Análise em longo prazo na síndrome coronariana aguda: existem diferenças na morbimortalidade?

FUNDAMENTO: A insuficiência cardíaca (IC) tem grande importância como preditor de morbimortalidade em pacientes com síndrome coronariana aguda (SCA). OBJETIVO: Avaliar os preditores de morbimortalidade na SCA em longo prazo. MÉTODOS: Foi um estudo de coorte de 403 pacientes consecutivos com queixas de dor torácica. Descreveram-se dados demográficos, clínicos, laboratoriais e terapêuticos, sendo avaliados durante a internação e até oito anos após alta, em relação à presença ou ausência de eventos cardiovasculares e óbitos. RESULTADOS: Foram 403 pacientes com queixas de dor torácica, em que 65,8% apresentavam diagnóstico de SCA sem supra de ST, 27,8% SCA com supra de ST e 6,5% sem SCA. Destes, foram avaliados os 377 pacientes com SCA, em que 37,9% eram do sexo feminino, e a média de idade foi de 62,2 ± 11,6 anos. A presença de IC antes ou durante a hospitalização influenciou a mortalidade. Dos fatores prognósticos, a creatinina inicial merece destaque, sendo o ponto de corte de 1,4 mg/dl (acurácia = 62,1%; HR = 3,27; p < 0,001). Notamos pior prognóstico para cada acréscimo de dez anos de idade (HR = 1,37; p < 0,001) e para cada incremento de 10 bpm na frequência cardíaca (HR = 1,22 p < 0,001). Quanto às terapias utilizadas antes e após 2002, houve aumento de uso de betabloqueadores, inibidores da enzima conversora da angiotensina (IECAs), estatinas e antiplaquetários, tendo impacto na mortalidade. CONCLUSÃO: Presença de IC admissional, creatinina, idade e FC foram preditores independentes de mortalidade. Observou-se que pacientes com IC atendidos antes de 2002 apresentaram pior sobrevida em relação aos atendidos após 2002 e que a mudança na terapia foi a responsável por isso.

Avaliação da presença de ácaros em cereais armazenados na grande São Paulo

O exame microscópico de 160 amostras de cereais (arroz, feijão, trigo, milho, a veia, ervilha e sorgo), 40% fornecidas pelo Instituto Adolfo Lutz e provenientes de distribuidores como COBAL, CIBRAZEM, PETROPACK, CEAGESP, DECOM e do 2º Exército, e 60% adquiridas em mercadinhos e armazéns na Grande São Paulo, feito no ato e após 42 dias de incubação a 25°C e 70% UR revelou que 49% das amostras apresentavam populações de ácaros primários de alimentos armazenados. Destas, 48% revelaram a presença de Tyrophagus putrescentiae (Schrank), 17,5% Aleuroglyphus ovatus (Troupeau), 6,8% Glycyphagus domesticus (DeGeer), 4,37% Chortoglyphus arcuatus (Troupeau), 3,8% Suidasia pontifica Oudemans, 3,12% Blomia tropicallis Bronswijck, Cook & Oshima, 1,25% Histiostoma sp. e Dermatophagoides pteronyssinus (Trouessart). Ácaros secundários também foram encontra dos destacando-se Tarsonemus sp., Cheyletus malaccensis Oudemans e Blattisocius dentriticus (Berlese), entre outros. As amostras originárias dos grandes distribuidores apresentavam bem menos ácaros do que aquelas dos pequenos armazéns onde a rotatividade de estoque é bem menor. O resultado positivo para ácaros de amostras mantidas em incubador por 42 dias quando seu exame no ato não os revelou, mostra que o simples exame de uma amostra de cereal num dado momento não exclui a hipótese dele estar contaminado por ovos de ácaros primários de alimentos. Dentre os insetos, o mais frequente foi o gorgulho Sitophilus orizae (L.) presente em amostras de arroz, milho e trigo.

Sôbre dois novos parasitos de peixe da costa do Peru (Cestoda, Tetraphyllidea)

Na presente nota estudamos alguns cestódeos coletados de Sarda chilensis (Cuv.) peixe comum da costa do pacífico, enviado por um de nós (N.I.H); o material era constituído por vários espécimes de Phyllobothriidae e paenas trêss de Onchobothriidae, infelizmente todos comprimidos; não obstante aqui fazemos o seu estudo por ser tratar de material de interêsse.

Quatro especies nuevas de nematodos del sur del Perú y redescripción de Hedruris Orestiae Moniez, 1889

En el estudio helmintológico de anfibios del género Telmatobius Wiegmann, 1834, y del pez Orestias luteus Valenciennes, 1839, de las zonas de Arequipa, Puno y del Lago Titicaca, se han encontrado nematodes de los géneros Hedruris Nitzsch, 1821 y Falcaustra Lane, 1915. Se redescribe Hedruris orestiae Moniez, 1889 y se describen cuatro especies nuevas: Hedruris moniezi sp. n., Falcaustra condorcanquii sp. n., Falcaustra pumacahuai sp. n. y Falcaustra tiahuanaquensis sp. n.

