Estudo das alterações eletrocorticográficas na insuficiência hepática aguda experimental.

The aim of this study was to test the application and value of electrocorticography (ECG) in the early diagnosis and characterization of electrocorticograms changes on experimental fulminant hepatic failure (FHF). Our material was composed of two groups of guinea pigs: a) ethanolamine group--42 animals with FHF induced by intrabiliary injection of 2.5 ml of monoethanolamine oleate; b) control group--10 animals submitted to intrabiliary injection of 2.5 ml of saline. Electrocorticograms recordings were taken in both groups with the electrodes implanted on the parieto-occipital regions of the skull. The hepatic failure was characterized by clinical manifestations, serum biochemical tests and histopathological findings. In the early hepatic coma the electrocorticograms could not be unequivocally distinguished from normal pattern, and alpha rhythm was recognizable in most animals. With further deterioration of the clinical condition the tracing showed progressive slowness of the normal rhythm, increased voltage and triphasic waves followed by suppression of electrical activity preceding the animal death. The electrocorticography was not suitable for the early diagnosis of hepatic coma, since the ECG alterations became evident only in overt coma. However the method could be useful for the characterization of cerebral disorders and the study of the pathogenesis of fulminant hepatic failure.

Linfonodo pulmonar na paracoccidioidomicose aguda infantil (relato de um caso).

The primary complex like Ghon was observed in a child's clinical roentgenographic study. C.S., white, male, 6 years old, was born in Curitiba (PR), Brazil and living in Guaratingueta (SP), Brazil, developed common cold, bimodal diary fever, chills, shake and sweats. Dyspnea, cough with general lymphadenopathy. Foot and right shoulder arthralgias. Six months ago visited a cave, equitation practice, dog and cat contacts and no transfusion, frontal sweats, fever (38.4 degrees C). T.A. was 8/6, tachycardia in generalized lymphadenopathy. Cardiopulmonary system was normal, mesogastric tumoral mass, hepatosplenomegaly and no ascites. Bone marrow with eosinophilia; nodule demonstrated presence of P. brasiliensis, hypoalbuminemia; hyperglobulinemia; anemia; leukocytosis with eosinophilia. Immunodiffusion with exoantigen 43 kd of P. brasiliensis was 1/32. Primary complex like Ghon was observed in interstitial pneumonia followed by mediastinal and mesogastric mass (35 to 40 days). Clavicular osteolytic lesions (45 to 60 days) appeared during paracoccidioidomycosis therapy. Recovery was observed 2 months after treatment of acute infantile paracoccidioidomycosis.

Insuficiência renal aguda. Estudo do quadro clínico e prognóstico.

Acute renal failure (ARF) is a frequent complication in hospitalized patients, and is strongly related to increase of mortality. PURPOSE: To analyze the clinical outcome and the prognostic factors in hospital acquired AFR. METHOD: A prospective study was performed. Data from 200 patients with established ARF admitted during the period of January, 1987 and July, 1990 were collected. RESULTS: The incidence of ARF was 4.9/1000 admissions. Renal ischemia (50%) and nephrotoxic drugs (21%) were the main etiologic factors. The histologic study done in 43 patients showed: acute tubular necrosis (53%), tubular hydrophic degeneration (16%), glomerulopathies (16%) and other lesions (15%). Dialysis therapy was performed in 101 patients and the main indications were: uremia (67%), hypervolemia (22%) and hyperkalemia (9%). The mortality rate was 46.5% and the most important causes of death were: sepsis (38%), respiratory failure (19%) and multiple organs failure (11%). Treatment withdraw was the cause of death in 2 patients. Higher mortality was observed in oliguric patients (62.9%) than non-oliguric (34.5%) (p < 0.05) and in ischemic renal failure (56.7%) when compared to nephrotoxic renal failure (14.7%) (p < 0.05). This difference was maintained when the comparison was done only between dialyzed patients. CONCLUSION: As primary cause of death was not associated to the acute renal failure, we conclude that acute renal failure is an important marker of the gravity of the underlying disease and not the cause of death.

