Avaliação da contratilidade segmentar na doença de Chagas utilizando a integral do gradiente intramiocárdico de velocidade (strain miocárdico) obtida pela ecocardiografia com Doppler tecidual

OBJETIVO: Quantificar o percentual de contratilidade dos diversos segmentos miocárdicos, em portadores de doença de Chagas, através da medida do strain miocárdico e verificar diferenças na função contrátil radial e longitudinal ventricular entre as formas indeterminada e dilatada da miocardiopatia chagásica crônica quando comparadas a um grupo de indivíduos normais. MÉTODOS: Foram estudados 39 indivíduos, 20 (51,3%) do sexo masculino divididos em quatro grupos: Nl: 17 (43,6%) indivíduos normais; Ind: 7 (17,9%) portadores de doença de Chagas forma indeterminada; C1, 7 (17,9%) portadores de doença de Chagas forma crônica com fração de ejeção < 50% e C2: 8 (20,5%) portadores de doença de Chagas forma crônica com fração de ejeção > 50%. Após realização de ecocardiograma basal foram registradas as imagem em Doppler tecidual para a medida do strain miocárdico nos diversos segmentos aos cortes paraesternais, longitudinal e transversal, e apicais, de duas e quatro câmaras. RESULTADOS E CONCLUSÃO: O percentual de contração dos diversos segmentos miocárdicos, tanto em seu componente radial quanto longitudinal é maior nos indivíduos normais do que em portadores da forma crônica da doença de Chagas e naqueles com a forma indeterminada da doença quando comparado com chagásicos crônicos com FE < 50%. A contratilidade radial do ventrículo esquerdo é maior que a longitudinal nos três grupos (Nl, Ind e Crônico). Os dados apresentados nos permitem propor um caráter progressivo do acometimento miocárdico em portadores da doença de Chagas.

An Equation for the Prediction of Oxygen Consumption in a Brazilian Population

Background: The equations predicting maximal oxygen uptake (VO2max or peak) presently in use in cardiopulmonary exercise testing (CPET) softwares in Brazil have not been adequately validated. These equations are very important for the diagnostic capacity of this method. Objective: Build and validate a Brazilian Equation (BE) for prediction of VO2peak in comparison to the equation cited by Jones (JE) and the Wasserman algorithm (WA). Methods: Treadmill evaluation was performed on 3119 individuals with CPET (breath by breath). The construction group (CG) of the equation consisted of 2495 healthy participants. The other 624 individuals were allocated to the external validation group (EVG). At the BE (derived from a multivariate regression model), age, gender, body mass index (BMI) and physical activity level were considered. The same equation was also tested in the EVG. Dispersion graphs and Bland-Altman analyses were built. Results: In the CG, the mean age was 42.6 years, 51.5% were male, the average BMI was 27.2, and the physical activity distribution level was: 51.3% sedentary, 44.4% active and 4.3% athletes. An optimal correlation between the BE and the CPET measured VO2peak was observed (0.807). On the other hand, difference came up between the average VO2peak expected by the JE and WA and the CPET measured VO2peak, as well as the one gotten from the BE (p = 0.001). Conclusion: BE presents VO2peak values close to those directly measured by CPET, while Jones and Wasserman differ significantly from the real VO2peak.

Substituição de subprodutos de trigo pelo sorgo moído na alimentação de pintos

Searching for a substitute of wheat bran and wheat standard middlings in chick mashes, three experiments were carried out using ground sorghums. In the first one, 30% of Atlas, Kafir e White Afrikan x Sumac (seed chops) were substituted for 30% of wheat by-products. All the rations with sorghum grain gave inferior results. In another experiment, 7, 14, 20 and 30% of sorghum substituted equal percentages of those wheat by-products, the best results having been obtained with 7% of Atlas and 23% of wheat by-products. Finally, in a third experiment, 5% of dried cow manure plus 10, 20 and 30% of ground Atlas sorghum were substituted for 5% of alfalfa hay meal plus, respectively, 10, 20 and 30% of wheat by-products. All results obtained from rations containing sorghum were as good as or better than that given by the ration including alfalfa hay meal and only wheat by-products. Under the conditions of this experiment, 5% of cow manure plus 12,25% of sorghum and 17,75% of wheat by-products is supposed to be the best combination to be recommended, this result having been attained through the study of the regression equation.

