Treatment of patients with Schistosomiasis mansoni: a double blind clinical trial comparing praziquantel with oxamniquine

A double-blind clinical trial involving 120 patients with chronic schistosomiasis was carried out to compare the tolerability and efficacy of praziquantel and oxamniquine. The patients were randomly allocated into two groups. One was treated with praziquantel, 55 mg/kg of body weight CBWT), and the other one with oxamniquine, 15mg/kg bwt, administered in a single oral dose. The diagnosis and the parasitological follow-up was based on stool examinations by quantitative Kato-Katz method and on rectal biopsies. Side-effects — mainly dizziness, sleepness, abdominal distress, headache, nausea and diarrhea — were observed in 87% of the cases. Their incidence, intensity and duration were similar for both drugs but abdominal pain was significantly more frequent after praziquantel intake and severe dizziness was more commonly reported after oxamniquine. A significant increase of alanine-aminotransferase and y-glutamyltransferase was found with the latter drug and of total bilirubin with the former one. A total of 48 patients treated with praziquantel and 46 with oxamniquine completed with negative findings the required three post-treatment parasitological controls — three slides of each stool sample on the first, third and sixth month. The achieved cure rates were 79.2% and 84.8%, respectively, a difference without statistical significance. The non-cured cases showed a mean reduction in the number of eggs per gram of feces of 93.5% after praziquantel and of 84.1% after oxamniquine. This diference also was not significant. Five patients retreated with praziquantel were cured but only one out of three treated a second time with oxamniquine. These findings show that both drugs — despite their different chemical structures, pharmacological properties and mechanisms-of-action — induce similar side-effects as well as a comparable therapeutical efficacy, in agreement with the results reported from analogous investigations.

Epidemiological aspects of acute viral hepatitis in São Paulo, Brazil

As few reports on the prevalence of each type of viral hepatitis have been published in our country, we studied 154 patients with acute viral hepatitis consecutively seen at the Liver Unit from November 1980 to November 1984. The frequency of hepatitis A, B and non-A, non-B was 52.6%, 27.3% and 20.1% respectively. Greater frequency in young people, previous contact with infected patients and ingestion of suspected foods were the predominant epidemiological features in the hepatitis A group. Hepatitis B was characterized by the parenteral, non-transfusional exposure, previous contact and a high occurence in health-care workers. A history of blood transfusion was a significant finding in the hepatitis non-A, non-B group. Finally, the routes of transmission were unknown in 30-40% of the three groups of patients.

Liver morphology with emphasis on bile ducts changes and survival analysis in mice submitted to multiple Schistosoma mansoni infections and chemotherapy

In an attempt to be as close as possible to the infected and treated patients of the endemic areas of schistosomiasis (S. mansoni) and in order to achieve a long period of follow-up, mice were repeatedly infected with a low number of cercariae. Survival data and histological variables such as schistosomal granuloma, portal changes, hepatocellular necrosis, hepatocellular regeneration, schistosomotic pigment, periductal fibrosis and chiefly bile ducts changes were analysed in the infected treated and non treated mice. Oxamniquine chemotherapy in repeatedly infected mice prolonged survival significantly when compared to non-treated animals (chi-square 9.24, p = 0.0024), thus confirming previous results with a similar experimental model but with a shorter term follow-up. Furthermore, mortality decreased rapidly after treatment suggesting an abrupt reduction in the severity of hepatic lesions. A morphological and immunohistochemical study of the liver was carried out. Portal fibrosis, with a pattern resembling human Symmers fibrosis was present at a late phase in the infected animals. Bile duct lesions were quite close to those described in human Mansonian schistosomiasis. Schistosomal antigen was observed in one isolated altered bile duct cell. The pathogenesis of the bile duct changes and its relation to the parasite infection and/or their antigens are discussed.

