Ruptura prematura das membranas amnióticas no pré-termo: fatores associados à displasia broncopulmonar

OBJETIVO: identificar os fatores obstétricos e neonatais associados ao desfecho de displasia broncopulmonar em pacientes com amniorrexe prematura no pré-termo. MÉTODOS: foram analisados 213 prontuários do Instituto Fernandes Figueira, entre 1998 e 2002, cujas pacientes evoluíram com quadro de amniorrexe prematura <34 semanas de gestação. Foram excluídas gestações múltiplas. As variáveis de natureza clínico-obstétricas e neonatais foram cotejadas com o desfecho de displasia broncopulmonar. Os dados foram submetidos à análise bivariada, sendo os valores que exibiam significância estatística (p<0,05) submetidos à regressão logística. RESULTADOS: a prevalência de displasia broncopulmonar foi de 6.10%. A análise univariada dos fatores associados ao desfecho de displasia broncopulmonar exibiu os seguintes resultados: tempo de ventilação mecânica neonatal >10 dias (OR: 54,00 [11,55-278,25] p=0,000); idade gestacional <30 semanas (OR: 6,33 [1,26-43,06] p=0,017) peso <1.000 g (OR: 4,82 [1,34-17,53] p=0,010); peso <1.500 g (OR: 14,09 [1,82-300,50] p=0,003; persistência do canal arterial (OR: 12,33 [3,07-50,10], p=0,000); doença da membrana hialina (OR: 8,46 [2,21-35,00] p=0,000); pneumonia congênita (OR: 7,48 [2,03-27,93] p=0,000); uso de surfactante neonatal (OR: 19,66 [4,54-97,76] p=0,000) e infecção neonatal (OR: 7,67 [0,99-163,79] p=0,049). No modelo multivariado final, somente as variáveis "ventilação mecânica">10 dias (p=0,001) e "uso de surfactante" (p=0,040) permaneceram independentemente associadas ao desfecho. CONCLUSÕES: observou-se que os fatores associados à displasia broncopulmonar são de natureza neonatal, sendo que a ventilação mecânica duradoura e o uso de surfactante neonatal influenciaram no desenvolvimento dessa doença.

Perdas econômicas ocasionadas por lesões em carcaças de bovinos abatidos em matadouro-frigorífico do norte de Mato Grosso

Este estudo teve o objetivo de avaliar as perdas econômicas decorrentes de lesões de transporte e manejo pré-abate em carcaças de bovinos abatidos em matadouro-frigorífico inspecionado na região norte do Estado de Mato Grosso/MT, Brasil. De um total de 1.021 animais avaliados identificou-se que 433(42,4%) apresentavam carcaças com lesões relacionadas ao transporte e manejo pré-abate. A frequência de lesões encontradas evidenciou uma diferença (P<0,05)de acordo com o tempo de transporte, em que, com o transporte de até duas horas foi observado 1,82 lesão/carcaça lesionada e 2,05 lesão/carcaça lesionada com o tempo de 2 a 8 horas, sendo que para tempo de transporte maior que 8 horas, foi observado 2,07 lesões/carcaça lesionada, sendo esse valor igual (P>0,05)aos valores encontrados para transporte entre 2 a 8 horas.Os animais lesionados apresentaram de uma até seis lesões em sua carcaça, com uma maioria (96,9%) variando entre 1 a 4 lesões, sendo que os animais transportados por mais de 2 horas apresentaram mais lesões que os animais transportados por até 2 horas (P<0,05).Foi observado que o local de maior incidência de lesões foi o lombo, com 50,35% das lesões, seguido pela região do coxão com 36,38% das lesões encontradas neste estudo. Encontrou-se também uma perca no valor de 115,76 kg para o total de animais estudados, estima-se que para um matodouro-frigorífico de médio porte, acumula-se uma perda anual superior a 200 mil reais com lesões em carcaças bovinas decorrentes do transporte e manejo pré-abate.

