Comparison of clinical features and drug therapies among European and Latin American patients with juvenile dermatomyositis

ObjectiveTo compare the demographic features, presenting manifestations, diagnostic investigations, disease course, and drug therapies of children with juvenile dermatomyositis (JDM) followed in Europe and Latin America.MethodsPatients were inception cohorts seen between 1980 and 2004 in 27 paediatric rheumatology centres. The following information was collected through the review of patient charts: sex; age at disease onset; date of disease onset and diagnosis; onset type; presenting clinical features; diagnostic investigations; course type; and medications received during disease course.ResultsFour hundred and ninety patients (65.5% females, mean onset age 7.0 years, mean disease duration 7.7 years) were included. Disease presentation was acute or insidious in 57.1% and 42.9% of the patients, respectively. The course type was monophasic in 41.3% of patients and chronic polycyclic or continuous in 58.6% of patients. The more common presenting manifestations were muscle weakness (84.9%), Gottron's papules (72.9%), heliotrope rash (62%), and malar rash (56.7%). Overall, the demographic and clinical features of the 2 continental cohorts were comparable. European patients received more frequently high-dose intravenous methylprednisolone, cyclosporine, cyclophosphamide, and azathioprine, while methotrexate and antimalarials medications were used more commonly by Latin American physicians.ConclusionThe demographic and clinical characteristics of JDM are similar in European and Latin American patients. We found, however, several differences in the use of medications between European and Latin American paediatric rheumatologists.

Interferon-gamma+874 Polymorphism in the First Intron of the Human Interferon-gamma Gene and Kidney Allograft Outcome

Background. Despite advances in immunosuppressive therapy in the past decade, allograft rejection remains an important cause of kidney graft failure. Cytokines play a major role in the inflammatory and immune responses that mediate allograft outcomes. Several studies have shown that the production of cytokines varies among individuals. These variations are determined by genetic polymorphisms, most commonly within the regulatory region of cytokine genes. The aim of the present study was to assess the effect of allelic variation on acute rejection episodes (ARE) or chronic allograft nephropathy (CAN) after kidney transplantation.Methods. To determine a possible correlation between the interferon (INF)-gamma +874 polymorphism and kidney allograft outcome, we isolated genomic DNA from 74 patients who underwent isolated kidney allografts and were classified into 2 groups-a rejection and a nonrejection group-for comparison with a control group of 163 healthy subjects.Results. We genotyped INF-gamma +874 polymorphisms in all groups. The transplant group showed a significantly increased homozygous genotype T/T (P = .0118) compared with healthy controls. Similarly, considering only patients with CAN, the homozygous genotype T/T (P = .0067) was significantly increased compared with the healthy controls. The rejection group indicated a significant increased homozygous genotype Tic compared with the control group (P = .0061).Conclusion. Homozygous genotype T/T was associated with increased levels of INF-gamma and greater numbers among the rejection and CAN cohorts.

Long-Term Outcome and Prognostic Factors of Juvenile Dermatomyositis: A Multinational, Multicenter Study of 490 Patients

Objective. To investigate the long-term outcome and prognostic factors of juvenile dermatomyositis (DM) through a multinational, multicenter study.Methods. Patients consisted of inception cohorts seen between 1980 and 2004 in 27 centers in Europe and Latin America. Predictor variables were sex, continent, ethnicity, onset year, onset age, onset type, onset manifestations, course type, disease duration, and active disease duration. Outcomes were muscle strength/endurance, continued disease activity, cumulative damage, muscle damage, cutaneous damage, calcinosis, lipodystrophy, physical function, and health-related quality of life (HRQOL).Results. A total of 490 patients with a mean disease duration of 7.7 years were included. At the cross-sectional visit, 41.2-52.8% of patients, depending on the instrument used, had reduced muscle strength/endurance, but less than 10% had severe impairment. Persistently active disease was recorded in 41.2-60.5% of the patients, depending on the activity measure used. Sixty-nine percent of the patients had cumulative damage. The frequency of calcinosis and lipodystrophy was 23.6% and 9.7%, respectively. A total of 40.7% of the patients had decreased functional ability, but only 6.5% had major impairment. Only a small fraction had decreased HRQOL. A chronic course, either polycyclic or continuous, consistently predicted a poorer outcome. Mortality rate was 3.1%.Conclusion. This study confirms the marked improvement in functional outcome of juvenile DM when compared with earlier literature. However, many patients had continued disease activity and cumulative damage at followup. A chronic course was the strongest predictor of poor prognosis. These findings highlight the need for treatment strategies that enable a better control of disease activity over time and the reduction of nonreversible damage.

