Metaloproteinases 2 e 9 são preditoras de remodelação ventricular esquerda após o infarto do miocárdio

FUNDAMENTO: O papel de metaloproteinases (MMP) séricas após o infarto do miocárdio (IM) é desconhecido. OBJETIVO: O objetivo deste estudo foi o de avaliar o papel das MMP-2 e -9 séricas como marcadores prognósticos da remodelação ventricular seis meses após o IM anterior. MÉTODOS: Fizemos um registro prospectivo dos pacientes após o seu primeiro IM anterior. A atividade de MMP foi analisada entre 12 a 72 horas após o IM. Foi feito um ecocardiograma durante a internação e seis meses depois. RESULTADOS: Incluímos 29 pacientes; 62% mostraram remodelação ventricular. Os pacientes que mostraram remodelação tinham maior tamanho de infarto baseado nos valores pico da creatinofosfoquinase (CPK) (p = 0,037), alta prevalência de insuficiência cardíaca congestiva em hospitais (p = 0,004), e redução da fração de ejeção (FE) (p = 0,007). Os pacientes com remodelação ventricular tiveram menores níveis séricos de MMP-9 inativa (p = 0,007) e maiores níveis da forma ativa da MMP-2 (p = 0,011). Em um modelo de regressão logística multivariada, ajustado pela idade, pico de CPK, FE e prevalência de insuficiência cardíaca, os níveis séricos da MMP-2 e -9 estavam associados à remodelação (p = 0,033 e 0,044, respectivamente). CONCLUSÃO: Níveis séricos mais elevados da MMP-9 inativa foram associados com a preservação dos volumes ventriculares esquerdos, e níveis séricos mais elevados da forma ativa da MMP-2 foram um preditor da remodelação seis meses após o IM.

Assessing bovine babesiosis in Rhipicephalus (Boophilus) microplus ticks and 3 to 9-month-old cattle in the middle Magdalena region, Colombia

Babesia sp. is a protozoan hemoparasite that affects livestock worldwide. The Colombian Middle Magdalena is an enzootic region for babesiosis, but there is no previous research providing detail on its transmission cycle. This study aims to assess some Babesia sp. infection indicators in cattle and ticks from the area, by using direct microscopic and molecular techniques to detect the infection. In the cattle, 59.9% and 3.4 % positivity values for B. bigemina and mixed infection (B. bovis + B. bigemina) were found respectively. In ticks, the positivity of B. bigemina reached 79.2% and 9.4% for the mixed infection. The degree of infestation in the region was 3.2 ticks per bovine. There was positive correlation between tick control acaricide frequencies and infestation in bovines. This leads us to infer that control periodicity greater than 90 days, in stable zones, is an abiotic factor that benefits the acquisition of protective immunity in calves, the natural control of the infection and eventual disease absence. It is necessary to monitor the disease by applying new entomological and parasitological indicators showing the complexity of this phenomenon.

Increase in skeletal muscle protein content by the ß-2 selective adrenergic agonist clenbuterol exacerbates hypoalbuminemia in rats fed a low-protein diet

This investigation examined how the nutritional status of rats fed a low-protein diet was affected when the animals were treated with the ß-2 selective agonist clenbuterol (CL). Males (4 weeks old) from an inbred, specific-pathogen-free strain of hooded rats maintained at the Dunn Nutritional Laboratory were used in the experiments (N = 6 rats per group). CL treatment (Ventipulmin, Boehringer-Ingelheim Ltd., 3.2 mg/kg diet for 2 weeks) caused an exacerbation of the symptoms associated with protein deficiency in rats. Plasma albumin concentrations, already low in rats fed a low-protein diet (group A), were further reduced in CL rats (A = 25.05 ± 0.31 vs CL = 23.64 ± 0.30 g/l, P<0.05). Total liver protein decreased below the level seen in either pair-fed animals (group P) or animals with free access to the low-protein diet (A = 736.56 ± 26 vs CL = 535.41 ± 54 mg, P<0.05), whereas gastrocnemius muscle protein was higher than the values normally described for control (C) animals (C = 210.88 ± 3.2 vs CL = 227.14 ± 1.7 mg/g, P<0.05). Clenbuterol-treated rats also showed a reduction in growth when compared to P rats (P = 3.2 ± 1.1 vs CL = -10.2 ± 1.9 g, P<0.05). This was associated with a marked decrease in fat stores (P = 5.35 ± 0.81 vs CL = 2.02 ± 0.16 g, P<0.05). Brown adipose tissue (BAT) cytochrome oxidase activity, although slightly lower than in P rats (P = 469.96 ± 16.20 vs CL = 414.48 ± 11.32 U/BAT x kg body weight, P<0.05), was still much higher than in control rats (C = 159.55 ± 11.54 vs CL = 414.48 ± 11.32 U/BAT x kg body weight, P<0.05). The present findings support the hypothesis that an increased muscle protein content due to clenbuterol stimulation worsened amino acid availability to the liver and further reduced albumin synthesis causing exacerbation of hypoalbuminemia in rats fed a low-protein diet.