Eficiência e seletividade dos herbicidas trifloxysulfuron-sodium + ametryne e hexazinone + diuron em função da tecnologia de aplicação e do manejo mecânico da palha de cana-de-açúcar na linha de plantio

Com objetivo de otimizar a utilização de trifloxysulfuron-sodium + ametryne e hexazinone + diuron em função da adoção de diferentes pontas de pulverização e manejo mecânico da palha de cana-de-açúcar na linha de plantio, dois experimentos foram conduzidos na Destilaria Parálcool S/A, localizada em Paraguaçu Paulista/SP. No experimento 1, 12 tratamentos foram estudados em esquema fatorial 2 x 2 x 3, com quatro repetições, contrastando a presença e ausência de palha da cana na linha de plantio; dos herbicidas trifloxysulfuron sodium + ametryne (37 + 1.463 g i.a. ha-1 e 0,2% v/v de Aterbane®) e hexazinone + diuron (330 + 1.170 g i.a. ha-1 e 0,2% v/v de Aterbane®) e das pontas de pulverização XR11002-VS (128 L ha-1), AI11002-VS (200 L ha-1) e TF-VP5 (310 L ha-1). No experimento 2, a deposição da calda de pulverização nas plantas de cana-de-açúcar e Digitaria horizontalis, gerada pelas interações entre herbicidas e pontas, foi monitorada utilizando-se solução traçadora constituída por corante FDC-1 + herbicida. Os resultados sugerem que a presença da palhada da cultura proporcionou controle excelente das espécies infestantes mesmo na ausência do tratamento herbicida. O controle químico de D. horizontalis (6 folhas até 1-2 perfilhos) e Brachiaria decumbens (2 a 6 folhas) apresentou-se eficiente (> 91%) nas linhas sem palha a partir dos 14 DAA (dias após aplicação) para os herbicidas e pontas de pulverização estudados. D. horizontalis foi mais rapidamente controlada aos 7 DAA pelo trifloxysulfuron-sodium + ametryne com a ponta AI11002-VS. Houve toxicidade até os 21 DAA, sendo esta mais intensa para os tratamentos com hexazinone + diuron associado com as pontas AI11002-VS e TF-VP5, em decorrência da maior deposição do herbicida nas folhas da cultura.

Dialysis, time and death: comparisons of two consecutive decades among patients treated at the same Brazilian dialysis center

The survival of hemodialysis patients is likely to be influenced not only by well-known risk factors like age and comorbidity, but also by changes in dialysis technology and practices accumulated along time. We compared the survival curves, dialysis routines and some risk factors of two groups of patients admitted to a Brazilian maintenance hemodialysis program during two consecutive decades: March 1977 to December 1986 (group 1, N = 162) and January 1987 to June 1997 (group 2, N = 237). The median treatment time was 22 months (range 1-198). Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank method. The Cox proportional hazard regression model was used to investigate the more important variables associated with outcome. The most important changes in dialysis routine and in patient care during the total period of observation were the progressive increase in the dose of dialysis delivered, the prohibition of potassium-free dialysate, the use of bicarbonate as a buffer and the upgrading of the dialysis equipment. There were no significant differences between the survival curves of the two groups. Survival rates at 1, 5 and 10 years were 84, 53 and 29%, respectively, for group 1 and 77, 42 and 21% for group 2. Patients in group 1 were younger (45.5 ± 15.2 vs 55.2 ± 15.9 years, P<0.001) and had a lower prevalence of diabetes (11.1 vs 27.4%, P<0.001) and of cardiovascular disease (9.3 vs 20.7%, P<0.001). According to the Cox multivariate model, only age (hazard ratio (HR) 1.04, confidence interval (CI) 1.03-1.05, P<0.001) and diabetes (HR 2.55, CI 1.82-3.58, P<0.001) were independent predictors of mortality for the whole group. Patients of group 2 had a lower prevalence of sudden death (19.1 vs 9.7%, P<0.001). After adjusting for age, diabetes and other mortality risk factors, the risk of death was 17% lower in group 2, although this difference was not statistically significant. We conclude that the negative effects of advanced age and of higher frequency of comorbidity on the survival of group 2 patients were probably offset by improvements in patient care and in the quality and dose of dialysis delivered, so that the survival curves did not undergo significant changes along time.