Características evolutivas do Cysticercus cellulosae no encéfalo e no coração humanos

O presente estudo teve como objetivos avaliar a prevalência de cisticercose, classificar as etapas evolutivas dos cisticercos encontrados nos encéfalos e corações humanos, diferenciá-las de acordo com os aspectos macro e microscópicos dos processos patológicos gerais e comparar os processos encontrados nos encéfalos e corações. Foram revisados protocolos de autópsias realizadas no Hospital Escola da Faculdade de Medicina do Triângulo Mineiro, Uberaba, MG, Brasil, no período de 1970 a 2000. Verificou-se a prevalência da cisticercose em 71 casos, sendo 18 (25,4%) de cisticercose cardíaca e 53 (74,6%) de encefálica. Foram analisados 19 cisticercos, sendo 9 de encéfalos e 10 de corações. Os cisticercos foram classificados, de acordo com sua fase evolutiva, em etapas: vesicular, vesicular coloidal, granular nodular e nodular calcificada, com similaridade entre os diagnósticos macro e microscópico. Entre os processos patológicos destacaram-se a beta-fibrilose e a fibroelastose endocárdica. Adicionalmente, demonstrou-se que a classificação pode ser aplicada tanto na cisticercose encefálica como na cardíaca.

Size of gastroesophageal varices: its behavior after the surgical treatment of portal hypertension

The size of gastroesophageal varices is one of the most important factors leading to hemorrhage related to portal hypertension. An endoscopic evaluation of the size of gastroesophageal varices before and after different operations for portal hypertension was performed in 73 patients with schistosomiasis, as part of a randomized trial: proximal splenorenal shunt (PSS n=24), distal splenorenal shunt (DSS n=24), and esophagogastric devascularization with splenectomy (EGDS n=25). The endoscopic evaluation was performed before and up to 10 years after the operations. Variceal size was graded according to Palmer's classification: grade 1 -- up to 3 mm, grade 2 -- from 3 to 6 mm, grade 3 -- greater than 6 mm, and were analyzed in four anatomical locations: inferior, middle or superior third of the esophagus, and proximal stomach. The total number of points in the pre-operative grading minus the number of points in the post-operative grading gave a differential grading, allowing statistical comparison among the surgical groups. Good results, in terms of disappearance or decrease of variceal size, were observed more frequently after PSS than after DSS or EGDS - 95.8%, 83.3%, and 72%, respectively. When differential grading was analyzed, a statistically significant difference was observed between PSS and EGDS, but not between proximal and distal splenorenal shunts. In conclusion, shunt surgeries were more efficient than devascularization in diminishing variceal size.

Pericardial Effusion with Cardiac Tamponade as a Form of Presentation of Primary Hypothyroidism

The authors describe a case of pericardial effusion accompanied by cardiac tamponade caused by primary hypothyroidism. Diagnosis was made by exclusion, because other causes of cardiac tamponade are more frequent. Emergency treatment of cardiac tamponade is pericardiocentesis (with possible pericardial window), and, after stabilization, performance of hormonal reposition therapy with L-thyroxin.

Heart Failure with Preserved Left Ventricular Ejection Fraction in Patients with Acute Myocardial Infarction

AbstractBackground:The prevalence and clinical outcomes of heart failure with preserved left ventricular ejection fraction after acute myocardial infarction have not been well elucidated.Objective:To analyze the prevalence of heart failure with preserved left ventricular ejection fraction in acute myocardial infarction and its association with mortality.Methods:Patients with acute myocardial infarction (n = 1,474) were prospectively included. Patients without heart failure (Killip score = 1), with heart failure with preserved left ventricular ejection fraction (Killip score > 1 and left ventricle ejection fraction ≥ 50%), and with systolic dysfunction (Killip score > 1 and left ventricle ejection fraction < 50%) on admission were compared. The association between systolic dysfunction with preserved left ventricular ejection fraction and in-hospital mortality was tested in adjusted models.Results:Among the patients included, 1,256 (85.2%) were admitted without heart failure (72% men, 67 ± 15 years), 78 (5.3%) with heart failure with preserved left ventricular ejection fraction (59% men, 76 ± 14 years), and 140 (9.5%) with systolic dysfunction (69% men, 76 ± 14 years), with mortality rates of 4.3%, 17.9%, and 27.1%, respectively (p < 0.001). Logistic regression (adjusted for sex, age, troponin, diabetes, and body mass index) demonstrated that heart failure with preserved left ventricular ejection fraction (OR 2.91; 95% CI 1.35–6.27; p = 0.006) and systolic dysfunction (OR 5.38; 95% CI 3.10 to 9.32; p < 0.001) were associated with in-hospital mortality.Conclusion:One-third of patients with acute myocardial infarction admitted with heart failure had preserved left ventricular ejection fraction. Although this subgroup exhibited more favorable outcomes than those with systolic dysfunction, this condition presented a three-fold higher risk of death than the group without heart failure. Patients with acute myocardial infarction and heart failure with preserved left ventricular ejection fraction encounter elevated short-term risk and require special attention and monitoring during hospitalization.

