The characteristics, clinical manifestations and outcomes of pandemic influenza A (H1N1) 2009 in the elderly

IntroductionThe objetctive of this study was to evaluate the 2009 Pandemic Influenza A (H1N1) in the elderly and identify the clinical characteristics, mortality and prognostic factors of the infection in these patients.MethodsThis was an observational, retrospective study. Data were collected from the National Notifiable Diseases (SINAN), from the Brazilian Ministry of Health. Only patients 60 years old or more that had laboratory confirmed infections were included. The socio-demographic and clinical variables and outcomes were evaluated to compare mortality rates in the presence or absence of these factors.ResultsWe included 93 patients in the study, 16.1% of whom died. The symptoms of cough and dyspnea, the use of the antiviral oseltamivir, influenza vaccine and comorbidities influenced the outcomes of cure or death. Chest radiography can aid in diagnosis.ConclusionsAlthough relatively few elderly people were infected, this population presented high lethality that can be justified by the sum of clinical, physical and immunological factors in this population. Treatment with oseltamivir and vaccination against seasonal influenza have significantly reduced rates of hospitalization and mortality.

Bone tuberculosis: a case report on child

The authors report a case of a 12-year-old child with a complaint of pain and deformity in the lower thoracic region that had lasted for two years. Clinical, epidemiological and laboratory characteristics associated with images of apparent damage in the T9-T10 and T11-T12 vertebrae taken by radiography of the thoracic spine and nuclear magnetic resonance in addition to the positivity of the molecular test based on the polymerase chain reaction, led to tuberculous spondylitis being diagnosed and specific therapy was started. Culture of vertebral biopsy was positive for Mycobacterium tuberculosis after thirty days.

Chagas disease: morbidity profile in an endemic area of Northeastern Brazil

Abstract: INTRODUCTION : This study evaluated the clinical forms and manifestation severities of Chagas disease among serologically reactive individuals from Western Rio Grande do Norte (Northeastern Brazil). METHODS : This cross-sectional study included 186 adults who were evaluated using electrocardiography, echocardiography, chest radiography, and contrast radiography of the esophagus and colon. A clinical-epidemiological questionnaire was also used. RESULTS : The indeterminate, cardiac, digestive, and cardiodigestive clinical forms of Chagas disease were diagnosed in 51.6% (96/186), 32.2% (60/186), 8.1% (15/186) and 8.1% (15/186) of the participants, respectively. Heart failure (functional classes I-IV) was detected in 7.5% (14/186) of the participants, and 36.4% (24/66), 30.3% (20/66), 15.2% (10/66), 13.6% (9/66), and 4.5% (3/66) of the patients were at stage A, B1, B2, C, and D, respectively. Dilated cardiomyopathy and electrocardiographic changes were detected in 10.2% (19/186) and 48.1% (91/186) of the participants, respectively. Apical aneurysm was diagnosed in 10.8% (20/186) of the participants, and other changes in the segmental myocardial contractility of the left ventricle were diagnosed in 33.9% (63/186) of the participants. Megaesophagus (groups I-IV) was observed in 7% (13/186) of the participants, megacolon (grades 1-3) was detected in12.9% (24/186) of the participants, and both organs were affected in 29.2% (7/24) of the megacolon cases. CONCLUSIONS : We detected various clinical forms of Chagas disease (including the digestive form). Our findings indicate that clinical symptoms alone may not be sufficient to exclude or confirm cardiac and/or digestive damage, and the number of patients with symptomatic clinical forms may be underestimated.

Evaluation of efficacy, reliability, and tolerability of sibutramine in obese patients, with an echocardiographic study