Effect of a selective nonsteroidal anti-inflammatory inhibitor of cyclooxygenase-2 on the small bowel of rats

The pathogenesis of nonsteroidal anti-inflammatory drug (NSAID) enteropathy is a complex process involving the uncoupling of mitochondrial oxidative phosphorylation and inhibition of cyclooxygenase (COX). Rofecoxib, a selective inhibitor of COX-2, has shown less gastric damage, but the same beneficial effect is not clear in the case of the small bowel. Fifty-seven male Wistar rats (250-350 g) were divided into three groups (N = 19 each) to evaluate the effect of this NSAID on the rat intestine. The groups received 2.5 mg/kg rofecoxib, 7.5 mg/kg indomethacin or water with 5% DMSO (control) given as a single dose by gavage 24 h before the beginning of the experiment. A macroscopic score was used to quantify intestinal lesions and intestinal permeability was measured using [51Cr]-ethylenediaminetetraacetic acid ([51Cr]-EDTA). The extent of intestinal lesion, indicated by a macroscopic score, was significantly lower when rofecoxib was administered compared to indomethacin (rofecoxib = 0.0 vs indomethacin = 63.6 ± 25.9; P < 0.05) and did not differ from control. The intestinal permeability to [51Cr]-EDTA was significantly increased after indomethacin (control = 1.82 ± 0.4 vs indomethacin = 9.12 ± 0.8%; P < 0.0001), but not after rofecoxib, whose effect did not differ significantly from control (control = 1.82 ± 0.4 vs rofecoxib = 2.17 ± 0.4%; ns), but was significantly different from indomethacin (indomethacin = 9.12 ± 0.8 vs rofecoxib = 2.17 ± 0.4%; P < 0.001). In conclusion, the present data show that rofecoxib is safer than indomethacin in rats because it does not induce macroscopic intestinal damage or increased intestinal permeability.

Cyclophosphamide in the treatment of focal segmental glomerulosclerosis

Prednisone is the initial treatment of primary focal segmental glomerulosclerosis. However, when immunosuppressive agents in combination with steroids are used in the treatment of prednisone-dependent and prednisone-resistant patients the remission rate is variable. We report a long-term trial using cyclophosphamide (2.0 to 3.0 mg/kg body weight for 12 weeks) in combination with prednisone (1.0 to 2.0 mg/kg body weight), as compared with prednisone alone for the treatment of prednisone-resistant and frequently relapsing nephrotic syndrome and focal segmental glomerulosclerosis. Fifty-four patients (34 males and 20 females) with a diagnosis of idiopathic nephrotic syndrome and focal segmental glomerulosclerosis, followed-up for an average of 86.1 ± 82.4 months, were evaluated. Complete remission occurred in 20.4% and partial remission in 14.8% of the patients treated with steroids and in 26.7 and 20.0% of the patients treated with cyclophosphamide + prednisone, respectively. Of the 24 prednisone-resistant patients treated with steroids in combination with cyclophosphamide, 33.3% obtained a complete/partial response. At the time of final evaluation, 25% of the patients treated with prednisone and 10.0% of those treated with prednisone in combination with cyclophosphamide had reached end-stage renal disease. Persistent nephrotic syndrome and progressive renal insufficiency were more frequently observed among the patients treated with prednisone alone (50.0 vs 33.3% and 33.3 vs 16.7%, respectively). The treatments were well tolerated and no patient experienced adverse reactions requiring discontinuation of medications. Although open-label and non-randomized, the present trial showed that cyclophosphamide is a reasonable choice for the treatment of primary focal segmental glomerulosclerosis and prednisone-resistant nephrotic syndrome.