Glifosato: Propriedades, toxicidade, usos e legislação

This paper supplies a compact revision on the herbicide glyphosate physic-chemistry characteristic mains, including toxicity and valid Brazilian legislation for its use.

Análise retrospectiva da toxicidade de gotas otológicas, medicamentos tópicos nasais e orofaríngeos registrada na Grande São Paulo.

BACKGROUND: Retrospective analysis of human toxicity files involving topical medicines for treatment of upper airways diseases (eardrops, topical nasal medicines, lozenges, drops and sprays for oropharyngeal affections). METHODS: Thirty-four brands of eardrops, 48 of topical nasal medicines and 22 of tablets, lozenges and sprays for oropharyngeal affections were selected, from a total of 104 products available in Brazil. We analyzed the registries in the electronic database from the Poison Control Centre of São Paulo (CCI-Jabaquara), Brazil, for the period from January 1996 through December 2000. The cases related to selected pharmaceuticals were collected. RESULTS: 10,823 cases of human toxicity caused by medicines were voluntarily reported to CCI-Jabaquara. Topical medicines for treatment of upper airways diseases accounted for 291 cases (2.68%), from which 240 (82.5%) represented poisoning; 12 (4.1%) involved ear drops, 268 (92%), topical nasal medicines and 11 (3.9%), topical medicines for oropharyngeal affections. Among topical nasal medicines, vasoconstrictors predominated (233 cases), and among medicines for oropharyngeal affections, it was tetracaine (four cases). Considering age distribution, toxicity predominated significantly in children aged from 1 to 4 years (p=0.0003). The main causes of toxicity were: accidental intake of medicines (43%) and error in drug administration (14.8%). Hypereflexia and vomiting were the most frequent symptoms related to toxicity. CONCLUSIONS: There was significant incidence of systemic toxicity due to eardrops, topical nasal and oropharyngeal medicines in children 1 to 4 years-old, whose main cause was accidental intake of these medicines.

Mortalidade e prognóstico específico em pacientes com insuficiência renal aguda

A variety of systems of risk factor stratification have been studied to predict the outcome in acute renal failure (ARF). OBJECTIVES. Assess and compare mortality and the Acute Tubular Necrosis Individual Severity Score (ATN-ISS) in patients with AFR treated in a university hospital. METHODS. A prospective analysis was made of 103 patients with a diagnosis of intrinsic ARF admitted to the Hospital das Clinicas da Faculdade de Medicina de Botucatu, UNESP. Patients were followed up until recovery of renal function or death. The Score ATN-ISS was recorded during the first hours of the assessment by a nephrologist. Results were reported as median or mean ± SD, with statistical significance of p<0.05. RESULTS. Fifty-one percent of patients were male with a mean age of 58 ± 36 years. Forty-four percent died in the hospital. Mortality was higher in patients from the surgical wards (52.7%) and in patients who were treated with dialysis (63.8%). The score ATN-ISS showed a good confidence level, with high discriminatory power (area under the curve of 0.95) and good accuracy. CONCLUSIONS. Mortality in this study was comparable to that found in literature. The ATN-ISS was shown to be a prognostic index with a high confidence level that could be routinely applied by nephrologists to patients with AFR.

Abordagem initial do paciente com mielopatia aguda não compressiva

Acute myelopathy are characterized by spinal cord dysfunction, developing sensitive, motor and autonomic signs and symptons. Since they are relatively rare, there are some difficulties to early diagnosis and to the beginning of the treatment. So, literature was reviewed to describe the main aetiologies of acute non compressive myelopathy: 1) demyelinating diseases; 2) systemic disease; 3) parainfectious; 4) delayed radiation myelopathy; 5) vascular myelopathy; 6) idiopatic and 7) vitamin B12 deficiency. Besides, we suggest an algorithm to initial approach of these patients and further aethiologic investigation. © Copyright Morelra Jr. Editora.