Reductions in the Prevalence and Incidence of Geohelminth Infections following a City-wide Sanitation Program in a Brazilian Urban Centre

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Eficácia e segurança do uso inalatório da adrenalina-L na laringite pós-intubação utilizada em associação com a dexametasona

Objective: to assess the efficacy and safety of the use of nebulized L-epinephrine associated with dexamethasone in post-intubation laryngitis. Method: we carried out a prospective, randomized, double-blind, placebo controlled study with two cohorts of patients with postintubation laryngitis graded 3 to 6 by Downes and Raphaely score and during two years. Our population was divided into two groups: A and B; both groups received intravenous dexamethasone and nebulized saline with (group B) and without (group A) L-epinephrine. The efficacy was assessed by Downes and Raphaely's score. The side effects of epinephrine were evaluated according to occurrence of arrhythmia, to increased blood pressure, and to average heart rate of group B in comparison to group A. Results: twenty-two patients were included in group A (average score = 4.8) and 19 in group B (average score = 5.2). During treatment, 3 patients in group A presented a score of 8 and were reintubated. This group also showed higher clinical scores than group B during the first two hours of the protocol; these results were not statistically significant. No side effects were observed due to epinephrine. The gasometric parameters were adequate in both groups, but better in the control group. Conclusions: we did not observe increased efficacy for the treatment of post-intubation laryngitis when nebulized L-epinephrine was used simultaneously with intravenous dexamethasone. Some indicators, however, did present a favorable trend when combined therapy was used and should be submitted to further evaluation.

Insulinoterapia, controle glicêmico materno e prognóstico perinatal - Diferença entre o diabetes gestacional e o clínico

PURPOSE: to evaluate the insulin therapy protocol and its maternal and perinatal outcome in patients with clinical or gestational diabetes in a high risk reference service. METHODS: descriptive and prospective study including 103 pregnant women with gestational or clinical diabetes treated with insulin and attended by the reference service from October 2003 to December 2005. Gemellarity, miscarriages, unfinished prenatal care and deliveries not attended by the service were excluded. The gestational age at the beginning of the treatment, dosage, doses/day, increment of insulin (UI/kg), glycemic index (GI) and perinatal outcomes were compared. ANOVA, Fisher's exact test and Goodman's test considering p<0.05 were used. RESULTS: multiparity (92 versus 67.9%), pre-gestational body mass index (BMI) >25 kg/m 2 (88 versus 58.5%), weight gain (WG) <8 kg (36 versus 17%) and a high increment of insulin characterized the gestational diabetes. For the patients with clinical diabetes, despite the highest GI (120 mg/dL (39.2 versus 24%)) at the end of the gestational period, insulin therapy started earlier (47.2 versus 4%), lasted longer (56.6 versus 6%) and higher doses of insulin (92 versus 43 UI/day) were administered up to three times a day (54.7 versus 16%). Macrosomia was higher among newborns from the cohort of patients with gestational diabetes (16 versus 3.8%), being the only significant neonatal outcome. There were no neonatal deaths, except for one fetal death in the cohort of patients with clinical diabetes. There were no differences in the other neonatal complications in both cohorts, and most of the newborns were discharged from hospital up to seven days after delivery (46% versus 55.8%). CONCLUSIONS: the analysis of these two cohorts has shown differences in the insulin therapy protocol in quantity (UI/day), dosage (UI/kg weight) and number of doses/day, higher for the clinical diabetes cohort, and in the increment of insulin, higher for the gestational diabetes cohort. Indirectly, the quality of maternal glycemic control and the satisfactory perinatal outcome have proven that the treatment protocol was adequate and did not depend on the type of diabetes.