Cytotoxicity of Marchantia convoluta leaf extracts to human liver and lung cancer cells

The cytotoxicity of three extracts (petroleum ether, ethyl acetate and n-butanol) from a plant used in folk medicine, Marchantia convoluta, to human non-small cell lung carcinoma (H1299) and liver carcinoma (HepG2) cell lines was tested. After 72-h incubation of lung and liver cancer cell cultures with varying concentrations of extracts (15 to 200 µg/mL), cytotoxicity was determined by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and reported in terms of cell viability. The extracts that showed a significant cytotoxicity were subjected to gas chromatography-mass spectrometry analysis to identify the components. The ethyl acetate, but not the petroleum ether or n-butanol extract, had a significant cytotoxicity against lung and liver carcinoma cells with IC50 values of 100 and 30 µg/mL, respectively. A high concentration of ethyl acetate extract (100 µg/mL) rapidly reduced the number of H1299 cells. At lower concentrations of ethyl acetate extract (15, 30, and 40 µg/mL), the numbers of HepG2 cells started to decrease markedly. Gas chromatography-mass spectrometry analysis of the ethyl acetate extract revealed the presence of several compounds such as phytol (23.42%), 1,2,4-tripropylbenzene (13.09%), 9-cedranone (12.75%), ledene oxide (7.22%), caryophyllene (1.82%), and caryophyllene oxide (1.15%). HPLC analysis result showed that there were no flavonoids in ethyl acetate extract, but flavonoids are abundant in n-butanol extract. Further studies are needed regarding the identification, toxicity, and mechanism of action of active compounds.

Trypanosoma cruzi infection induces up-regulation of cardiac muscarinic acetylcholine receptors in vivo and in vitro

The pathogenesis of chagasic cardiomyopathy is not completely understood, but it has been correlated with parasympathetic denervation (neurogenic theory) and inflammatory activity (immunogenic theory) that could affect heart muscarinic acetylcholine receptor (mAChR) expression. In order to further understand whether neurogenic and/or immunogenic alterations are related to changes in mAChR expression, we studied two models of Trypanosoma cruzi infection: 1) in 3-week-old male Sprague Dawley rats chronically infected with T. cruzi and 2) isolated primary cardiomyocytes co-cultured with T. cruzi and peripheral blood mononuclear cells (PBMC). Using [³H]-quinuclidinylbenzilate ([³H]-QNB) binding assays, we evaluated mAChR expression in homogenates from selected cardiac regions, PBMC, and cultured cardiomyocytes. We also determined in vitro protein expression and pro-inflammatory cytokine expression in serum and cell culture medium by ELISA. Our results showed that: 1) mAChR were significantly (P < 0.05) up-regulated in right ventricular myocardium (means ± SEM; control: 58.69 ± 5.54, N = 29; Chagas: 72.29 ± 5.79 fmol/mg, N = 34) and PBMC (control: 12.88 ± 2.45, N = 18; Chagas: 20.22 ± 1.82 fmol/mg, N = 19), as well as in cardiomyocyte transmembranes cultured with either PBMC/T. cruzi co-cultures (control: 24.33 ± 3.83; Chagas: 43.62 ± 5.08 fmol/mg, N = 7 for both) or their conditioned medium (control: 37.84 ± 3.84, N = 4; Chagas: 54.38 ± 6.28 fmol/mg, N = 20); 2) [³H]-leucine uptake was increased in cardiomyocytes co-cultured with PBMC/T. cruzi-conditioned medium (Chagas: 21,030 ± 2321; control 10,940 ± 2385 dpm, N = 7 for both; P < 0.05); 3) plasma IL-6 was increased in chagasic rats, IL-1β, was increased in both plasma of chagasic rats and in the culture medium, and TNF-α level was decreased in the culture medium. In conclusion, our results suggest that cytokines are involved in the up-regulation of mAChR in chronic Chagas disease.

The efficacy of moxifloxacin-based triple therapy in treatment of Helicobacter pylori infection: a systematic review and meta-analysis of randomized clinical trials