Teníase: Uma causa rara de apendicite aguda

Acute appendicitis is the most common surgical condition of acute abdomen. Approximately 7 percent of the population will have appendicitis during their lifetime, with the peak incidence occurring between 10 through 30 years-old Obstruction of the appendix lumen with subsequent bacterial infection initiates the pathophysiological sequence of acute appendicitis. Obstruction may have multiple causes, including fecalith, lymphoid hyperplasia (related to viral illnesses, including upper respiratory infection, mononucleosis, and gastroenteritis), foreign bodies, carcinoid tumor and parasites. In Asia, Africa and Latin America, Enterobius vermicularis has been reported as the main parasite that causes appendix obstruction. Rarely, Taenia sp., has been pointed as a cause of parasitic appendicitis. We reported a 30 years-old patient clinically diagnosed with acute appendicitis. The appendectomy was performed through a McBurney incision. The patient's convalescence was uneventful, and he was discharged from hospital 48 hours after operation. Histological examination of the appendix showed acute appendicitis, and it was found aparasite (Taenia sp.) lying inside of the appendix lumen at a transverse section. He has received 10 mg/Kg weight of praziquantel for taeniasis treatment.

Toxicidade de fármacos nitrofurânicos

During the structural designing of new drugs, it is possible predict the influence of specific chemical groups on pharmacological activity. Among these, the nitro group has potential antiparasitic activity, being present in many antimicrobial drugs, such as metronidazole, nitrofurazone, furazolidone, oxamniquine and chloramphenicol. Also, the introduction of the nitro group into a molecule can modify the physicochemical and electronic properties of the substance. Besides antimicrobial drugs, this group is also found in other drug classes, such as antiulcer, anti-inflamatory and anxiolytic. However, the use of the nitro group in drug design has encountered restrictions, due to the associated toxicity. This article is a review of the toxicity of nitrofuran compounds, as well the possible mechanisms involved and the strategy of latentiation by molecular modification to decrease their toxicity.

Perfil eletroforético das proteínas de fase aguda em caprinos experimentalmente infectados com Trypanosoma evansi

Considered as one of the main agents of the tripanossomiases, Trypanosoma evansi causes a disease generically know as surra, with wide geographic occurence. This work has the aim to study the electrophoretic profile of the acute phase proteins of goats, experimentally infected with T. evansi. Ten crossbread female goats, around 4 months of age, clinically healthy and serum negative for the presence of antibodies anti-T. evansi (IFAT) were used. The animals were divided in two groups: six were inoculated (G1) intravenously with 2,38 × 10 6 tripomastigotes of T. evansi and four were kept as noninfected controls. The blood for serum was collected daily until the 14 days after inoculation (DAI), weekly up to the 98 th DAI and every two weeks up to the 364 th DAI. The serum proteins were separacted by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDSPAGE). Twenty-one proteins were found in the serum of the goats, eight were nominally identified; phosphorylase, transferrin, albumin, antitrypsin, acid glicoprotein, haptoglobin, hemoglobin, and light chain immunoglobulin.

Determinação da toxicidade do selênio por meio de análises hematológicas em Oreochromis niloticus

Selenium (Se) is described as an essential micronutrient and participates in different biological functions, as the antioxidant defense systems maintenance and regulation. However, when in high concentrations, Se may cause toxic effects as well as hematological changes in fish. The aim of the present study was to determine the toxicity of selenium in the form of sodium selenate (Na 2Se 6+O 4) in Oreochromis niloticus based on hematological parameters, after exposure to different concentrations (0.01, 0.14 and 1.4 mg Se 6+ L -1). The erythrocytic and leukocytic series were examined over 14 days at intervals of 0, 3, 5, 7,10 and 14 days. The erythrocytic series showed significant alterations in the first 7 days, including the control group. Neutrophils and monocytes showed variations in the first 3 days at a concentration of 1.40 mgSe 6+ L -1 characterizing an acute response. The total number of leukocytes was different in relation to time zero on all Se concentrations. The thrombocyte count also differed statistically from time zero and control in the first 3 days at 0.14 mgSe 6+ L -1. These results indicate that different concentrations induce an acute response with diminution of total leukocytes, neutrophilia, monocytosis and thrombocytosis.