O problema técnico-econômico da adubação

The authors discuss from the economic point of view the use of a few functions intended to represent the yield y corresponding to a level xof the nutrient. They point out that under conditions of scarce capital what is actually most important is not to obtain the highest profit per hectare but the highest return per cruzeiro spent, so that we should maximize the function z = _R - C_ = _R_ - 1 , C C where R is the gross income and C the cost of production (fixed plus variable, both per hectare). Being C = M + rx, with r the unit price of the nutrient and Af the fixed cost of the crop, wo are led to the equation (M + rx)R' - rR = 0. With R = k + sx + tx², this gives a solution Xo = - Mt - √ M²t² - r t(Ms - Kr)- _____________________ rt on the other hand, with R = PyA [1 - 10-c(x + b)], x0 will be the root of equation (M + rx)cL 10 + r 10c(x + b) = 0 (12). Another solution, pointed out by PESEK and HEADY, is to maximize the function z = sx + tx² _________ m + rx where the numerator is the additional income due to the nutrient, and m is the fixed cost of fertilization. This leads to a solution x+ = - mt - √m²t² - mrst (13) _________________ rt However, we must have x+< _r_-_s_ I if we want to satisfy t _dy_ > r. dx This condition is satisfied only if we have m < _(s__-__r)² (14), - 4 t a restriction apparently not perceived by PESEK and HEADY. A similar reasoning using Mitscherlich's law leads to equation (mcL 10 + r) + cr(L 10)x - r 10cx = 0 (15), with a similar restriction. As an example, data of VIEGAS referring to fertilization of corn (maize) gave the equation y - 1534 + 22.99 x - 0. 1069 x², with x in kg/ha of the cereal. With the prices of Cr$ 5.00 per kilo of maize, Cr$ 26.00 per kilo of P2O3,. and M = Cr$ 5,000.00, we obtain x0 = 61 kg/ha of P(2)0(5). A similar reasoning using Mitscherlich's law leads to x0 = 53 kg/ha. Now, if we take in account only the fixed cost of fertilization m = Cr$ 600.00 per hectare, we obtain from (13) x+ = 51 kg/ha of P2O5, while (14) gives x+ - 41 kg/ha. Note that if m = Cr$ 5,000.00, we obtain by formula (13) x+ = 88 kg/ha of P2O5, a solution which is not valid, since condition (14) is not satisfied.

Estudo do aproveitamento integral da planta mandioca

This paper deals with cassava leaf, stem and root production. Field competition trial showed that production of leaves and stems are the same; as that of roots and that leaves and stems can be used in animal feeding beside the industrialization of roots.

Tratamento da osteomielite por assepsia integral e penicilina intra-arterial: sutura primitiva e secundária da ferida

Os AA. apresentam dois casos de Osteomilite crônica submetidos durante anos a diversos tratamentos, sem resultado. Pela associação da assepsia integral com a Penicilina intra-arterial (via ainda não usada), conseguiram a cura após sutura primitiva num caso e secundária no outro. Por serem fátos excepcionais acham que devem ficar registrado.