Sex ratio, growth and recruitment of the pelagic shrimp Acetes americanus on the southeastern coast of Brazil

We evaluated the population dynamics of Acetes americanus Ortmann, 1893 focusing on sex ratio, individual growth, longevity, and the juvenile recruitment period. Samples were collected monthly from January 2006 to June 2007 in the bay of Ubatuba, Brazil. Specimen growth was identified for each gender, and the chosen cohorts were fitted in a von Bertalanffy Growth Model (VBGM); longevity was estimated by the von Bertalanffy inverse equation, considering 99% of the asymptotic length. A total of 6881 individuals (2343 males and 4538 females) were captured. On average the body size (total length) was greater in females (14.64 ± 3.34 mm) than in males (12.27 ± 1.86 mm). The mean growth curves (obtained by grouping the cohorts for each sex), provided estimates of TL∞ = 19.33 mm, k = 0.02 and t0 = -0.12 days for females and TL∞ = 15.13 mm, k = 0.03 and to = -0.07 days for males, where TL∞ is the asymptotic length, k is coefficient of growth and to is the theorical age when the size is equal to 0. Longevity was estimated at 0.61 years for females and 0.50 years for males. The sex ratio tended to favor females, which corroborates with others studies of sergestids. Our finding that males of A. americanus have higher values of k and therefore achieve a smaller size relative to females has been observed in other penaeids. We concluded that this differential growth pattern between the sexes is found across Dendrobranchiata. The life cycles of penaeids have an average duration of approximately 1-2 years, but our results corroborate other studies that estimate a shorter longevity for Acetes, as species of this genus are typically smaller in size. We found continuous recruitment with two main peaks observed during the study period, corroborating previous studies of Acetes. © The Crustacean Society, 2013. Published by Brill NV, Leiden.

Effects of vaccination against reproductive diseases on reproductive performance of beef cows submitted to fixed-timed AI in Brazilian cow-calf operations

The objectives were to assess incidence of pregnancy losses, associate this outcome with immunization programs against reproductive diseases, and evaluate the effects of vaccination against bovine herpesvirus-1 (BoHV-1), bovine viral diarrhea virus (BVDV), and Leptospira spp., on reproductive efficiency of Brazilian cow-calf operations. In experiment 1, 7614 lactating Nelore cows from 18 ranches were assigned to the same estrus synchronization and fixed-time AI protocol (ESFTAI; Days -11 to 0). Pregnancy status was determined with transrectal ultrasonography on Days 30 and 120 after AI. Pregnancy loss was deemed to have occurred when cows were pregnant on Day 30 but nonpregnant on Day 120. Incidence of pregnancy loss across all ranches was 4.1%; pregnancy losses were detected (P < 0.10) in 14 ranches but not detected (P > 0.11) in four ranches. Pregnancy loss was lower (P ≤ 0.02) in ranches that vaccinated against BoHV-1, BVDV, and Leptospira spp. compared with ranches that did not vaccinate, or only vaccinated against Leptospira spp. In experiments 2 and 3, lactating Nelore cows (N = 1950 and 2793, respectively) from ranches that did not have a history of vaccinating against reproductive diseases (experiment 2), or only vaccinated against Leptospira spp. (experiment 3), were assigned to the same ESFTAI used in experiment 1. Within each ranch, cows received (VAC) or not (CON) vaccination against BoHV-1, BVDV, and Leptospira spp. at the beginning of the ESFTAI (Day -11) and 30 days after (Day 41) AI. In experiment 2, VAC cows had greater (P ≤ 0.05) pregnancy rates compared with CON on Days 30 and 120. In experiments 2 and 3, pregnancy loss was reduced (P ≤ 0.03) in primiparous VAC cows compared with CON cohorts. In experiment 4, 367 primiparous, lactating Nelore cows previously vaccinated against Leptospira spp. were assigned to the same ESFTAI used in experiment 1. Cows received VAC, or the same vaccine 30 days before (Day -41) and at the beginning (Day -11) of the ESFTAI (PREVAC). Pregnancy rates on Days 30 and 120 were greater (P ≤ 0.05) in PREVAC cows compared with VAC cows. In conclusion, pregnancy losses affected reproductive and overall efficiency of Brazilian cow-calf operations, and might be directly associated with BoHV-1, BVDV, and Leptospira spp. infections. Hence, vaccinating cows against these pathogens, particularly when both doses are administered before fixed-time AI, improved reproductive performance in Brazilian cow-calf systems. © 2013 Elsevier Inc.

