Diabetes subdiagnosticado e necrose miocárdica: preditores de hiperglicemia no infarto do miocárdio

FUNDAMENTO: Hiperglicemia na fase aguda do infarto do miocárdio é importante fator prognóstico. Entretanto, sua fisiopatologia não está completamente elucidada. OBJETIVO: Analisar simultaneamente correlação entre hiperglicemia e marcadores bioquímicos relacionados ao estresse,metabolismo glicídico e lipídico, coagulação, inflamação e necrose miocárdica. MÉTODOS: Oitenta pacientes com infarto agudo do miocárdio foram incluídos prospectivamente. Os parâmetros analisados foram: glicose, hormônios do estresse (cortisol e norepinefrina), fatores do metabolismo glicídico [hemoglobina glicada (HbA1c), insulina], lipoproteínas (colesterol total, LDL, HDL, LDL eletronegativa minimamente modificada e adiponectina), glicerídeos (triglicérides, VLDL e ácido graxo), fatores da coagulação (fator VII, fibrinogênio,inibidor do ativador do plasminogênio-1), inflamação (proteína C reativa ultrassensível) e necrose miocárdica (CK-MB e troponina). Variáveis contínuas foram convertidas em graus de pertinência por intermédio de lógica fuzzy. RESULTADOS: Houve correlação significativa entre hiperglicemia e metabolismo glicídico (p < 0,001), lipoproteínas (p = 0,03) e fatores de necrose (p = 0,03). Na análise multivariada, somente metabolismo glicídico (OR = 4,3; IC = 2,1-68,9 e p < 0,001) e necrose miocárdica (OR = 22,5; IC = 2-253 e p = 0,012) mantiveram correlação independente e significativa.Para análise da influência da história de diabetes mellitus , modelo de regressão, incluindo somente pacientes sem diabetes mellitus foi desenvolvido, e os resultados não alteraram. Finalmente, no modelo ajustado para idade, sexo e variáveis clínicas(história de diabetes mellitus, hipertensão arterial e dislipidemia), três variáveis mantiveram associação significativa e independente com hiperglicemia: metabolismo glicídico (OR = 24,1; IC = 4,8-122,1 e p < 0,001) necrose miocárdica (OR = 21,9; IC = 1,3-360,9 e p = 0,03) e história de DM (OR = 27, IC = 3,7-195,7 e p = 0,001). CONCLUSÃO: Marcadores do metabolismo glicídico e necrose miocárdica foram os melhores preditores de hiperglicemia em pacientes com infarto agudo do miocárdio.

Lipoprotein (a): Structure, Pathophysiology and Clinical Implications

The chemical structure of lipoprotein (a) is similar to that of LDL, from which it differs due to the presence of apolipoprotein (a) bound to apo B100 via one disulfide bridge. Lipoprotein (a) is synthesized in the liver and its plasma concentration, which can be determined by use of monoclonal antibody-based methods, ranges from < 1 mg to > 1,000 mg/dL. Lipoprotein (a) levels over 20-30 mg/dL are associated with a two-fold risk of developing coronary artery disease. Usually, black subjects have higher lipoprotein (a) levels that, differently from Caucasians and Orientals, are not related to coronary artery disease. However, the risk of black subjects must be considered. Sex and age have little influence on lipoprotein (a) levels. Lipoprotein (a) homology with plasminogen might lead to interference with the fibrinolytic cascade, accounting for an atherogenic mechanism of that lipoprotein. Nevertheless, direct deposition of lipoprotein (a) on arterial wall is also a possible mechanism, lipoprotein (a) being more prone to oxidation than LDL. Most prospective studies have confirmed lipoprotein (a) as a predisposing factor to atherosclerosis. Statin treatment does not lower lipoprotein (a) levels, differently from niacin and ezetimibe, which tend to reduce lipoprotein (a), although confirmation of ezetimibe effects is pending. The reduction in lipoprotein (a) concentrations has not been demonstrated to reduce the risk for coronary artery disease. Whenever higher lipoprotein (a) concentrations are found, and in the absence of more effective and well-tolerated drugs, a more strict and vigorous control of the other coronary artery disease risk factors should be sought.

