Características psicológicas dos pacientes submetidos à intervenção coronária percutânea

FUNDAMENTO: Há poucos dados sobre análises da prevalência e da influência de características psicológicas adversas no prognóstico dos indivíduos submetidos a intervenções coronárias percutâneas. Nenhum estudo abordou essa questão no Brasil. OBJETIVO: Investigar a prevalência de depressão, ansiedade, estresse psicológico e personalidade tipo D, bem como sua associação com eventos cardiovasculares em pacientes submetidos à intervenção coronária percutânea (ICP). MÉTODOS: As características psicológicas foram avaliadas por escalas: inventário de depressão de Beck (IDB), inventário de ansiedade de Beck (IAB), inventário de sintomas de estresse de Lipp para adultos (ISSL) e escala de personalidade tipo D. A meta do estudo foi a ocorrência de eventos cardiovasculares maiores em um seguimento de um ano. RESULTADOS: Durante março e maio de 2006, 137 pacientes foram incluídos. A personalidade tipo D foi identificada em 34% dos casos; 29% apresentaram ansiedade, 25% apresentaram depressão, e 70% dos pacientes apresentaram estresse. Em relação à frequência de características psicológicas de acordo com a ocorrência de eventos cardiovasculares adversos maiores, não houve diferença estatística entre os dois grupos de pacientes no que se refere à depressão (29% vs. 26% p = 0,8), ansiedade (33% vs. 23% p = 0,3), estresse (76% vs. 65% p = 0,3) e personalidade tipo D (33% vs. 32% p = 0,9). No entanto, encontrou-se um escore de afetividade negativa significativamente maior no grupo de pacientes que apresentaram eventos (13,9 vs. 9,8 p = 0,01). CONCLUSÃO: Em pacientes submetidos à intervenção coronária percutânea, a prevalência de efeitos adversos psicológicos característicos foi alta. Eventos adversos cardiovasculares maiores em um ano foram associados à afetividade negativa basal, mas não a outras características psicológicas estudadas.

Relação entre o Paratormônio e Depressão na insuficiência cardíaca

FUNDAMENTO: Tem-se observado que a depressão é preditora de reinternação e mortalidade na insuficiência cardíaca. O hormônio da paratireoide é um biomarcador novo e promissor que pode predizer a internação, a capacidade funcional e a mortalidade na insuficiência cardíaca. OBJETIVO: Nosso objetivo foi investigar a associação da depressão aos níveis séricos de hormônio da paratireoide em pacientes com insuficiência cardíaca sistólica. MÉTODOS: Cem pacientes ambulatoriais consecutivos com IC sistólica com fração de ejeção do ventrículo esquerdo < 40% foram examinados prospectivamente. Todos os pacientes foram submetidos a exames laboratoriais, incluindo análises de peptídeo natriurético cerebral e de hormônio da tireoide. Os pacientes foram convidados a completar o Inventário de Depressão de Beck-II. RESULTADOS: Cinquenta e um pacientes (51%) apresentavam escore de BDI ruim (escore de BDI > 18). Esses pacientes apresentavam níveis de hormônio da paratireoide significativamente mais elevados em comparação com aqueles com bons escores de BDI (133 ± 46 pg/ml versus 71 ± 26 pg/ml, p < 0,001). No modelo de regressão logística multivariada, constatou-se que o nível do hormônio da tireoide (razão de chances (OR) = 1.035, p = 0,003), fração de ejeção do ventrículo esquerdo (OR = 0,854, p = 0,004), classe funcional III / IV (OR = 28,022, p = 0,005), C-reactive protein (CRP) (OR = 1,088, p = 0,020) e presença de edema pré-tibial (OR = 12,341, p = 0,033) constituíam preditores independentes de depressão moderada a importante após o ajuste de outros possíveis fatores de confusão. CONCLUSÃO: Pacientes com insuficiência cardíaca sistólica com depressão moderada a importante apresentavam níveis séricos elevados de hormônio da tireoide e CRP, capacidade funcional ruim e fração de ejeção do ventrículo esquerdo mais baixa. A associação da depressão com esses parâmetros pode explicar a contribuição da depressão para a internação e a mortalidade na insuficiência cardíaca.