Recent evidence shows that moxifloxacin could exert an antimicrobial effect against Helicobacter pylori in both in vitroand in vivo models. To systematically evaluate whether moxifloxacin-containing triple therapy could improve eradication rates and reduce side effects in first-line or second-line anti-H. pyloritreatment, eligible articles were identified by searches of electronic databases. We included all randomized trials comparing moxifloxacin-based triple therapy with standard triple or quadruple therapy during H. pylori eradication treatment. Statistical analysis was performed with Review Manager 5.0.10. Subanalysis/sensitivity analysis was also performed. We identified seven randomized trials (n=1263). Pooled H. pylori eradication rates were 79.03% (95%CI: 75.73-82.07) and 68.33% (95%CI: 64.44-72.04) for patients with moxifloxacin-based triple therapy or with standard triple or quadruple therapy, respectively (intention-to-treat analysis). The odds ratio (OR) was 1.82 (95%CI: 1.17-2.81), the occurrence of total side effects was 15.23% (95%CI: 12.58-18.20) and 27.17% (95%CI: 23.64-30.92) for groups with or without moxifloxacin, and the summary OR was 0.45 (95%CI: 0.26-0.77). In subgroup analyses, we noted that the second-line eradication rate in the moxifloxacin group was significantly higher than that in the quadruple therapy group (73.33 vs 60.17%, OR: 1.78, 95%CI: 1.16-2.73, P<0.001). However, there was no difference in first-line eradication treatment. Findings from this meta-analysis suggest that moxifloxacin-based triple therapy is more effective and better tolerated than standard triple or quadruple therapy. Therefore, a moxifloxacin-based triple regimen should be used in the second-line treatment of H. pylori infection.

Gender, race and socioeconomic influence on diagnosis and treatment of thyroid disorders in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Thyroid diseases are common, and use of levothyroxine is increasing worldwide. We investigated the influence of gender, race and socioeconomic status on the diagnosis and treatment of thyroid disorders using data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of civil servants (35-74 years of age) from six Brazilian cities. Diagnosis of thyroid dysfunction was by thyrotropin (TSH), and free thyroxine (FT4) if TSH was altered, and the use of specific medications. Multivariate logistic regression models were constructed using overt hyperthyroidism/hypothyroidism and levothyroxine use as dependent variables and sociodemographic characteristics as independent variables. The frequencies of overt hyper- and hypothyroidism were 0.7 and 7.4%, respectively. Using whites as the reference ethnicity, brown, and black race were protective for overt hypothyroidism (OR=0.76, 95%CI=0.64-0.89, and OR=0.53, 95%CI=0.43-0.67, respectively, and black race was associated with overt hyperthyroidism (OR=1.82, 95%CI=1.06-3.11). Frequency of hypothyroidism treatment was higher in women, browns, highly educated participants and those with high net family incomes. After multivariate adjustment, levothyroxine use was associated with female gender (OR=6.06, 95%CI=3.19-11.49) and high net family income (OR=3.23, 95%CI=1.02-10.23). Frequency of hyperthyroidism treatment was higher in older than in younger individuals. Sociodemographic factors strongly influenced the diagnosis and treatment of thyroid disorders, including the use of levothyroxine.

Determinação simultânea dos teores de cinza e proteína em farinha de trigo empregando NIRR-PLS e DRIFT-PLS

As técnicas de espectroscopia por reflexão no infravermelho próximo (NIRRS) e por reflexão difusa no infravermelho médio com transformada de Fourier (DRIFTS) foram empregadas com o método de regressão multivariado por mínimos quadrados parciais (PLS) para a determinação simultânea dos teores de proteína e cinza em amostras de farinha de trigo da variedade Triticum aestivum L. Foram coletados espectros no infravermelho em duplicata de 100 amostras, empregando-se acessórios de reflexão difusa. Os teores de proteína (8,85-13,23%) e cinza (0,330-1,287%), empregados como referência, foram determinados pelo método Kjeldhal e método gravimétrico, respectivamente. Os dados espectrais foram utilizados no formato log(1/R), bem como suas derivadas de primeira e segunda ordem, sendo pré-processados usando-se os dados centrados na média (MC) ou escalados pela variância (VS) ou ambos. Cinqüenta e cinco amostras foram usadas para calibração e 45 para validação dos modelos, adotando-se como critério de construção os valores mínimos do erro padrão de calibração (SEC) e do erro padrão de validação (SEV). Estes valores foram inferiores a 0,33% para proteína e a 0,07% para cinza. Os métodos desenvolvidos apresentam como vantagens a não agressão ao ambiente, bem como permitem uma determinação direta, simultânea, rápida e não destrutiva dos teores de proteína e cinza em amostras de farinha de trigo.

