Acquired hepatocerebral degeneration and hepatic encephalopathy: correlations and variety of clinical presentations in overt and subclinical liver disease

A degeneração hepatocerebral adquirida (AHD) e a degeneração hepatolenticular podem ter apresentações clínicas semelhantes, mas quando uma doença hepática crônica e achados motores atípicos coexistem, a distinção entre AHD e encefalopatia hepática (HE) pode ser ainda mais complicada. Descrevemos três casos de AHD (dois tendo HE) com diferentes achados em neuroimagem, doenças hepáticas distintas e apresentações motoras semelhantes, todos com hipertensão arterial e perda de peso antes das manifestações motoras. O diagnóstico e a fisiopatologia são comentados e comparados com relatos prévios. Concluímos que existem muitas correlações entre HE, degeneração hepatolenticular e AHD, mas a sobreposição de HE e AHD pode ser mais comum dependendo do conhecimento clínico e da acurácia dos critérios diagnósticos adotados para cada enfermidade. Como a AHD não é considerada prioridade na lista de transplante hepático, o prognóstico dos pacientes com AHD permanece ruim, e a interrupção do fluxo nos shunts portossistêmicos deve ser sempre considerada.

A STORM* environment for building multimedia presentations

This paper describes an environment for constructing multimedia applications which are used to present different multimedia database objects in accordance with spatiotemporal constraints and from different sources. The main contribution of this paper is to propose an environment which integrates both a modelling case tool and an object-oriented database system.

Detecção de formas amastigotas em exame parasitológico de esfregaço obtido a partir de suabe conjuntival de cães com leishmaniose visceral

Leishmaniose é uma enfermidade multissistêmica cujas manifestações clínicas são extremamente variáveis. em cães sinais clínicos oftálmicos são relativamente frequentes, ainda que outros sinais sistêmicos não sejam identificados. Atualmente, o diagnóstico da doença baseia-se em métodos parasitológicos, sorológicos e moleculares, mas, até o momento, a identificação de formas amastigotas desse parasito em esfregaços feitos a partir de suabes conjuntivais não é empregada rotineiramente. Valendo-se de cães sorologicamente positivos para leishmaniose, portadores (G1) ou não (G2) de alterações oftálmicas, este estudo avaliou a viabilidade do esfregaço a partir de suabe conjuntival como método de diagnóstico para a enfermidade. O exame suprarreferido foi positivo em 60% dos animais do G1 e 38,1% do G2, no entanto não houve diferença estatisticamente significativa em relação à positividade nos dois grupos (P=0,2167). Os dados apontam para uma tendência de os cães com leishmaniose e com sinais oftálmicos serem positivos ao exame parasitológico de esfregaço a partir de suabe conjuntival, podendo esse método ser útil no diagnóstico parasitológico da leishmaniose canina.

Differential antibody isotype expression to the major Paracoccidioides brasiliensis antigen in juvenile and adult form paracoccidioidomycosis

We investigated the relationship between antibody response to the major Paracoccidioides brasiliensis antigen, a 43-kDa glycoprotein, and the two paracoccidioidomycosis (PCM) clinical presentations, the juvenile and the adult forms. Total immunoglobulin G (IgG), IgG isotypes, and IgA anti-gp43 antibodies were determined by enzyme-linked immunosorbent assay in patients' sera. Juvenile PCM patients had higher (P =.003) IgG anti-gp43 levels than adult form patients. IgG1 subclass levels, however, were comparable between the two clinical forms. Patients with the juvenile form had higher (P <.001) IgG4, but lower(P =.03) IgG2 levels than patients with the adult form. The IgG4 isotype, regulated by interleukin 4, was found in all juvenile form patients but in only 12% of the adult form patients. In contrast, high levels of the IgG2 isotype, regulated by interferon-gamma, were found in 41% of the adult PCM patients, mainly those with a more benign disease, but in only 12% of the juvenile patients. IgG3 was either absent or detected at low levels. These results demonstrate, for the first time, specific IgG4 antibodies in the humoral immune response of patients with an endemic deep mycosis and suggest that the switch to the IgG subclasses in PCM is regulated by the patients' T-helper subset (Th-l or Th-2) dominant cytokine profile. A possible role for IgG4 in the immunopathogenesis of the juvenile, more severe form of the disease is discussed. Finally, IgA was found mainly in adult form patients, probably as a result of the chronic mucosal antigenic stimulation characteristic of this form. (C) Elsevier, Paris.