Anxiety, Depression, and General Psychological Distress in Patients with Coronary Slow Flow

AbstractBackground:The relationship between psychiatric illness and heart disease has been frequently discussed in the literature. The aim of the present study was to investigate the relationship between anxiety, depression and overall psychological distress, and coronary slow flow (CSF).Methods:In total, 44 patients with CSF and a control group of 50 patients with normal coronary arteries (NCA) were prospectively recruited. Clinical data, admission laboratory parameters, and echocardiographic and angiographic characteristics were recorded. Symptom Checklist 90 Revised (SCL-90-R), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scales were administered to each patient.Results:The groups were comparable with respect to age, sex, and atherosclerotic risk factors. In the CSF group, BAI score, BDI score, and general symptom index were significantly higher than controls (13 [18.7] vs. 7.5 [7], p = 0.01; 11 [14.7] vs. 6.5 [7], p = 0.01; 1.76 [0.81] vs. 1.1[0.24], p = 0.01; respectively). Patients with CSF in more than one vessel had the highest test scores. In univariate correlation analysis, mean thrombolysis in myocardial infarction (TIMI) frame counts were positively correlated with BAI (r = 0.56, p = 0.01), BDI (r = 0.47, p = 0.01), and general symptom index (r = 0.65, p = 0.01). The psychiatric tests were not correlated with risk factors for atherosclerosis.Conclusion:Our study revealed higher rates of depression, anxiety, and overall psychological distress in patients with CSF. This conclusion warrants further studies.

O grupo pullorum-gallinarum em provas bacteriologicas comparativas

Foram examinadas 38 amostras de germens do grupo pullorumgallinarum, de origem européa, americana ou isoladas no Brasil, acompanhadas bacteriologicamente durante 3 annos, na fixidez de suas propriedades ou na possibilidade de sua transformação dum typo em outro. a) Distinguiram-se no estudo das propriedades cinco typos de germens no grupo pullorumgallinarum - 1) pullorum gazogeno, 2) pullorum não gazogeno, 3) intermedius, 4) gallinarum ou intermedius? gazogeno, 5) gallinarum não gazogeno. Os 2 primeiros e o 5º já bem cinhecidos e acceitos; o 4º admittido por Beck & Eber, em 1929, o 3º evidenciado por nós em 1935. b) O typo gallinarum gazogeno deve ser mais propriamente talvez considerado como typo intermedius gazogeno a vista de sua acção sobre sorbita e a xylose e sobre o meio de Jordan. c) O quadro final resume as caracteristicas mais importantes destes cinco typos, baseando-se a differenciação principalmente na alteração do vermelho neutro, na produção de H²S, na fermentação de glycerina, rhamnose, xylose, dulcita, sorbita e maltose, na acção sobre o tartaro, na producção de gaz e no aspecto das colonias na superficie de certos meios de cultura. d) Outras propriedades biologicas examinadas - acção sobre o leite, sôro de leite, dextrina, etc, admitidos por varios pesquizadores na differenciação, parecem distituidas de valor. e) As amostras mantiveram fixas as suas propriedades durante todo o tempo em que foram acompanhadas. A hypothese de uma possivel transformação de um typo em outro não foi confirmada em nenhuma das amostras estudadas, justificando a entidade dos varios typos admittidos. f) Discrepancias observadas na fermentação da maltose, referidas por varios pesquizadores com germens desse grupo, não foram confirmadas no presente trabalho. g) Encontrou-se no sôro sanguineo um factor capaz de transformar a maltose em glycose, tornando aquelle assucar fermentescivel. Essa substancia é thermo-estavel e resiste á acção de substancias antidiastasicas. h) A analyse sôrologica das amostras estudadas não permittiu differenciar os typos entre si.

Aspectos bionômicos de Squamatoides trivittatus (Diptera, Sarcophagidae) sob condições de laboratório

Experiments with Squamatoides trivitattus were carried out in two different controlled temperatures (16±1°C/50-60% RH and 27±1°C/70-80% RH). The viability of larvae and pupae at 27°C was 89.82% and 92.75% respectively. Larvae did not develop at 16°C. Larval development lasted for 20±4 hr, 16±8 hr and 60±7 hr for the first, second and third instars, respectively, completing a total of 96±6 hr. The mean pupal period lasted for 15.7±1.6 days. In longevity tables for the adults, life-expectancy for 50% of the colony submitted to 16°C was of 1.78 weeks for males and 2.42 for females. At 27°C a life-expectancy of 1.15 weeks for males and 0.78 week for females was recorded. The average life-spans for males and females at 16°C were 3.5±2.0 and 3.8±2.6 weeks, respectively, and 1.9±1.2 weeks for both sexes. At 27°C, the longevity recorded was of 2.1±1.3 weeks for males and 1.7±1.1 week for females.