Proliferative diabetic retinopathy is associated with microalbuminuria in patients with type 2 diabetes

Diabetic retinopathy is one of the leading causes of blindness in working-age individuals. Diabetic patients with proteinuria or those on dialysis usually present severe forms of diabetic retinopathy, but the association of diabetic retinopathy with early stages of diabetic nephropathy has not been entirely established. A cross-sectional study was conducted on 1214 type 2 diabetic patients to determine whether microalbuminuria is associated with proliferative diabetic retinopathy in these patients. Patients were evaluated by direct and indirect ophthalmoscopy and grouped according to the presence or absence of proliferative diabetic retinopathy. The agreement of diabetic retinopathy classification performed by ophthalmoscopy and by stereoscopic color fundus photographs was 95.1% (kappa = 0.735; P < 0.001). Demographic information, smoking history, anthropometric and blood pressure measurements, glycemic and lipid profile, and urinary albumin were evaluated. On multiple regression analysis, diabetic nephropathy (OR = 5.18, 95% CI = 2.91-9.22, P < 0.001), insulin use (OR = 2.52, 95% CI = 1.47-4.31, P = 0.001) and diabetes duration (OR = 1.04, 95% CI = 1.01-1.07, P = 0.011) were positively associated with proliferative diabetic retinopathy, and body mass index (OR = 0.90, 95% CI = 0.86-0.96, P < 0.001) was negatively associated with it. When patients with macroalbuminuria and on dialysis were excluded, microalbuminuria (OR = 3.3, 95% CI = 1.56-6.98, P = 0.002) remained associated with proliferative diabetic retinopathy. Therefore, type 2 diabetic patients with proliferative diabetic retinopathy more often presented renal involvement, including urinary albumin excretion within the microalbuminuria range. Therefore, all patients with proliferative diabetic retinopathy should undergo an evaluation of renal function including urinary albumin measurements.

The blockade of cyclooxygenases-1 and -2 reduces the effects of hypoxia on endothelial cells

Hypoxia activates endothelial cells by the action of reactive oxygen species generated in part by cyclooxygenases (COX) production enhancing leukocyte transmigration. We investigated the effect of specific COX inhibition on the function of endothelial cells exposed to hypoxia. Mouse immortalized endothelial cells were subjected to 30 min of oxygen deprivation by gas exchange. Acridine orange/ethidium bromide dyes and lactate dehydrogenase activity were used to monitor cell viability. The mRNA of COX-1 and -2 was amplified and semi-quantified before and after hypoxia in cells treated or not with indomethacin, a non-selective COX inhibitor. Expression of RANTES (regulated upon activation, normal T cell expressed and secreted) protein and the protective role of heme oxygenase-1 (HO-1) were also investigated by PCR. Gas exchange decreased partial oxygen pressure (PaO2) by 45.12 ± 5.85% (from 162 ± 10 to 73 ± 7.4 mmHg). Thirty minutes of hypoxia decreased cell viability and enhanced lactate dehydrogenase levels compared to control (73.1 ± 2.7 vs 91.2 ± 0.9%, P < 0.02; 35.96 ± 11.64 vs 22.19 ± 9.65%, P = 0.002, respectively). COX-2 and HO-1 mRNA were up-regulated after hypoxia. Indomethacin (300 µM) decreased COX-2, HO-1, hypoxia-inducible factor-1alpha and RANTES mRNA and increased cell viability after hypoxia. We conclude that blockade of COX up-regulation can ameliorate endothelial injury, resulting in reduced production of chemokines.

Alteração do teor de cálcio no banho de DP para 2,5 mEq/L é eficaz no reestabelecimento dos valores preconizados por diretrizes atuais em pacientes com PTH < 150 pg/dL

INTRODUÇÃO/OBJETIVO: A doença óssea adinâmica (DOA) é um achado comum em diálise peritoneal (PD) e é considerada fator de risco para desenvolvimento de fraturas e doença cardiovascular. Dados do BRAZPD apontam as soluções de cálcio a 3,5 mEq/L presentes na maioria das prescrições no país, que possui quase 9.000 pacientes em PD. É comum o balanço positivo de cálcio com concentrações a 3,5 mEq/L contribuindo para o desenvolvimento de DOA. Diretrizes atuais recomendam um PTHi na DRC V em diálise entre 2 e 9 vezes (150-500 pg/mL) o valor máximo da normalidade. O objetivo deste estudo foi avaliar a resposta em 6 meses do PTH-i após a conversão para solução de cálcio a 2,5 mEq/L de pacientes que usavam soluções com cálcio a 3,5 mEq/L e com PTH-i basal < 150 pg/mL. MÉTODOS: Coorte prospectiva, observacional, na qual todos pacientes prevalentes em PD entre janeiro de 2008 e janeiro de 2009 de um único centro foram incluídos. Critérios de inclusão foram:(1) estar em uso de solução de DP com cálcio a 3,5 mEq/L; (2)PTH sérico < 150 pg/mL. A critério médico, os pacientes poderiam ser convertidos ou não para soluções cálcio a 2,5 mEq/L. RESULTADOS: 35 pacientes (idade média 62 ± 17 anos) foram incluídos. Desses, 22 foram convertidos para solução de cálcio 2,5 mEq/L. Nefropatia diabética foi a principal doença de base (36%) seguido por HAS (25%) e GNC (14%). Os grupos apresentavam valores basais semelhantes de PTH, cálcio, fósforo e fosfatase alcalina. No grupo-intervenção, houve aumento significativamente maior de PTH em 6 meses comparado com o grupo-controle (Δ194 pg/dL versus Δ 92/dL; p < 0,05). Dos convertidos, 41% atingiram os valores alvo de PTH contra 14% (p < 0,05) do grupo-controle. Fósforo, cálcio e fosfatase alcalina foram semelhantes entre os grupos. CONCLUSÃO: O uso de soluções com cálcio a 2,5 mEq/L para pacientes com PTHi < 150 pg/dL comparado a soluções de cálcio 3,5 mEq/L parece uma estratégia simples e efetiva para trazer os valores de PTHi dentro da faixa atualmente sugerida nas diretrizes.