On Dichelyne (Cucullanellus) elongatus (Tornquist, 1931) Petter, 1974: South American correlated species (Nematoda, Cucullanidae) and some other helminths of micropogonias furnieri (Desmarest, 1823) (Pisces, Sciaenidae)

Dichelyne (Cucullanellus) elongatus (Tomquist, 1931) Petter, 1974, from Venezuela, of which D.(C.) amaurincai (Freitas, Vicente & Ibáñez, 1969) Petter, 1974 is proposed as a junior synonym, is redescribed and comments on the present status of the remaining species under the group, namely D.(C.) dichelyneformes (Szidat, 1950) Petter, 1974, D.(C.) rodriguesi (Pinto, Fábio & Noronha, 1970) Petter, 1974 and D.(C.) travassosi (Guimarães & Cristofaro, 1974), occuring in South America are made. Dollfusentis chandleri Golvan, 1969 (Acanthocephala, Illiosentidae), Poecilancistrium caryophyllum (Diesing, 1850)(Cestoidea, Otobothriidae) and Callitetrarhynchus gracilis (Rudolphi, 1819)(Cestoidea, Dasyrhynchidae) as well as larval forms of Echinocephalus sp. (Nematoda, Gnathostomatidae) and Contracaecum sp. (Nematoda, Anisakidae) are also reported.

Dengue 2 virus enhancement in asthmatic and non asthmatic individual

During the 1981 dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) Cuban epidemic, bronchial asthma (BA) was frequently found as a personal or family antecedent in dengue hemorragic fever patients. Considering that antibody dependent enhancement (ADE) plays an important role in the etiopathogenic mechanism of DHF/DSS, we decide to study the Dengue 2 virus (D2V) capability of replication in peripheral blood leukocytes (PBL) from asthmatic patients and healthy persons. In 90% of asthmatic patients and 53.8% of control group it was obtained PBL with a significant D2V enhancing activity (X² p < 0.01). Power enhancement was higher in asthmatic group. This is the first in vitro study relating BA and the dengue 2 virus immuno enhancement. The results obtained support the role of BA as a risk factor for DHF/DSS as already described on epidemiological data.

Sensitivity of a Vacuum Aspiratory Culture Technique for Diagnosis of Localized Cutaneous Leishmaniasis in an Endemic Area of Leishmania (Viannia) braziliensis Transmission

Sixty eight patients with localized cutaneous leishmaniasis from an area with Leishmania (Viannia) braziliensis transmission had cultures performed with a modified Marzochi´s vacuum aspiratory puncture technique to establish sensitivity and contamination rate with this new method. Overall sensitivity of three aspirates was 47.1%; (CI95% 39.4; 59.4) significantly greater than the sensitivity of a single one aspirate. Fungal contamination was observed in 6/204 (2.9%) inoculated culture tubes. We recommend that this useful technique should be adopted as routine for primary isolation of L. (V.) braziliensis from localized cutaneous ulcers.

Sensitivity of Lymph Node Aspiration in Localized Cutaneous Leishmaniasis Due to Leishmania (Viannia) braziliensis

Twenty nine patients with localized cutaneous leishmaniasis had lymph node and skin ulcer aspirations for culture of Leishmania with the modified Marzochi´s vacuum aspiratory technique. Sensitivity of lymph node aspiration was 58.6% and 34.5% for skin ulcer aspiration (P=0.06). Combined sensitivity of the two methods was 79.3%. There was no agreement between methods (Kappa Index = -0.084; CI95% -0,45; 0,28) showing the potential complementary roles in diagnostic approach.

High frequency of skin reactions in patients with leishmaniasis treated with meglumine antimoniate contaminated with heavy metals: a comparative approach using historical controls

We analyzed data from historical controls treated with meglumine antimoniate to compare the frequency of adverse events observed in patients with cutaneous leishmaniasis treated with the same dose of meglumine antimoniate contaminated with heavy metals in an endemic area of the State of Bahia, Brazil. Group A patients were treated in 2000 with the drug produced by Eurofarma Laboratórios Ltda., São Paulo, Brazil (lot A) and group B patients were treated in 1996 with the reference drug produced by Rhodia Farma Ltda., São Paulo, Brazil (lot B). We observed an unusual higher frequency of skin reactions in group A patients. However, all type of adverse events observed in group A were also observed in group B. The physico-chemical analysis of these lots revealed that lot A had lower pH and higher concentration of total and trivalent antimony, lead, cadmium, and arsenic. Our findings suggest that the skin reactions could be attributed to heavy metal contamination of lot A.

Trypanosoma (Herpetosoma) rangeli Tejera, 1920: an updated review

Trypanosoma rangeli, a parasite generally considered non-pathogenic for man, is the second species of human trypanosome to be reported from the New World. The geographical distribution of T. rangeli often overlaps with that of T. cruzi, the same vertebrate and invertebrate hosts being infected. Their differentiation thus becomes of real, practical importance, particularly as they share approximately half the antigenic determinants recognized by the humoral response. Little is known about the life cycle of T. rangeli in the vertebrate host, although thousands of human and wild animal infections have been reported. Recent studies have revealed 2 major phylogenetic lineages in T. rangeli having different characteristics, thus leading to better understanding of the epidemiology and interactions with this parasite's vertebrate hosts and triatomine vectors. Based on further genetic characterization analysis, the authors have proposed 2 alternative hypotheses and consider that T. rangeli could have had clonal evolution or have been subjected to speciation processes.