Os insetos como agentes polinizadores da mangueira

The authors study the insect population that visit the mango trees and search for their pollinizing activity. Prior operations showed that very few bees (Apis mellifera) visited the flowers of mango trees. It was known that the percentage of fecundation is low (Simão 1955), Popenoe (1929), Spencer and Kennard (1955), Lynch and Mustard (1955), Ruehle and Ledin (1955), so that the authors wented to Know if insects could be responsible for this. Insects were collected from mango trees, belonging to 10 orders, which, on the whole are not pollinizing agents. Bees were not collected, 21% were Hymenoptera, 20% were Diptera, 13% Hemiptera, 10% Coleoptera, 3% Blattariae and smoller percentages belonged to other orders.

Contribuição para o conhecimento de duas espécies de cupim do Vale do Paraíba (Estado de São Paulo)

Duas espécies de cupim do Vale do Paraíba, Estado de São Paulo, são estudadas. A primeira, Cornitermes bequaerti Emerson, 1952, é pouco conhecida, embora sua área de dispersão abranja três estados; a segunda espécie, Syntermes silvestrii Holmgren, 1911, é menos conhecida ainda, ocorrendo aparentemente apenas em São Paulo. As duas espécies constroem ninhos que afloram à superfície do solo; os termiteiros de C. bequaerti são encontrados em pastagens e eucaliptais e os de S. silvestrii, em pastagens.

Cuidado parental em Leptodactylus natalensis (Amphibia, Anura, Leptodactylidae)

O presente trabalho registra mais uma espécie pertencente à família Leptodactylidae apresentando cuidado parental, Leptodactylus natalensis Lutz, 1930. Fêmeas foram observadas em assistência a ovos e cardumes de girinos em duas poças temporárias na mata Atlântica do Estado de Pernambuco, Brasil.

Biologia reprodutiva de Hexanematichthys proops (Siluriformes, Ariidae) no litoral ocidental maranhense

Objetivou-se investigar a influência dos índices gonadais e nutricionais sobre a biologia reprodutiva de Hexanematichthys proops (Valenciennes, 1840) (Siluriformes, Ariidae) na costa ocidental do Maranhão entre julho de 2001 e julho de 2002. Houve uma significante dominância de fêmeas quando considerado o período total amostrado. A relação peso/comprimento apresentou uma significante diferença entre os sexos em relação ao coeficiente de alometria, embora ambos tenham apresentado crescimento alométrico positivo. Análises da curva de maturação baseadas na variação mensal dos índices gonadossomático e hepatossomático sugerem que o período reprodutivo ocorre entre outubro e maio. A variação mensal do fator de condição revelou que as fêmeas apresentaram condições gerais inferiores aos machos durante todo o período amostral. Foi observado que a diminuição do peso do fígado ocorre durante a maturação gonadal e processos reprodutivos. Análises do índice de repleção médio mostraram que os peixes exibem melhores condições alimentares antes e depois do período reprodutivo.

Description of the larva of Orthemis schmidti (Odonata, Libellulidae)

The larva of Orthemis schmidti Buchholz, 1950 is described and illustrated for the first time based on one specimen from the northeastern region Brazil. Diagnostic characters which separate this larva from known larvae of other congeners are mentioned, and some notes on the habitat of the species are presented.