This is a double-blind, placebo-controlled study of the efficacy, safety, and tolerability of sibutramine in the management of obese patients for a 6-month period. METHOD: Sixty-one obese patients (BMI >30, <40 kg/m2), aged 18-65 years were evaluated. In the first phase of the study (30 days), the patients were given a placebo. We monitored compliance with a low-calorie diet (1200 kcal/day) and to the placebo. In the next stage, the double-blind phase (6 months), we compared placebo and sibutramine (10 mg/day). The criteria for evaluating efficacy were weight loss, reduction in body mass index (BMI), and abdominal and hip circumferences. Tolerability was assessed based on reported side effects, variation in arterial blood pressure and heart rate, metabolic profile (fasting glucose, total cholesterol and its fractions, and triglycerides), laboratory tests (renal and hepatic functions), and flow Doppler echocardiogram. RESULTS: We observed a greater weight loss (7.3 kg, 8% vs 2.6 kg, 2.8%) and a reduction in body mass index (7.4% vs 2.1%) in the sibutramine group than in the placebo group. Classifying the patients into 4 subgroups according to weight loss (weight gain, loss <5%, loss of 5% to 9.9%, and loss >10%), we observed a weight loss of >5% in 40% of the patients on sibutramine compared with 12.9% in the placebo group. We also detected weight gain in 45.2% of the placebo group compared to 20% in the sibutramine group. The sibutramine group showed improvement in HDL- cholesterol values (increased by 17%) and triglyceride values (decreased by 12.8%). This group also showed an increase in systolic blood pressure (6.7%, 5 mmHg). There were no changes in echocardiograms comparing the beginning and end of follow-up, and side effects did not lead to discontinuation of treatment. DISCUSSION: Sibutramine proved to be effective for weight loss providing an 8% loss of the initial weight. Compliance to prolonged treatment was good, and side effects did not result in discontinuation of treatment. These data confirmed the good efficacy, tolerability, and safety profiles of sibutramine for treatment of obesity.

Morfologia, germinação e teor de água das sementes De Araçá-boi (Eugenia Stipitata Ssp. Sororia)

O araçá-boi (Eugenia stipitata ssp. sororia McVaugh - Myrtaceae) é uma espécie frutífera originária da Amazônia Ocidental que apresenta grande potencial para a indústria de sucos e sorvetes. A morfologia das sementes é complexa e sua fisiologia pouco compreendida. Sabe-se que elas são resistentes a injúrias mecânicas e sensíveis ao dessecamento. Objetivou-se caracterizar a morfologia das sementes através da biometria, determinar o grau de umidade das sementes e descrever os eventos do processo germinativo, visando dar subsídios para o manejo das sementes e a produção de mudas. As médias de comprimento, peso fresco e peso seco das sementes foram de 1,06 cm, 0,49 g c 0,17 g, respectivamente. O teor de água encontrado nas sementes foi de 62%. A germinação das sementes é hipógea c criptocotiledonar, mostrando-se lenta e desuniforme. A germinação iniciou-se por volta de 50 dias e estendeu-se até mais de 280 dias. A plântula, com 60 dias, apresentou altura média de 13 cm e 18 folhas. As sementes apresentam alto poder de regeneração pois, mesmo quando cortadas ao meio ou na zona meristemática, foram capazes de formar plântulas.

Discriminação de raças primitivas de Pupunha (Bactris Gasipaes) na Amazônia brasileira por meio de marcadores moleculares (RAPDs)

A pupunha (Bactris gasipaes Kunth, Palmae) foi domesticada por seu fruto pelos primeiros povos da Amazônia Ocidental, possuindo um complexo de raças primitivas (landraces) parcialmente caracterizado e mapeado morfologicamente. Ao longo dos Rios Amazonas e Solimões, no Brasil, foram propostas três raças primitivas [Pará (Rio Amazonas), Solimões (baixo e médio Rio Solimões), Putumayo (alto Rio Solimões)], com indicações de que a raça Solimões poderia ser artefato de análise morfométrica. Marcadores RAPDs foram usados para avaliar a hipótese de três raças. Extraiu-se DNA de 30 plantas de cada raça mantida no BAG de Pupunha em Manaus, AM, Brasil. Na amplificação por PCR, 8 primers geraram 80 marcadores, cujas similaridades de Jaccard foram estimadas para agrupamento das plantas com UPGMA. O dendrograma conteve 2 grandes grupos que juntaram-se a uma similaridade de 0,535: o grupo da raça Pará conteve 26 plantas dessa raça, 5 da Putumayo e 1 da Solimões; o grupo do Rio Solimões conteve 29 plantas da raça Solimões, 19 da Putumayo e 1 da Pará. A estrutura do segundo grupo sugere que existe apenas uma raça ao longo do Rio Solimões, pois as plantas amostradas são misturadas em sub-grupos sem ordem aparente. A análise genética não apoia a hipótese de três raças e sugere que a raça Putumayo estende-se ao longo do Rio Solimões até Amazônia central. Será necessário juntar dados genéticos com morfológicos para avaliar esta nova hipótese com mais precisão.