Short communication: Acute but transient increase in serum insulin reduces messenger RNA expression of hepatic enzymes associated with progesterone catabolism in dairy cows

The objective of this experiment was to evaluate the effects of glucose infusion on serum concentrations of glucose, insulin, and progesterone (P4), as well as mRNA expression of hepatic CYP2C19 and CYP3A4 in nonlactating, ovariectomized cows in adequate nutritional status. Eight Gir × Holstein cows were maintained on a low-quality Brachiaria brizantha pasture with reduced forage availability, but they individually received, on average, 3. kg/cow daily (as fed) of a corn-based concentrate from d -28 to 0 of the experiment. All cows had an intravaginal P4-releasing device inserted on d -14, which remained in cows until the end of the experiment (d 1). On d 0, cows were randomly assigned to receive, in a crossover design containing 2 periods of 24. h each (d 0 and 1), (1) an intravenous glucose infusion (GLUC; 0.5. g of glucose/kg of BW, over a 3-h period) or (2) an intravenous saline infusion (SAL; 0.9%, over a 3-h period). Cows were fasted for 12. h before infusions, and they remained fasted during infusion and sample collections. Blood samples were collected at 0, 3, and 6. h relative to the beginning of infusions. Liver biopsies were performed concurrently with blood collections at 0 and 3. h. After the last blood collection of period 1, cows received concentrate and returned to pasture. Cows gained BW (16.5 ± 3.6. kg) and BCS (0.08 ± 0.06) from d -28 to 0. Cows receiving GLUC had greater serum glucose and insulin concentrations at 3. h compared with SAL cohorts. No treatment effects were detected for serum P4 concentrations, although mRNA expression of CYP2C19 and CYP3A4 after the infusion period was reduced for cows in the GLUC treatment compared with their cohorts in the SAL treatment. In conclusion, hepatic CYP3A4 and CYP2C19 mRNA expression can be promptly modulated by glucose infusion followed by acute increases in circulating insulin, which provides novel insight into the physiological mechanisms associating nutrition and reproductive function in dairy cows. © 2013 American Dairy Science Association.

Effects of bovine somatotropin injection on serum concentrations of progesterone in non-lactating dairy cows