IgE antibody response to the main antigenic component of Paracoccidioides brasiliensis in patients with paracoccidioidomycosis

Paracoccidioidomycosis (PCM) has two main clinical presentations, a chronic form (CF) and an acute, more severe form (AF). The AF is associated with a more marked dysfunction of the patient's immune response, and a distinct anti-Paracoccidioides brasiliensis immunoglobulin (Ig)A and IgG antibody subclass expression, compared with that seen in the CF. In this study we investigated the presence of IgE antibodies against the main P. brasiliensis antigen (a 43-kDa molecule) in the serum of PCM patients using an enzyme-linked immunosorbent assay. We found that 100% of the AF patients (n = 16) produced IgE antibodies, mostly at high levels, whereas only 9 (27%) out of 33 CF patients produced this isotype. Interestingly, these nine patients presented higher serological titers on the counter-immunoelectrophoresis assays than did those who did not produce IgE; a finding that suggests that they had a relatively more severe disease. As IgE is a characteristic feature of the AF patients, and switching to a positive IgE response is dependent on interleukin-4, our results support the notion that the relatively more severe impairment of cellular immunity in the AF is probably related to a Th-2 pattern of immune response.

Pós-graduação stricto sensu em anestesiologia: experiência de dez anos na UNESP

JUSTIFICATIVA E OBJETIVOS: O número de Programas de Pós-Graduação em Anestesiologia stricto sensu existente no país ainda é muito pequeno. Com a finalidade de incentivar a pós-graduação em Anestesiologia no Brasil, é apresentada a experiência acumulada em dez anos de atividades do programa da Universidade Estadual Paulista (UNESP). CONTEÚDO: O Programa de Pós-Graduação em Anestesiologia stricto sensu da UNESP foi credenciado pela CAPES, desde a sua criação em 1994, nos Cursos de Mestrado e Doutorado. O Programa é desenvolvido em três Áreas de Concentração: Risco e Proteção de Órgãos e Sistemas em Anestesia e Cirurgia; Qualidade e Segurança em Anestesiologia; e Modelos Clínicos e Experimentais em Terapia Antálgica, com as suas respectivas linhas de pesquisa, em número de 14. O número de alunos regulares do Programa é compatível com o número de orientadores (12), com proporção média de três alunos por orientador. Desde o seu início até setembro de 2004, ocorreram 45 Dissertações de Mestrado e 24 de Doutorado, perfazendo 69 defesas, a maioria com bolsas e financiamentos de Órgãos de Fomento à Pesquisa. Após a conclusão do doutorado, 65% dos alunos têm atividade de docência e pesquisa em instituições públicas e privadas do ensino universitário do país. A maioria das publicações do programa tem sido realizada em revistas nacionais com Qualis A, com menor número de publicações em revistas internacionais Qualis A ou B. O programa recebeu da CAPES o conceito 4,0 numa escala de 1 a 7, em suas três últimas avaliações. CONCLUSÕES: O programa tem se desenvolvido muito bem nos 10 anos de sua existência, alcançando os principais objetivos, como a formação de professores e pesquisadores na área de Anestesiologia para as instituições universitárias do país.

