of 36 contigs. The information of the valid SNPs were used in the PCA. SNPs were visualized by Geneious 7.1 and IGV. The genome annotations were transferred to their respective chromosomes and displayed on Geneious. The matching sequences of all chromosomes were aligned using Mauve. The phylogenetic trees were calculated according to maximum likelihood and JTT models. Sandflies were analyzed by PCR for the identification of Leishmania infection, a blood meal source and GAPDH sand fly. As a result, hsp70 and ITS1 were not capable of identifying genetic variability among human isolates from symptomatic and asymptomatic, and dogs. The complete sequencing of the 20 Brazilian isolates revealed a strong similarity between the circulating Leishmania strains in Rio Grande do Norte. The isolates collected in the city of Natal from humans and canines remained grouped in all analyzes, suggesting that there is genotypic and geographic proximity among the isolates. The isolated samples in the 1990s had a higher genotypic diversity when compared to freshly isolated samples. All isolates presented 36 chromosomes with variable ploidy among them, no correlation was found between the number of amastina genes copies, gp63, A2 and SSG with such clinic forms. In general, we did not find correlation between symptomatic and asymptomatic clinical forms and the gene content of the Brazilian isolates of Leishmania. 34,28% of the sandflies collected in the upper west region were L. longipalpis and the main sources of blood meal were humans, dogs and chickens.

Prevalência de sintomas do climatério em mulheres dos meios rural e urbano no Rio Grande do Norte, Brasil

OBJETIVO: avaliar a sintomatologia climatérica e fatores relacionados entre mulheres dos meios urbano e rural do Rio Grande do Norte. MÉTODOS: estudo transversal, descritivo, envolvendo casuística de 261 mulheres climatéricas residentes em Natal e Mossoró (grupo urbano; n=130) e Uruaçu, em São Gonçalo do Amarante (grupo rural; n=131). A sintomatologia climatérica foi avaliada pelo Índice Menopausal de Blatt-Kupperman (IMBK) e Escala Climatérica de Greene (ECG). A análise estatística constou de comparações das medianas dos escores entre os grupos e regressão logística. Defi niram-se como “muito sintomáticas” as pacientes com escores ≥20, para ambos instrumentos (variável dependente). As variáveis independentes foram: idade, procedência, alfabetização, obesidade e prática de atividade física. RESULTADOS: o grupo urbano apresentou escores signifi cativamente superiores ao grupo rural, tanto para o IMBK (medianas de 26,0 e 17,0, respectivamente; p<0,0001), quanto para a ECG (medianas de 27,0 e 16,0, respectivamente; p<0,0001). Na amostra total, evidenciou-se que 56,3% (n=147) das mulheres foram classifi cadas como “muito sintomáticas”. Na comparação intergrupos, essa prevalência foi signifi cativamente mais elevada nas mulheres urbanas em relação às rurais (79,2 e 33,6%, respectivamente; p<0,05). Pela análise de regressão logística, evidenciou-se que a chance de pertencer ao grupo defi nido como “muito sintomáticas” foi maior para mulheres do meio urbano [odds ratio ajustado (OR)=7,1; 95% intervalo de confi ança a 95% (IC95%)=3,69-13,66] e alfabetizadas (OR=2,19; IC95%=1,16-4,13). A idade superior a 60 anos associou-se com menor chance de ocorrência de sintomas signifi cativos (OR=0,38; IC95%=0,17-0,87). CONCLUSÕES: a prevalência de sintomas climatéricos signifi cativos é menor em mulheres do meio rural, demonstrando que fatores socioculturais e ambientais estão fortemente relacionados ao surgimento dos sintomas climatéricos em nossa população.___________________________________ABSTRACT PURPOSE: to evaluate climacteric symptoms and related factors in women living in rural and urban areas of Rio Grande do Norte, Brazil. METHODS: a cross-sectional study involving 261 women in the climacteric was performed. A total of 130 women from Natal and Mossoró (urban group) and 131 from Uruaçu, in São Gonçalo do Amarante (rural group), were studied. Climacteric symptoms were assessed by the Blatt-Kupperman Menopausal Index (BKMI) and Greene Climacteric Scale (GCE). Statistical analysis involved comparison of median between groups and logistic regression analysis. Patients were defi ned as “very symptomatic” when the climacteric score was ≥20 for both questionnaires (dependent variable). Independent variables were: age, living area, schooling, obesity and physical activity. RESULTS: the urban group had signifi cantly higher scores than those of the rural group, both for BKMI (median of 26.0 and 17.0, respectively; p<0.0001) and for GCE (median of 27.0 and 16.0, respectively; p<0.0001). For the entire sample, a total of 56.3% (n=147) of the women were classifi ed as “very symptomatic”. This prevalence was signifi cantly higher in urban than in rural women (79.2 and 33.6%, respectively; p<0.05). Logistic regression analysis showed that the likelihood of belonging to the group defi ned as “very symptomatic” was greater for urban women [adjusted odds ratio (OR)=7.1; confi dence interval at 95% (95%CI)=3.69-13.66] who were literate (OR=2.19; 95%CI=1.16- 4.13). Individuals over the age of 60 years had less chance of having signifi cant symptoms (OR=0.38; 95%CI=0.17-0.87). CONCLUSIONS: the prevalence of signifi cant climacteric symptoms is less in women from a rural environment, showing that sociocultural and environmental factors are strongly related to the appearance of climacteric symptoms in our population