Infection of Anopheles darlingi fed on patients infected with Plasmodium vivax before and during treatment with chloroquine plus primaquine in Costa Marques, Rondônia, Brazil

Five patients with asexual and sexual parasites of Plasmodium vivax were treated orally with 600 mg chloroquine diphosphate (hour 0) followed with 300 mg at 8, 24 and 48 h later. Primaquine phospate, 15 mg, was administered concurrently at h 0 and 24 h intervals for 14 days. Anopheles darlingi were fed before the first dose (h-0.5) and 0.5, 1, 2, 4, 6, 8, 10, 12, 16, 20, 24, 36, 48, 60 and 72 h later. Mosquitoes were examined for oocysts on day 8 and for sporozoites on day 15 after infection. Four of the five patients studied were still infective to mosquitoes from 1-5 h after the first dose of chloroquine plus primaquine. One of these and one other patient, who vomited 15 min after the first dose, became inffective again at hours 10 and 12, respectively. Once produced, oocysts in mosquitoes fed on patients before, during and after chloroquine plus primaquine treatment appeared normal and produced sporozoite infected salivary glands. In view of these data , it is concluded that primaquine demonstrated rapid gametocytocidal activity and should be administred concurrently with chloroquine to reduce vivax malaria transmission.

Factors that can interfere with virus concentration from wastewater when using zeta plus 60S filter membranes

Zeta plus filter membranes (ZP60S) have been shown to be efficient for rotavirus concentration from wastewater and for the reduction of cytotoxicity for cell cultures. Recently a variability in both properties was observed. In view of the low costs and the high virus recovery rates obtained in the past, we re-evaluated the application of ZP60S filter membranes for virus concentration from environmental samples. Some factors that could interfere with the concentration strategy using ZP60S were also considered and assessed including the type of water to be filtered and the possible release of toxic substances from the membrane matrix during filtration.

Differential expression of notch signaling-related transcripts accompanies Pro-thymocyte proliferation and phenotype transition induced by epidermal growth factor plus insulin in fetal thymus organ cultures

Thymus regression upon stressing stimuli, such as infectious diseases, is followed by organ reconstitution, paralleling its development in ontogeny. A narrow window of thymus development was here studied, encompassing the pro-T lymphoid precursor expansion during specification stages, by the use of epidermal growth factor plus insulin (INS) in murine fetal thymus organ cultures. Aiming to disclose signaling pathways related to these stages, cultured thymus lobes had their RNA extracted, for the search of transcripts differentially expressed using RNAse protection assays and reverse transcriptase-polymerase chain reactions. We found no difference that could explain INS-driven thymocyte growth, in the pattern of transcripts for death/proliferation mediators, or for a series of growth factor receptors and transcriptional regulators known as essential for thymus development. Thymocyte suspensions from cultured lobes, stained for phenotype analysis by fluorescence activated cell sorting, showed a decreased staining for Notch1 protein at cell surfaces upon INS addition. We analyzed the expression of Notch-related elements, and observed the recruitment of a specific set of transcripts simultaneous and compatible with INS-driven thymocyte growth, namely, transcripts for Notch3, for its ligand Jagged2, and for Deltex1, a mediator of a poorly characterized alternative pathway downstream of the Notch receptor.

Effects of pyrimethamine-sulphadoxine, chloroquine plus chlorpheniramine, and amodiaquine plus pyrimethamine-sulphadoxine on gametocytes during and after treatment of acute, uncomplicated malaria in children

The effects of pyrimethamine-sulphadoxine (PS), chloroquine plus chlorpheniramine, a H1 receptor antagonist that reverses chloroquine resistance in Plasmodium falciparum in vitro and in vivo (CQCP), and amodiaquine plus pyrimethamine-sulphadoxine (AQPS) on gametocyte production were evaluated in 157 children with acute, symptomatic, uncomplicated falciparum malaria who were treated with these drugs. PS was significantly less effective than CQCP or AQPS at clearing asexual parasitaemia or other symptoms of malaria. Gametocyte carriage on days 3, 7, and 14 were significantly higher in those treated with PS. The ratio of the density (per µl blood) of peripheral young gametocyte (PYG), that is, < stage III to peripheral mature gametocyte (PMG), that is, stage IV and V, an index of continuing generation of gametocytes, rose to 1 by day 7 of treatment in those treated with PS, but remained consistently below 1 in the other treatment groups. PYG-PMG density ratio increased significantly from day 0-14 in those treated with PS and CQCP (chi2 = 76, P = 0.000001 and chi2 = 42.2, P = 0.00001, respectively) but decreased significantly in those treated with AQPS (chi2 = 53.2, P = 0.000001). Both PS-sensitive and -resistant infections generated PYG (18 of 29 vs 13 of 20, chi2 = 0.04, P = 0.93) but PYG was present only in those with resistant response to CQCP. Combination of PS with amodiaquine (AQ), that is, (AQPS) resulted in less production of PYG, but in this setting, PYG was not indicative of response to AQPS. These data indicate that PS enhanced production or release of young gametocytes when used alone, but generated less young gametocytes when used in combination with AQ. PYG may be used as an indicator of response to CQCP but not PS or PS-based combination drugs.