Publicações indexadas geradas a partir de resumos de congressos de angiologia e cirurgia vascular no Brasil

CONTEXTO: Grande parte da produção científica apresentada em congressos não é publicada. Mesmo nos países do primeiro mundo, os números demonstram que essa perda é expressiva. OBJETIVO: Dimensionar o número de artigos publicados e indexados em bases de dados nacionais e internacionais, a partir dos títulos e autores de temas livres ou painéis dos congressos brasileiros de cirurgia vascular de 2001 e 2003. MÉTODOS: Foram pesquisados os 541 e 567 resumos apresentados, respectivamente, no XXXIV Congresso Brasileiro de Angiologia e Cirurgia Vascular, em 2001 e no XXXV Congresso de Angiologia e Cirurgia Vascular, em 2003. Foi realizada pesquisa computadorizada através dos seguintes instrumentos de busca: Scirus, Bireme, LILACS, SciELO, MEDLINE-PubMed e Biblioteca Cochrane, Google Acadêmico e índices remissivos e onomásticos do Jornal Vascular Brasileiro. Os artigos foram classificados em internacionais ou nacionais e em completos ou modificados. RESULTADOS: Foram encontrados 21 (3,89%) e 49 (8,64%) artigos publicados, a partir dos congressos de 2001 e 2003, respectivamente. A média de publicação dos dois congressos foi de 6,32%. CONCLUSÕES: Os números revelados nessa amostra revelam o quanto a publicação das pesquisas no Brasil é relegada a segundo plano. Muitos trabalhos deixam de ser publicados pela falta de prioridade e tradição em escrever, falta de tempo, empenho e de incentivo.

Potenciais evocados na neurocisticercose

Em 25 pacientes com neurocisticercose, classificados em dois grupos, formas benignas e formas malignas, foram obtidos potenciais evocados multimodais. Os exames foram normais em 9 casos com formas benignas. Dentre 4 pacientes com manifestações malignas, 2 apresentaram anormalidades de todos os potenciais evocados e alterações da onda F, obtida no membro superior. Os autores sugerem que alterações de vários potenciais, associadas a alterações da onda F, talvez indiquem mau prognóstico.

Reproductive responses of rabbit does to a supplemental lighting program

The objective was to investigate whether the productivity of rabbit does can be improved, when natural photoperiod is decreasing, by adopting a supplemental lighting program. Three experiments were conducted involving two groups: control, submitted to the natural decreasing photoperiod, and supplemented with a lighting program which provided 14 h light/24 h beginning at 10 weeks of age. In the first experiment, 20 nulliparous does, 10 from each group, were euthanized 8 h after being presented to a buck; the overall number of follicles, whose diameter exceeded I mm, was determined macroscopically. The right ovaries were collected, histologically analyzed, and electronically measured. In the second experiment, 30 nulliparous does, 15 from each group, were presented to a buck (day 1). Receptive does were euthanized on day 8 to evaluate embryonic survival (number of normal embryos/ovulation rate). In the third experiment, 48 nulliparous does, 24 from each group, were followed from the first presentation to the buck until the weaning of the first litter. The effect of treatment on reproductive and body weight traits of does, and litter performance traits, at birth and weaning, was evaluated. The average number of follicles whose diameter exceeded 1 mm was higher in the treatment group (12.05 +/- 1.07 vs. 8.63 +/- 1.00, P=0.03 7). Receptive does of the treatment group had heavier ovaries relative to those of the control group (790 +/- 59 vs. 470 +/- 64 mg, P=0.004), whereas no treatment difference regarding this trait was found for non-receptive ones. Treatment had a favorable effect on pregnancy rate of total exposed and of receptive does (80.0% vs. 33.3%, P=0.01, and 92.3% vs. 50.0%, P=0.02, respectively). The number of underdeveloped embryos was lower (0.067 +/- 0.380 vs. 2.500 +/- 0.455, P=0.004), embryonic survival up to day 8, and uterus weight was higher in the treatment group (0.839 +/- 0.075 vs. 0.534 +/- 0.087, P=0.033 and 13.83 +/- 0.72 vs. 10.99 +/- 0.84, P=0.037, respectively). Number of presentations tended to be lower (1.32 +/- 0.17 vs. 1.75 +/- 0.16, P=0.077) and adjusted litter size in the first reproductive cycle tended to be higher (7.09 +/- 0.89 vs. 5.22 +/- 0.68, P=0.091) in the treatment group relative to the control.