Os grandes clímaces do Brasil: IV - considerações gerais sôbre a vegetação da região nordeste

Die grosse Nordost-region zeigt klimatische und geomorphologische Eigenheiten, die die Vegetationstypen gut begrenzen, die ihrerseits fast immer alten Klimaces entsprechen. So finden wir: I - Feuchtes Gebiet. 1. Die Kuestenflaechen (immergruener und teil-regengruener Wald) mit starken, gleichmaessig verteilten Niederschlaegen zeigt: 10 - 20 m tiefe Lehmboeden, wenig durchlaessig, ohne Lateritkruste, besiedelt mit Baumarten weiter Verbreitung, untermischt mit endemischen Streuformen, was auf eine ziemlich alte Besiedlung hinweist. 2. Die Flaechen der Hochebenen (mikroklimatisch bedingter Wald), abhaengig von "Bergklima" oder hoher Oberflaechenfeuchtigkeit, zeigen folgende Eigenheiten: In den Bergzuegen aus Urgestein, mit lehmigsandigen Boeden hoher Feuchtigkeit wegen der Passatwinde und der haeufigen Nebelbildung, finden sich dieselben Baumarten, die auch in den benachbarten Waldgebieten vorkommen untermischt mit wenigen endemischen Formen; an den Haengen der Bergzuege aus Sandstein, mit sandig-lehmigen Boeden, die wegen des Anschnitts des Grundwasserspiegels dauernd feucht sind, finden sich endemische Arten - in der Mehrzahl Streuformen aus den Cerradões des mittleren Westens - vergesellschaftet mit anderen groesserer Verbreitung Beide Flaechen scheinen florestale Rueckzugsgebiete darzustellen. 3. Die "Agreste"-Flaechen (mit eingesprengten, mikroklimatisch unterschiedlichen Wald- und "Caatinga"-Gebieten), mit schwachen, jedoch regelmaessig verteilten Regenfaellen, zeigen flache, 1 - 3 m tiefe Sandboeden und ausgedehnte, relativ tiefreichende Lehmboeden, und sind besiedelt von Arten der benachbarten Flaechen, in einzelnen, durch die Savannen getrennten Inseln stehend, was auf eine moderne Besiedlung hinzuweisen scheint. 4. Die Flaechen des "Sertão" (regengruene Buesche und stacheltragende Formationen), mit unregelmaessigen Niederschlaegen, zeigen niedrige (weniger als 1 m Tiefe), abgetragene Sandboeden und Bloecke aus Urgestein auf den Kuppen der Huegel, besiedelt mit endemischen Streuformen der entsprechenden amerikanischen Regionen, was eine sehr alte Besiedlung anzeigt. III - Komplexes Gebiet. Die uebrigen Flaechen, die Niederung von Maranhão (Schwemmland, Mangrove und Palmblattwaelder) und Sandsteintafeln (Cerrado), ebenso wie der Sandstreifen (heide- und buschfoermige Vegetation) und anschliessende Gebiete (Mischwaelder und Cerrado-Caatinga) sind durch sehr spezielle Verhaeltnisse innerhalb der Nordost-Region bedingt. 5. Der Palmblattwald, bedingt durch Steigeregen und begrenzt auf einen Kontaktstreifen zwischen ueberfeuchtem Klima (Amazonas-wald) und Halbtrocken-klima mit scharf begrenzter, oft verlaengerter Trockenzeit (Savanne und Caatinga), stellt eine Uebergangsvegetation dar, wo die gruppenfoermig auftretenden, vorherrschenden endemischen formen ihm den Charakter einer relativ jungen Besiedlung geben. 6. Der Cerrado mit ausgesprochener Trockenperiode wird bedingt durch die tiefgruendigen Sandsteingebiete der unveraendert erhaltenenSchollen der Vorkreidezeit, debeckt mit einer wahrscheinlichen Reliktenvegetation, die frueher grosse Teile des Westens der Nordost-region ueberzog. 7. Die noerdlich und suedlich anschliessenden Gebiete, die zwischen Caatinga-Cerrado und dem geschlossenen Wald und den Agreste-Flächen liegen, zeigen Eigenheiten, die auf eine neuere Veraenderung des vorherrschenden regenreichen Klimas der Region hinweisen - trocken im Sertão und feucht an der Kueste. Zusammenfassend laesst sich sagen, dass in der grossen Nordost-Region die feuchten Kuestenflaechen einen immergruenen Wald besitzen, der sich einem anderem, teil-regengruenen vorlagert, und dass die trockenen Gebiete der Rumpfflaechen des Inneren eine regengruene, dornige bewachsung mit eingeschlossener reliktenvegetation auf den Erhebungen zeigen.