Immune response in cattle vaccinated against rabies

In order to determine the best type of rabies vaccine to use as a booster, 78 serological samples from singly vaccinated cattle were analyzed by counterimmunoelectrophoresis technique. The animals were divided into several groups, received the first vaccine dose with modified live virus vaccine (ERA strain) and were revaccinated with inactivated virus or modified live virus vaccines. Boosters were given at 2, 4, 8, 12 and 16 weeks following first vaccination. Results showed high titres in the cases of booster with inactivated vaccine. In all cases, however, detectable antibody titres declined quickly.

Replacing oxamniquine by praziquantel against Schistosoma mansoni infection in a rural community from the sugar-cane zone of Northeast Brazil: an epidemiological follow-up

A group of 52 villagers was followed-up for three years regarding Schistosoma mansoni infection. All villagers were periodically surveyed by the Kato-Katz method. In March 1997 and March 1998 the positives were treated with oxamniquine (15-20 mg/kg), and in March 1999, with praziquantel (60 mg/kg). All infection indices decreased substantially between March 1999 and March 2000: prevalence of infection (from 32.7% to 21.2%), prevalence of moderate/heavy infection (from 7.7% to 1.9%), intensity of infection (from 23.1 epg to 7.4 epg) and reinfection (from 35.7% to 14.3%). Negativation increased from 53.8 to 82.4. An optimistic prognostic is assumed in the short term for the introduction of praziquantel in the study area.

Longitudinal Study on the Natural Infection of Biomphalaria straminea and B. glabrata by Schistosoma mansoni in an Endemic Area of Schistosomiasis in Pernambuco, Brazil

The abundance of snail hosts and the rates of infection with Schistosoma mansoni were monitored monthly for four years in two representative localities subjected to repeated chemotherapy of infected persons. Snail abundance varied from 1.0 to 4.4 collected per person/minute/station for Biomphalaria straminea and from 0.1 to 7.0 for B. glabrata. Infection rates of snails in nature varied from 0% to 15% for the former and from 0% to 70% for the latter species. Human infection increased from 35.5% to 61.9% in the locality occupied by B. straminea, and decreased from 40.3% to 20.8% in that occupied by B. glabrata. No relationship could be detected between human infection and the snail variables. Despite seasonal variations, natural infection persisted throughout the monitoring period in both snail species. It reached remarkably high levels in B. straminea when compared to those obtained by other authors probably because of differences in methodology. It is recommended that longitudinal studies should be carried out focally and periodically to avoid underestimating the prevalence of schistosome infection in snails.

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.

Evaluation of tests based on the antibody response to keyhole limpet haemocyanin and soluble egg antigen to differentiate acute and chronic human schistosomiasis mansoni

Specific IgG and IgM responses to soluble egg antigen (SEA) and keyhole limpet haemocyanin (KLH) were measured by ELISA in patients with acute and chronic schistosomiasis. The tests based upon IgM and IgG antibodies responses to KLH presented the best diagnostic discrimination, and can be used in conjunction with clinical and epidemiological data to the differential diagnosis of acute schistosomiasis.

Patterns of tuberculosis in the Americas: how can modern biomedicine inform the ancient past?

Tuberculosis (TB) is an infectious disease that continues to take its toll on human lives. Paleopathological research indicates that it has been a significant cause of death among humans for at least five thousand years. Because of the devastating consequences to human health, social systems, and endangered primate species, TB has been the subject of many and varied research efforts throughout the world, efforts that are amassing an enormous amount of data concerning the causative agent Mycobacterium tuberculosis. Despite sequencing of the M. tuberculosis genome and numerous molecular epidemiological studies, many questions remain regarding the origin, evolution, and future co-evolutionary trajectory of M. tuberculosis and humans. Indeed, the origin of pre-Columbian New World TB has been and remains hotly debated, and resolution of this controversy will likely only come with integration of data and theory from multiple disciplines. In this paper, we discuss the pre-Columbian TB controversy, and then use research from biological and biomedical sciences to help inform paleopathological and archaeological studies of this ubiquitous disease that plagued our ancient forbears.