Soluble inflammatory markers as predictors of virological response in patients with chronic hepatitis C virus infection treated with interferon-α plus ribavirin

The host immune response plays an important role in viral clearance in patients who are chronically infected with hepatitis C virus (HCV) and are treated with interferon and ribavirin. Activation of the immune system involves the release of pro and anti-inflammatory molecules that can be measured in plasma samples. The present study aimed to evaluate the association between pretreatment plasma levels of chemokines and soluble tumor necrosis factor receptors (sTNF-R) and the virological response in treated patients with chronic hepatitis C infection. Forty-one chronically-infected HCV patients that were being treated with interferon-α (IFN-α) plus ribavirin were included in the study. Socio-demographic, clinical and laboratory data were collected and pretreatment plasma levels of chemokine CCL2, CCL3, CCL11, CCL24, chemokine CXCL9, CXCL10, sTNF-R1 and sTNF-R2 were measured. The virological response was assessed at treatment week 12, at the end of treatment and 24 weeks after treatment. Pretreatment CXCL10 levels were significantly higher in patients without an early virological response (EVR) or sustained virological response (SVR) compared to responders [512.9 pg/mL vs. 179.1 pg/mL (p = 0.011) and 289.9 pg/mL vs. 142.7 pg/mL (p = 0.045), respectively]. The accuracy of CXCL10 as a predictor of the absence of EVR and SVR was 0.79 [confidence interval (CI) 95%: 0.59-0.99] and 0.69 (CI 95%: 0.51-0.87), respectively. Pretreatment plasma levels of the other soluble inflammatory markers evaluated were not associated with a treatment response. Pretreatment CXCL10 levels were predictive of both EVR and SVR to IFN-α and ribavirin and may be useful in the evaluation of candidates for therapy.

Projeto de recuperação integral da criança desnutrida - uma proposta de atuação para o enfermeiro: Relato de caso

As autoras apresentam um relato de caso de recuperação nutricional de criança desnutrida, envolvida no Projeto de Recuperação Integral do Desnutrido implantado no Ambulatório de Pediatria do Hospital Universitário de Campo Grande, Mato Grosso do Sul. Mostram a importância da atuação do enfermeiro como membro da equipe multiprofissional em projetos dessa natureza.

Atenção integral à saúde feminina: significados e implicações

Neste artigo, discutimos implicações políticas e práticas vinculadas a diferentes interpretações do conceito atenção integral à saúde da mulher, tomando por referência a multidimensionalidade humana/feminina.

O cuidado como uma Lei da Natureza: uma percepção integral do cuidar

Este trabalho faz uma reflexão entre a percepção do cuidar pelo profissional de enfermagem e a relação do significado dado ao termo Cuidar, que é um instrumento norteador da qualidade da assistência. Questiona o nível de profundidade do significado que essa palavra pode assumir, identificando sua presença em todos os processos do Universo e na história mitológica do ser humano. Propõe que o cuidar é a Lei que permite a manifestação dos potenciais de organização numa certa direção de estabilidade dinâmica, manifestos na matéria, até a promoção e estabelecimento da saúde e do bem-estar. Concluiu-se, afirmando que a Lei do Cuidar pode ser entendida como um conjunto de forças que permitem o prolongamento ou abreviamento de certo grau de organização, que pode ser expresso em diversos níveis.