Fatores Associados à Prevalência de Sintomas Osteomusculares em Professores

FERNANDES, Marcos Henrique; ROCHA, Vera Maria da; RONCALLI, Angelo Giuseppe. Fatores Associados à Prevalência de Sintomas Osteomusculares em Professores. Revista de salud pública, v. 11, n. 2, p. 256-267, 2009.

Estudo clínico-laboratorial e histopatológico de cães naturalmente infectados por Leishmania chagasi com diferentes graus de manifestação física

Canine Visceral Leishmania (CVL) is an important zoonotic disease that has a world wide distribution and has a large impact on public health on the American Continent, especially in Brazil, where the nature of endemic diseases in humans affects a large part of the nation. The influence of the prevalence of CVL in the increased rate of human cases in endemic areas and in the unleashing of epidemic outbreaks shows the need for a more profound understanding, that would generate significant advances in the current measures used to control the reservoirs of sickness that are practiced by the Programa Nacional de Vigilância e Controle da Leishmaniose Visceral. The present work describes and compares the clinical-laboratorial and histopathological findings of twenty-three dogs that were naturally infected by Leishmania chagasi, from endemic areas in metropolitan Natal, Rio Grande do Norte, Brazil. These animals, that were selected and given physical and serological exams (IFI and ELISA rK-39), were classified according to the degree of clinical severity and had blood samples drawn (whole blood and serum) for a complete hemogram and a coagulogram to be done as well as biochemical tests for kidney and liver function. The confirmation of infection by L. chagasi was done after the euthanasia of the animals, through the direct demonstration of the parasite in the impression of the spleen and liver crowned with GIEMSA and through a cultivation by means of NNN/Schneider. According to the clinical evaluation, the animals were classified as asymptomatic (7), oligosymptomatic (7) and polysymptomatic (9). Among the animals that were chosen to be autopsied, there were 2 asymptomatic, 3 oligosymptomatic and 3 polysymptomatic, for the purpose of studying their histopathology, having collected fragments of the spleen, liver, kidneys and skin and were fixed in 10% tamponed formol. The comparison between the average parameters of the clinical-laboratory tested animals in the groups was done through the Student t test (a<0.05). The main clinical signals observed were lymphadenomegaly, alopecy, dermatitis, exfoliation, cutaneous ulcers, onicogriphosis and emaciation. The main clinical-laboratorial alterations established, mainly in the polysymptomatic group, were anemia, hyperproteinemia, hyperglobulinemia, alterations in the albumin/globulin ratio and increased ALT activity. Renal alterations were not verified (urea and creatinine levels were normal). Thrombocytopenia was observed in three clinical groups. However, the other indicators of coagulation function (TAP and TTPA) did not have abnormal variations. There were inflammatory infiltrations and leishmania amastigotes in the skin of polysymptomatic dogs, however, they were not found in the skin of asymptomatic animals. Hypertrophy and hyperplasia of the phagocyte mononuclear system, leishmania amastigote parasites were found in the macrophages, extramedullary hematopoiesis and degenerative alterations were detected in the spleen and liver of 8 of the animals submitted to histopathological exams. In accord with these results, it was demonstrated that the expected alterations in the hematological and biochemical parameters in function of their viscerotropic nature of CVL are mainly observed in the more advanced stages of the disease. The absence of inflammatory infiltration and parasite load in the skin suggest that infected animals without symptoms may have an importance irrelevant to the infectiousness of the vector