The objective of this experiment was to evaluate the effects of bovine somatotropin administration on serum concentrations of glucose, insulin, NEFA, IGF-I, and progesterone (P4) in ovariectomized non-lactating dairy cows receiving exogenous P4, as a model to estimate treatment effects on hepatic P4 degradation. Ten non-lactating, non-pregnant, and ovariectomized Gir×Holstein cows were assigned to the experiment (d -14 to 27). On d 0, cows were ranked by BW and BCS, and randomly assigned to one of two treatments: (1) bovine somatotropin (BST; n=5) or (2) saline control (control; n=5). Cows assigned to the BST treatment were administered s.c. injections containing 500. mg of sometribove zinc on d 0, 9, and 18 of the experiment, whereas control cows concurrently received a 10-mL s.c. injection of 0.9% saline. On d -2, cows were inserted with an intravaginal releasing device containing 1.9. g of P4, which remained in the cows until the end the experiment (d 27). Cow BW and BCS were assessed on d -14, 0, and 27. Blood samples were collected daily from d 0 to d 27, at 0 (immediately before), 1, and 2. h relative to concentrate feeding for determination of serum glucose, insulin, NEFA, P4, and IGF-I concentrations. Concentrations of glucose, NEFA, and insulin obtained prior to feeding (0. h) were used to determine pre-prandial revised quantitative insulin sensitivity check index (RQUICKI). No treatment effects were detected for BW (P=0.72) and BCS change (P=0.79) during the experiment. Beginning on d 2 of the experiment, BST cows had greater (P≤0.01) serum IGF-I concentrations compared with control cohorts (treatment×day interaction; P<0.01). Cows receiving BST had greater (P≤0.05) insulin concentrations compared with control cohorts from d 8 to d 11, d 16 and 17, as well as from d 19 to d 21 of the experiment (treatment×day interaction; P<0.01). Cows receiving BST had greater (P≤0.01) mean glucose and NEFA concentrations, as well as reduced (P<0.01) mean RQUICKI during the experiment compared with control cohorts. No treatment effects, however, were detected (P=0.73) for serum P4 concentrations. In conclusion, results from this experiment indicate that hepatic P4 catabolism is not directly regulated by circulating IGF-I, whereas BST administration decreases insulin sensitivity in non-lactating dairy cows in adequate nutritional status. © 2013 Elsevier B.V.

Effects of bovine somatotropin administration on growth, physiological, and reproductive responses of replacement beef heifers

This experiment compared growth, body composition, plasma IGF-I and leptin, and reproductive development of beef heifers receiving or not recombinant bovine ST (BST) beginning after weaning until the first breeding season. Fifty Angus × Hereford heifers (initial BW = 219 ± 2 kg; initial age = 208 ± 2 d), weaned at approximately 6 mo of age, were assigned to the experiment (d 0 to 210). On d 0, heifers were ranked by initial BW and age and assigned to 1) treatment with BST or 2) saline control. Heifers assigned to the BST treatment received subcutaneous (s.c.) injections containing 250 mg of sometribove zinc whereas control heifers received a 5-mL s.c. injection of 0.9% saline every 14 d. Treatments were initiated on d 14 and last administered on d 196. Heifers were maintained on separate pastures harvested for hay the previous summer according to treatment and received grass and alfalfa hay at a rate to provide a daily amount of 7.0 and 1.0 kg of DM per heifer, respectively. Heifer shrunk BW was collected on d 1 and 211 for heifer ADG calculation. Blood samples were collected weekly from d 0 to 210 for determination of plasma progesterone to estimate puberty attainment as well as plasma concentrations of IGF-I and leptin in selected samples. On d 0, 63, 133, and 189, heifers were evaluated for intramuscular marbling, LM depth, and backfat thickness via real-time ultrasonography. No treatment effects were detected (P = 0.27) for heifer ADG (0.49 vs. 0.51 kg/d for control and BST heifers, respectively; SEM = 0.02). Mean backfat thickness was lesser (P < 0.01) in BST heifers compared with control cohorts (3.56 vs. 3.92 mm, respectively; SEM = 0.08). Heifers receiving BST had greater plasma IGF-I concentrations compared with control cohorts 7 d after treatment administration (treatment × day interaction; P < 0.01). Mean plasma leptin concentrations were lesser (P = 0.05) in BST heifers compared with control cohorts (1.82 vs. 2.03 ng/mL, respectively; SEM = 0.07). Onset of puberty was hastened in BST heifers compared with control cohorts (treatment x day interaction; P = 0.04). In summary, a greater proportion of BST heifers reached puberty during the experiment compared with control cohorts, despite lesser plasma leptin concentrations, backfat thickness, and similar ADG. Hence, circulating IGF-I was positively associated with hastened puberty attainment independently of growth rate, circulating leptin concentrations, and body fat content of replacement beef heifers. © 2013 American Society of Animal Science. All rights reserved.