A survey of planorbid molluscs in the Amazonian region of Brazil

A survey of the plarnorbid fauna in the Brazilian states of the Amazonian river basin revealed the occurence of 14 species, 8 of the genus Biomphalaria, 4 of Drepanotrema, 1 of Antillorbis and 1 of Plesiophysa, besides a naturalized puopulation of Helisoma duryi at Santa Rosa, municipality of Formosa, state of Goiás. The following is the distribution of the species by genera, in decreasing order of frequency (number of localities in parenthesis): 1. Biomphalaria straminea (50): Acre, Amazonas, Distrito Federal, Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Pará and Roraima; 2. B. occidentalis (30): Acre, Amazonas, Mato Grosso and Mato Grosso do Sul; 3. B. schrammi (22); Distrito Federal, Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul and Pará; 4. B. amazonica (14): Acre, Amazonas and Rondônia; 5. B. glabrata (13): Distrito Federal, Goiás, Maranhão and Pará; 6. B. peregrina (4): Distrito Federal, Goiás and Mato Grosso do Sul; 7. B. tenagophila (2): Distrito Federal and Goiás; 8. B. oligoza (2): Mato Grosso do Sul; 9. Drepanotrema lucidium (72): Acre, Amapá, Amazonas, Distrito Federal, Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Pará, Rondônia and Roraima; 10. D. anatinum (41): Acre, Amazonas, Distrito Federal, Goiás, Maranhão, Mato Grosso do Sul, Pará, Rondônia and Roraima; 11. D. depressissimum (19): Acre, Amazonas, Distrito Federal, Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul and Pará; 12. D. cimex (15): Acre, Amazonas, Distrito Federal, Goiás, Mato Grosso, Mato Grosso do Sul and Pará; 13. Antillorbis nordestensis (3): Distrito Federal, Maranhão and Pará; 14. Plesiophysa ornata (1): Goiás. B. glabrata is responsibel for transmission of schistosomiasis mansoni in northeastern Pará, northern Marnhão and central Goiás including the Distrito Fedreal. B. tenagophila, although susceptible to experimental infection with Schistosoma mansoni, has not been found naturally infected so far in the area. B. straminea has been incriminated as...

Infecção natural do Holochilus brasiliensis nanus Thomas, 1897 (Rodentia, cricetidae) por Litomosoides carinii

É registrada a infecção natural do Holochilus brasiliensis nanus, um pequeno roedor semi-aquático da Baixada Ocidental do Estado do Maranhão, Brasil, por Litomosoides carinii.

The distribution of two morphological forms of Lutzomyia longipalpis (Lutz & Neiva) (Diptera: Psychodidae)

The males of the sandfly Lutzomyia longipalpis occur in two forms, one which bears a single pair of pale spots on tergite 4 and another in which an additional pair of spots characterizes tergite 3. Almost complete reproductive isolation between sumpatric populations of the two forms and between allopatric populations of the one-spot form has been reported (Ward et al., 1983). Micromorphological differences in cuticular structures on the spots have also been observed and may be sites of pheromone release (Lane & Ward, 1984). Detais of the known distribution of the two are based on the examination of new specimens captured in Brazil during 1982, as well as museum collections and specimens from other laboratories. Males with a single pair of pale spots have been found from Mexico to southern Brazil, whilst the two-spot form is found only from the state of Maranhão in North Brazil to Minas Gerais and the border with Paraguay. In the eastern area of Brazil the two forms occur sympatrically in some locations and separately in others.