Peróxido de hidrogênio: importância e determinação

A brief discussion about the hydrogen peroxide importance and its determination is presented. It was emphasized some consideration of the H2O2 as reagent (separated or combined), uses and methods of analysis (techniques, detection limits, linear response intervals, sensor specifications). Moreover, it was presented several applications, such as in environmental, pharmaceutical, medicine and food samples.

Burnout e pensamentos suicidas em médicos residentes de hospital universitário

Este estudo objetivou descrever e analisar a prevalência de burnout e pensamentos suicidas em médicos residentes de um hospital público de Goiânia e verificar se há correlação entre os dois. Foi realizada uma investigação por meio de um estudo analítico-descritivo em corte transversal em 72 residentes através do MBI (Malasch Burnout Inventory) e do questionário de suicídio de Paykel. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital das Clínicas da Universidade Federal de Goiás sob o Parecer nº 052/2009. Resultados indicam a prevalência de burnout em 18,05% da amostra. Dentre os 13 sujeitos com manifestação de burnout, 61,53% já apresentaram pensamentos suicidas. Dentre os 42 sujeitos com baixo risco para manifestação de burnout, 28,57% já apresentaram pensamentos suicidas. Evidenciou-se correlação entre burnout e pensamentos suicidas, o que torna preciso elaborar programas de prevenção do burnout. Pesquisas nesta área são necessárias para a compreensão do burnout e sua correlação com pensamentos suicidas e outros distúrbios psiquiátricos.

Determinação de cobre e outros minerais em caprinos e ovinos criados no sertão do vale do rio São Francisco, Pernambuco

Resumo: Para a determinação dos teores de cobre e de seus antagonistas, foram utilizadas 160 amostras de soro e de fígados, de caprinos e ovinos enviados ao matadouro municipal de Petrolina. As amostras de fígado e soro foram correlacionadas para o mesmo animal, a fim de evitar erros na obtenção dos dados. No soro a atividade da ceruloplasmina foi determinada por método colorimétrico. Para a determinação dos minerais, as amostras foram diluídas de seis a vinte vezes com água Milli-Q. Para determinação das concentrações dos elementos minerais no fígado, as amostras foram digeridas até que se obtivesse uma solução que mantivesse os minerais da amostra inicial e que fosse totalmente liquida, sem a presença de partículas sólidas que pudessem obstruir os capilares de sucção do espectrômetro e assim impedir as leituras das amostras. As concentrações de cobre, molibdênio, ferro e zinco foram determinadas através de espectrometria óptica por emissão de plasma (ICP). Desta forma, foi conduzido o experimento objetivando determinar a ocorrência e distribuição da carência de cobre no território do sertão do vale do rio São Francisco em Pernambuco. Foi observado que não houve carência de cobre nesta região do estado de Pernambuco, quando se avaliou os níveis médios de cobre hepático,. Os níveis de zinco estavam dentro de um padrão de normalidade, enquanto que os níveis de ferro foram mais elevados em ovinos, e os níveis de molibdênio mais reduzidos em caprinos. Verificou-se também que a atividade de ceruloplasmina foi um indicador dos níveis séricos de cobre.