Caracterização do perfil de atividade física na vida diária de pacientes portadores de DPOC do Brasil e comparação com pacientes da Áustria

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Biologia e ciclo de vida de Astyanax cf. scabripinnis paranae Eigenmann, 1914 (Characidae, Tetragonopterinae), no Ribeirão Grande, Parque Estadual da Serra do Mar, núcleo Santa Virginia, SP

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Effects of flunixin meglumine administration on physiological and performance responses of transported feeder cattle

The objective was to evaluate the effects of flunixin meglumine administration on physiological and performance responses of transported cattle during feedlot receiving. Forty-five Angus x Hereford steers were ranked by BW on d 0 and assigned to 1 of 3 treatments:1) transport for 1,280 km in a commercial livestock trailer and administration of flunixin meglumine (1.1 mg/kg BW; intravenous) at loading (d 0) and unloading (d 1; FM), 2) transport for 1,280 km in a commercial livestock trailer and administration of 0.9% saline (0.022 mL/kg BW; intravenous) at loading (d 0) and unloading (d 1; TRANS), or 3) no transport and administration of 0.9% saline (0.022 mL/kg BW; intravenous) concurrently with loading (d 0) and unloading (d 1) of FM and TRANS cohorts (CON). Upon arrival and processing for treatment administration on d 1, steers within each treatment were ranked by BW and assigned to 15 feedlot pens (5 pens/treatment, 3 steers/pen). Full BW was recorded before (d -1 and 0) treatment application and at the end of experiment (d 28 and 29) for ADG calculation. Total DMI was evaluated daily from d 1 to 28. Blood samples were collected on d 0 (before treatment administration), 1 (after unloading but before treatment administration), 4, 7, 10, 14, 21, and 28. Body weight shrink from d 0 to 1 was less (P < 0.01) in CON vs. FM and TRANS but similar (P = 0.94) between TRANS and FM. Mean ADG was greater (P <= 0.04) in CON vs. FM and TRANS but similar (P = 0.69) between TRANS and FM. No treatment effects were detected on DMI, but CON had greater G:F vs. TRANS (P = 0.08) and FM (P = 0.02), whereas G:F was similar (P = 0.68) between TRANS and FM. Mean plasma cortisol concentrations tended (P <= 0.09) to be greater in TRANS vs. FM and CON but was similar (P = 0.87) between CON and FM. Plasma NEFA concentrations were greater (P <= 0.02) for TRANS and FM vs. CON on d 1 and greater (P <= 0.04) for FM vs. TRANS and CON on d 4. Plasma ceruloplasmin concentrations were greater (P <= 0.03) for TRANS vs. CON on d 1, 4, and 7, greater (P <= 0.05) for TRANS vs. FM on d 4 and 7, and greater (P <= 0.04) for FM vs. CON on d 1 and 4. Plasma haptoglobin concentrations were greater (P < 0.01) for TRANS vs. CON and FM on d 1 and 4 and greater (P <= 0.05) for FM vs. CON on d 1 and 4. In conclusion, flunixin meglumine reduced the cortisol and acute-phase protein responses elicited by road transport but did not improve receiving performance of feeder cattle.

Impacts of Reproductive Technologies on Beef Production in South America

The majority of beef cow herds in South America are constituted by Bos indicus females, which have particular reproductive features that contribute to reduced reproductive efficiency compared with that of B. taurus cohorts. Hence, several alternatives to enhance reproductive efficiency of B. indicus heifers and cows have been developed to address their inherent reproductive shortcomings. These research-based technologies are being described in detail within this chapter and have already made an impact on South American B. indicus-based production systems. These include the following: (a) hormonal protocols to induce puberty in nulliparous heifers or estrous cyclicity in postpartum cows to maximize their reproductive performance during the subsequent breeding season, (b) hormonal protocols to synchronize estrus and/or ovulation in B. indicus females to exploit their reproductive responses to artificial insemination, and (c) genetic and environmental factors that influence reproductive success in beef herds, including reproductive diseases and excitable temperament of B. indicus females, that have been investigated to support/promote the development of appropriate mitigation technologies.