In vitro inhibition of Plasmodium falciparum by substances isolated from Amazonian antimalarial plants

In the present study, a quassinoid, neosergeolide, isolated from the roots and stems of Picrolemma sprucei (Simaroubaceae), the indole alkaloids ellipticine and aspidocarpine, isolated from the bark of Aspidosperma vargasii and A. desmanthum (Apocynaceae), respectively, and 4-nerolidylcatechol, isolated from the roots of Pothomorphe peltata (Piperaceae), all presented significant in vitro inhibition (more active than quinine and chloroquine) of the multi-drug resistant K1 strain of Plasmodium falciparum. Neosergeolide presented activity in the nanomolar range. This is the first report on the antimalarial activity of these known, natural compounds. This is also the first report on the isolation of aspidocarpine from A. desmanthum. These compounds are good candidates for pre-clinical tests as novel lead structures with the aim of finding new antimalarial prototypes and lend support to the traditional use of the plants from which these compounds are derived.

Biological activity of neosergeolide and isobrucein B (and two semi-synthetic derivatives) isolated from the Amazonian medicinal plant Picrolemma sprucei (Simaroubaceae)

In the present study, in vitro techniques were used to investigate a range of biological activities of known natural quassinoids isobrucein B (1) and neosergeolide (2), known semi-synthetic derivative 1,12-diacetylisobrucein B (3), and a new semi-synthetic derivative, 12-acetylneosergeolide (4). These compounds were evaluated for general toxicity toward the brine shrimp species Artemia franciscana, cytotoxicity toward human tumour cells, larvicidal activity toward the dengue fever mosquito vector Aedes aegypti, haemolytic activity in mouse erythrocytes and antimalarial activity against the human malaria parasite Plasmodium falciparum. Compounds 1 and 2 exhibited the greatest cytotoxicity against all the tumor cells tested (IC50 = 5-27 µg/L) and against multidrug-resistant P. falciparum K1 strain (IC50 = 1.0-4.0 g/L) and 3 was only cytotoxic toward the leukaemia HL-60 strain (IC50 = 11.8 µg/L). Quassinoids 1 and 2 (LC50 = 3.2-4.4 mg/L) displayed greater lethality than derivative 4 (LC50 = 75.0 mg/L) toward A. aegypti larvae, while derivative 3 was inactive. These results suggest a novel application for these natural quassinoids as larvicides. The toxicity toward A. franciscana could be correlated with the activity in several biological models, a finding that is in agreement with the literature. Importantly, none of the studied compounds exhibited in vitro haemolytic activity, suggesting specificity of the observed cytotoxic effects. This study reveals the biological potential of quassinoids 1 and 2 and to a lesser extent their semi-synthetic derivatives for their in vitro antimalarial and cytotoxic activities.

The prevalence of schistosomiasis in school-aged children as an appropriate indicator of its prevalence in the community

School-aged children (6-15 years) from the endemic area of Pernambuco were evaluated both as a target group for and an indicator of schistosomiasis control in the community. Parasitological data were drawn from baseline stool surveys of whole populations that were obtained to diagnose Schistosoma mansoni infection. Nineteen representative localities were selected for assessing the prevalence of schistosomiasis among individuals in the following age groups: 0-5, 6-15, 16-25, 26-40 and 41-80 years. For each locality, the prevalence in each age group was compared to that of the overall population using contingency table analysis. To select a reference group, the operational difficulties of conducting residential surveys were considered. School-aged children may be considered to be the group of choice as the reference group for the overall population for the following reasons: (i) the prevalence of schistosomiasis in this age group had the highest correlation with the prevalence in the overall population (r = 0.967), (ii) this age group is particularly vulnerable to infection and plays an important role in parasite transmission and (iii) school-aged children are the main target of the World Health Organization in terms of helminth control. The Schistosomiasis Control Program should consider school-aged children both as a reference group for assessing the need for intervention at the community level and as a target group for integrated health care actions of the Unified Health System that are focused on high-risk groups.