Fondaparinux em intervenção coronária percutânea no tratamento da síndrome coronária aguda

Background: Fondaparinux is considered an agent with a well-established safety and efficacy profile in the treatment of non-ST segment elevation acute coronary syndromes, but when used alone, is associated to a higher incidence of thrombotic complications during invasive coronary procedures, requiring the supplementation of an anti-IIa agent. This study aimed to evaluate the efficacy and safety of percutaneous coronary intervention (PCI) in patients with non-ST segment elevation acute coronary syndromes previously treated with fondaparinux. Methods: Prospective, controlled registry enrolling 127 consecutive patients submitted to an early invasive stratification during treatment with fondaparinux, with supplementation of intravenous unfractionated heparin at a dose of 85 U/kg at the time of PCI. Results: The rate of the composite primary endpoint including death, acute myocardial infarction, stroke, stent thrombosis or emergency myocardial revascularization was 3.2%. The cumulative incidence of major bleeding and vascular complications was 3.2%. There were no cases of guidecatheter thrombosis or abrupt vessel closure. Conclusions: PCI in patients with acute coronary syndromes receiving fondaparinux is associated with a low rate of major adverse cardiovascular ischemic events and severe hemorrhagic complications. Supplementation of unfractionated heparin during the invasive procedures eliminates the risk of catheter-related thrombosis.

Toxicidade de águas e sedimentos em um rio afetado por atividades mineradoras pretéritas

The Ribeira de Iguape River basin received intense mining activities for lead exploiting and, as a result, the river received the discharges of estimated amounts of 5.5 tons/month of material rich in As, Ba, Cd, Pb, Cu, Cr and Zn. In this article, the toxicity of waters and sediments collected in Ribeira de Iguape River was assessed aiming to estimate environmental quality. Three sampling campaigns were conducted, from 2009 to 2010. Toxicity tests with the cladoceran Daphnia similis were done for water samples and for sediments, in this case using sediment-water interface exposure. Results showed in general absence of toxicity for sediments and waters, and only eventually were acute effects registered (marginal toxicity). Results are consistent with the conditions indicated by the literature, of low concentrations of metals in waters and sediments; however they differ from the monitoring made by the state environmental agency, which registered chronic toxicity. The occurrence of eventual acute toxicity indicates that although Ribeira de Iguape River quality is being restored, conditions still are not totally under control.

Aerocistite aguda induzida por tioglicolato, lipolisacarídeo e Aeromona hydrophila inativada em Piaractus mesopotamicus: Efeitos hematológicos

The effects of swim bladder injection with thioglycolate, Escherichia coli lipopolysaccharide (LPS) and heat-inactivated Aeromonas hydrophila were assessed on hematological responses in pacu, Piaractus mesopotamicus (Characidae). A quantitative assessment was done on erythrocytes, thrombocytes e leucocytes at 6, 24, and 48 h pos-injection of the inflammatory agents and compared with fish injected with saline solution (control). Fish injected with inactivated A. hydrophila showed a reduction of erythrocytes and hemoglobin, whereas the hematocrit increased 6 h pos-injection. The results show that thioglycolate and LPS also induced a reduction on hemoglobin and an increase on the hematocrit. The thrombocytes count decreased 6 h post A. hydrophila injection, whereas increased 48 hours post LPS injection. The leukocytes count increased after 6 h post A. hydrophila injection, while the lymphocytes and PAS-positive granular leukocytes (PAS-LG) count decreased after 24 h post injection. In fish injected with thioglycolate or with LPS showed an increase in the LG-PAS counts when compared to A. hydrophila or control groups. The monocytes count was not affected by the different inflammatory agents.