Bioestimulação da atividade reprodutiva de coelhas lactantes em regime de monta natural

Esta pesquisa avaliou o efeito da separação mãe-ninhada sobre o desempenho reprodutivo de coelhas lactantes e ponderal das ninhadas até aos 70 dias de idade. Examinaram-se 415 exposições ao macho de 157 fêmeas lactantes distribuídas em dois grupos: controle, com livre acesso ao ninho, e tratado, cujo acesso bloqueou-se entre o sétimo e o nono dias pós-parto, durante as 39 horas que precederam a cobrição. Das 415 exposições ao macho, 387 resultaram em cobrições e 264 em partos. As fêmeas tratadas, de quinta lactação em diante, apresentaram receptividade e taxa de parição, respectivamente, 6,7% e 10,8% maiores em comparação às fêmeas do grupo controle. Não se constatou efeito da interação tratamento x ordem de lactação, ou do tratamento, com respeito ao número de láparos/ninhada à desmama e nos 70 dias de idade. em ninhadas de primíparas, a taxa de mortalidade da separação até 70 dias de idade foi maior no grupo tratado, em relação ao controle (0,248±0,047 vs. 0,120±0,047). O peso total da ninhada à desmama foi inferior no grupo tratado, do que no controle (5.753±93 g vs. 6.222±89 g) em todas as ordens. Todavia, não se observou diferença no peso total ou médio da ninhada nos 70 dias de idade. O tratamento também reduziu o peso individual à desmama (912,4±4,9 g vs. 962,7±4,5 g) em todas as ordens de lactação, entretanto, elevou o ganho de peso médio diário pós-desmama (32,25±0,19 g/d vs. 31,44±0,17 g/d), proporcionando a ocorrência de ganho compensatório neste período. Pode-se recomendar a separação temporária mãe-ninhada para melhorar o desempenho reprodutivo de coelhas lactantes multíparas; mas deve ser evitada para as primíparas, devido à elevação da taxa de mortalidade das ninhadas.

Analysis of Abstracts Presented at the Prosthodontic Research Section of IADR General Sessions 2004-2005: Demographics, Publication Rates, and Factors Contributing to Publication

Purpose: The purposes of this study were to describe the demographics of abstracts presented at the prosthodontics section of IADR General Sessions from 2004 to 2005, evaluate the publication rate of abstracts, and analyze the relationship between variables in abstracts and publication.Materials and Methods: Prosthodontics research section abstracts from the IADR General Session in 2004 and 2005 were evaluated for: number of authors, presentation type, origin, affiliation, topic, study design, statistics, study outcome, and funding. The publication rate was calculated following a PubMed search. The journal of publication, year of publication, and the length of time before publication were analyzed. Descriptive statistics were used for the data analysis; the relationships between presentation type, study design, study outcome, statistics, funding, and publication were analyzed using logistic regression (alpha = 0.05).Results: From 346 abstracts, 37.0% were published. For oral presentations, 40.7% were published; 35.8% of poster presentations were published. The mean duration before publicationwas 26.4months. North America had themost abstracts, and Europe had the most publications. Fixed prosthodontic research had the highest number and proportion for publication. A significant association with publication was noted for neutral study outcomes (p = 0.018), studies with funding (p = 0.035), and abstracts from Europe (p = 0.001).Conclusions: The majority of abstracts from the prosthodontics research section of IADR General Sessions from 2004 and 2005 remain unpublished. A significant association for publication was noted with neutral outcomes, funding, and abstracts from Europe.