Resistance to Starvation of Triatoma rubrofasciata (De Geer, 1773) under Laboratory Conditions (Hemiptera: Reduviidae: Triatominae)

The present work aims at learning the period of resistance to starvation (molting/death) of Triatoma rubrofasciata in different stages of development and the respective loss of weight until death. Eggs of specimens from the greater area of the city of São Luis in the State of Maranhão, Brazil, yielded approximately 300 nymphs. These nymphs were placed in labelled Borrel glasses, in which they were weekly fed on rats (Rattus norvegicus), until reaching the stage to be observed. The experiments were conducted in a climatic chamber regulated at 29 ± 1° C, 70% relative humidity and 12 hr photoperiod. The resistance to starvation increased according to the stage of development, except for adult bugs, whose results were similar to the 3rd stage nymphs. In all these development stages there was an abrupt loss of weight in the first week, followed by a gradual loss until death. Comparing this work with those of other authors, it was observed that T. rubrofasciata is among the less resistant triatomine species.

Susceptibility of Biomphalaria straminea (Dunker, 1848) from Serra da Mesa Dam, Goiás, Brazil to infection with three strains of Schistosoma mansoni Sambon, 1907

Ecological changes from water resources development projects often affect the epidemiology of water-associated diseases. In order to investigate the occurrence and distribution of freshwater snails of medical and veterinary importance in the area of influence of the Serra da Mesa Hydroelectric a survey has been performed since 1997 and revealed the occurrence of well-established populations of Biomphalaria straminea (Dunker, 1848) in the 8 municipalities surrounding the lake. Areas of epidemiologic risk for schistosomiasis were selected and studies of parasite-mollusc compatibility were undertaken using specimens from 19 populations of B. straminea and 3 strains (CM, EC and PB) originally isolated from B. straminea. Among 1,135 specimens used 15 became infected (infection index of 1.3%) and 8 populations were susceptible to the schistosome strains: B. straminea from Campinorte (Castelão, susceptible to CM and EC strains, and Planeta Água, EC strain), Colinas (Tocantinzinho river, CM and EC strains), Minaçu (Canabrava river, EC strain), Niquelândia (Codemin, CM and PB strains, and Almas river, CM strain), Uruaçu (touristic area, PB strain) and Santa Rita do Novo Destino (Maranhão river, CM and EC strains). These results, associated with marked social and ecological changes occurred, strongly suggest the possibility of B. straminea coming to act as a vector of schistosomiasis in the studied area.

The epidemiologic importance of Triatoma brasiliensis as a Chagas disease vector in Brazil: a revision of domiciliary captures during 1993-1999

To clarify the epidemiologic importance of Triatoma brasiliensis, the most important Chagas disease vector in the Northeastern of Brazil, capture data related to this species, its distribution, capture index, and percentages of natural infection by Trypanosoma cruzi were examined in 12 different Brazilian states. The Brazilian National Health Foundation collected these data from 1993 to 1999, a period during which a total of 1,591,280 triatomines (21 species) were captured in domiciles within the geographic range of T. brasiliensis. Of this total, 422,965 (26.6%) were T. brasiliensis, 99.8% of which were collected in six states, and 54% in only one state (Ceará). The percentage of bugs infected with T. cruzi varied significantly among states, ranging from 0% (Goiás, Maranhão, Sergipe, and Tocantins) to more than 3% (Alagoas, Minas Gerais, and Rio Grande do Norte) with an average of 1.3%. This latter value represents a dramatic reduction in the natural infection percentages since 1983 (6.7%) suggesting that, despite the impossibility of eradicating this native species, the control measures have significantly reduced the risk of transmission. However, the wide geographic distribution of T. brasiliensis, its high incidence observed in some states, and its variable percentages of natural infection by T. cruzi indicate the need for sustained entomological surveillance and continuous control measures against this vector.