Influência dos sistemas de pastagem e confinamento na contaminação microbiana de carcaças bovinas

O objetivo deste trabalho foi avaliar a contaminação microbiana do couro e da superfície de carcaças bovinas, provenientes de bovinos em diferentes sistemas de engorda: extensiva em pastagem e intensiva em confinamento. Foram utilizados 40 bovinos sadios, da raça nelore, sendo metade proveniente de pastagem e a outra metade de confinamento, que foram abatidos em matadouro-frigorífico sob Serviço de Inspeção Federal, localizado no Estado de Minas Gerais, Brasil. A coleta das amostras realizou-se pela técnica de esfregaço de superfície nas carcaças utilizando-se de suabe. As contagens médias (log10 UFC/cm²) de aeróbios mesófilos e anaeróbios facultativos, coliformes totais e E. coli foram: antes da esfola, 3,72, 1,27 e 0,86; após a esfola, 1,89, 0,40 e 0,40, e após a lavagem, 2,19, 0,55 e 0,42, respectivamente, para os bovinos de pastagem; antes da esfola, 3,31, 0,65 e 0,64; após a esfola, 1,78, 0,40 e 0,40, e após a lavagem, 1,82, 0,41 e 0,40 para os bovinos de confinamento. Evidenciou-se, pela análise microbiológica, que as amostras provenientes de bovinos em pastagem apresentaram contagens médias superiores, e no caso do couro, essas diferenças foram estatisticamente significativas. Essa constatação foi confirmada pela observação visual de que os animais de confinamento apresentavam o couro "mais limpo" no momento do abate.

Changes in the physicochemical and microbiological properties of frozen araça pulp during storage

Araça belongs to the Myrtaceae family and is popularly known as araçá-comum, araçá-azedo, or araçá-do-campo. Frozen fruit pulp is of great importance for the food industry, which can produce it at the time of harvest, store it, and use it according to the demand of the consumer market and/or as an ingredient in the formulation of products such as yogurt, candies, and ice creams among others. The aim of this study was to evaluate the physical, chemical, and microbiological stability of frozen araça pulp during 12 months of frozen storage. It was observed that the levels of moisture (90.55-88.75%), ash (0.34-0.26%) total soluble sugars (7.11-6.62%), sucrose (3.55-1.39%), soluble pectin (0.24-0.23%), total pectin (0.5-0.46%), pH (3.82-2.31%), organic acids (698.12-122.25 µg.g-1 citric acid), and phenolic compounds (6.22-0.00 mg GAE.100 g-1) decreased during storage, whereas the levels of protein (0.61-0.83%), lipids (0.14-0.38%), total carbohydrates (8.36-9.78%), calorific value (37.14-45.86 kcal.100 g-1), reducing sugars (3.51-5.21%), soluble solids (5.17-6.0%), total antioxidant capacity (6.89-35.13%), and color parameters (L*49.75-50.67; a*0.79-1.82 and b*22.5-25.19) increased over the one-year storage period. According to the chemical and microbiological parameters assessed, the product can be stored for 12 months without loss of quality with addition of citric acid as a preservative.

Prevalência de achados radiográficos da neurofibromatose tipo 1: estudo de 82 casos

A neurofibromatose tipo 1 é uma das enfermidades genéticas mais comuns da espécie humana com padrão de herança autossômica dominante. As alterações radiológicas encontradas com maior freqüência são: escoliose, cifose, cifoescoliose, áreas de erosão óssea, crescimento anormal do osso, pseudo-artrose, meningocele, deformidade da parede posterior dos corpos vertebrais ("scalloping"), peito escavado, lesões osteolíticas nos ossos longos e alterações do sistema nervoso central. Os autores apresentam dados estatísticos dos achados radiográficos prevalentes em 82 pacientes com neurofibromatose tipo 1 acompanhados pelo Centro de Pesquisa e Atendimento em Neurofibromatose, de São José do Rio Preto, SP, um centro multidisciplinar de estudo e tratamento dos portadores da doença.