Gingival primary extranodal non-Hodgkin's lymphoma as the first manifestation of acquired immunodeficiency syndrome

Background: Non-Hodgkin's lymphomas (NHLs) are a heterogeneous group of lymphoproliferative malignancies that may be associated with acquired immunodeficiency syndrome (AIDS). NHL can disseminate to extranodal sites; however, its dissemination to the jaws and mouth is not common. This report presents and discusses two unusual cases of gingival primary extranodal non-Hodgkin's lymphoma (PE-NHL) as the first manifestation of AIDS.Methods: Two mates presented with asymptomatic gingival swelling. They were examined clinically. Biopsies of the gingival tissue were evaluated using routine histologic techniques and immunohistochemistry. The patients were tested for human immunodeficiency virus (HIV) infection.Results: The clinicopathological evaluation and the serological HIV examination of the patients led us to the final diagnosis of gingival PE-NHL as the first manifestation of AIDS. Both patients were referred to an oncologist and to an infectious disease specialist and were given antineoplastic chemotherapy and highly active antiretroviral therapy. Only one patient presented a favorable clinical evolution.Conclusion: The present case reports have important clinical implications; the two unusual presentations of gingival PE-NHL contribute to information about the differential diagnosis of rapidly progressing gingival swelling.

Oral cleft prevention program (OCPP)

Background: Oral clefts are one of the most common birth defects with significant medical, psychosocial, and economic ramifications. Oral clefts have a complex etiology with genetic and environmental risk factors. There are suggestive results for decreased risks of cleft occurrence and recurrence with folic acid supplements taken at preconception and during pregnancy with a stronger evidence for higher than lower doses in preventing recurrence. Yet previous studies have suffered from considerable design limitations particularly non-randomization into treatment. There is also well-documented effectiveness for folic acid in preventing neural tube defect occurrence at 0.4 mg and recurrence with 4 mg. Given the substantial burden of clefting on the individual and the family and the supportive data for the effectiveness of folic acid supplementation as well as its low cost, a randomized clinical trial of the effectiveness of high versus low dose folic acid for prevention of cleft recurrence is warranted.Methods/design: This study will assess the effect of 4 mg and 0.4 mg doses of folic acid, taken on a daily basis during preconception and up to 3 months of pregnancy by women who are at risk of having a child with nonsyndromic cleft lip with/without palate (NSCL/P), on the recurrence of NSCL/P. The total sample will include about 6,000 women (that either have NSCL/P or that have at least one child with NSCL/P) randomly assigned to the 4 mg and the 0.4 mg folic acid study groups. The study will also compare the recurrence rates of NSCL/P in the total sample of subjects, as well as the two study groups (4mg, 0.4 mg) to that of a historical control group. The study has been approved by IRBs (ethics committees) of all involved sites. Results will be disseminated through publications and presentations at scientific meetings.Discussion: The costs related to oral clefts are high, including long term psychological and socio-economic effects. This study provides an opportunity for huge savings in not only money but the overall quality of life. This may help establish more specific clinical guidelines for oral cleft prevention so that the intervention can be better tailored for at-risk women.

The Perception of Smile Attractiveness Variations from Esthetic Norms, Photographic Framing and Order of Presentation

Objectives: To evaluate the attractiveness of a smile according to variations from esthetic norms, photographic framing, and the order of the presentation of photographs.Materials and Methods: A photograph of an individual was selected and digitally manipulated to create the following smiles: an ideal control smile (I), a smile with diastema (D1), a smile with midline deviation (LM3), a smile with deviation from the long axes of the lateral incisors (10D), and a smile with an inverted smile arc (LSRV). The manipulated photographs were developed in framings of the face and of the mouth and evaluated by 20 laypeople. For half the evaluators, the presentation started with facial photographs and, for the other half, the presentation began with the mouth shots. Evaluators were asked to rank the photographs from the least to the most attractive; then, each photograph was awarded a mark (scale of 0.0 to 10.0).Results: In both presentations, the smiles I, LM3, 10D, and LSRV received favorable ratings, whereas the D1 smile got poor ratings. The photographic framings used (face vs mouth) and the order of presentation of the photographs did not influence the rankings.Conclusion: The absence of variations from beauty norms of a smile has a positive impact on its esthetic perception, but variations from the norms do not necessarily result in reduced attractiveness. (Angle Orthod. 2009;79:634-639.)

Avaliação do emprego dos adsorventes: carvão ativo, chromosorb W e membrana C18 na preparação de amostras de ar para a determinação de d-aletrina em ambientes fechados

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)