Fulminant hepatitis: a clinical review of 11 years

24 cases of fulminant hepatitis (FH) hospitalized in the Clínica de Doenças Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo during the period from January 1976 to December 1986 were reviewed from their clinical, epidemiological and laboratorial aspects. 88% of the patients died; 20 patients (83%) presented hemorrhages and, of these, 19 died. Bacterial infections occurred in 14 patients (58%) all of whom died. Ascitis was noted in 3 cases; cerebral edema was present in 16 cases. Maximal ALT levels for each patient during hospitalization ranged widely from 81 to 4,460 UI/l. Thirteen patients presented high creatinine levels (54%). Prothrombin time activity ranged from 2.1% to 67%. Fever was present in 20 cases (83%). Encephalopathy occurred within the first 2 weeks of illness in 72% of the cases. In 7 cases other illnesses were present. The etiology could not be determined in 13 cases. In 3 cases it was due to yellow fever and 6 cases were caused by viruses other than yellow fever. In one case the cause was drug usage and in another case, possibly alcohol. The authors believe that the clinical definition of FH requires further discussion before it is established. In this study FH is a young person's disease. The mortality found was similar to that by other authors. Factors that contributed to death were: hemorrhages and bacterial infection. Factors that worsened the prognosis of hepatitis were: associated illnesses and surgical procedure. The levels of ALT during hospitalization did not correlate well with the severity of the hepatitis. The authors believe that yellow fever should be considered a cause of FH where the clinical picture meets the criteria for such, although its mechanisms of encephalopathy remain obscure. The clinical details of the 3 cases of yellow fever are presented.

Atividade farmacológica dos extratos da casca do caule do tropeiro. O Connarus fulvus, Planch

O Cannarus fulvus Planch é utilizado em Goiás por ser "bom para o coração". Este trabalho estudou, a atividade farmacológica do extrato bruto etanólico (EE) do pó da casca do caule e da fração hidrossolúvel (FH) obtida após partição benzina/água. O EE e a FH produziram em ratos e camundongos diminuição da motilidade, sonolência sem hipnose, dificuldade respiratória, analgésia e arrastamento do trem posterior; estes proporcionais às doses. As DL50 em camundongos foram 210+/-22 e 310+/-52mg/kg, i.p. para o EE e FH respectivamente. A FH prolongou o sono barbitúrico, o tempo de reação ao calor na placa, quente e antagonizou (80%) as ações convulsivantes do pentilenotetrazol, mas não as da estricnina. Protegeu (100%) camundongos contra a ação letal do pancurônio e potencializou a ação da succinilcolina. Em preparações isolada, a FH potencializou (20%) a contração do diafragma em resposta ao estímulo elétrico do nervo frênico de ratos e reverteu o bloqueio neuromuscular produzido pela d-tubocurarina, em átrios de ratos e cobaias a freqüência e a força de contração não foram alteradas. As injeções do EE e FH em ratos anestesiados produziram hipotensão (5 a 100mg/kg); doses maiores foram letais. Os dados obtidos não confirmaram ação cardiativa direta. A planta apresentou ações depressões do S.N.C., analgésica, anticonvulsivante e descurarizante.

Association of Peripheral Arterial and Cardiovascular Diseases in Familial Hypercholesterolemia

Background: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disease characterized by an elevation in the serum levels of total cholesterol and of low-density lipoproteins (LDL- c). Known to be closely related to the atherosclerotic process, FH can determine the development of early obstructive lesions in different arterial beds. In this context, FH has also been proposed to be a risk factor for peripheral arterial disease (PAD). Objective: This observational cross-sectional study assessed the association of PAD with other manifestations of cardiovascular disease (CVD), such as coronary artery and cerebrovascular disease, in patients with heterozygous FH. Methods: The diagnosis of PAD was established by ankle-brachial index (ABI) values ≤ 0.90. This study assessed 202 patients (35% of men) with heterozygous FH (90.6% with LDL receptor mutations), mean age of 51 ± 14 years and total cholesterol levels of 342 ± 86 mg /dL. Results: The prevalences of PAD and previous CVD were 17% and 28.2 %, respectively. On multivariate analysis, an independent association between CVD and the diagnosis of PAD was observed (OR = 2.50; 95% CI: 1.004 - 6.230; p = 0.049). Conclusion: Systematic screening for PAD by use of ABI is feasible to assess patients with FH, and it might indicate an increased risk for CVD. However, further studies are required to determine the role of ABI as a tool to assess the cardiovascular risk of those patients.

Spectrum of Morphologic Changes of Lymph Nodes in HIV Infection

Cervical lymph nodes biopsies from 31 HIV positive patients (with or without AIDS) were studied by histologic methods and immunohistochemistry (StreptABC staining of paraffin sections) to identify cellular and extracellular matrix components. The results were the following: (1) the biopsies were included in the stages of follicular hyperplasia without fragmentation FH-FF (4 cases); follicular hyperplasia with follicular fragmentation FH+FF (16 cases); follicular involution FI (6 cases) and diffuse pattern DP (5 cases); (2) the most important alteration was the germinal centers disruption due to follicle lysis, which began in the light zone; (3) there was coincidence between intrafollicular hemorrhages and segmental hyaline mycroangiopathy; (4) during the progression of the disease occurred: (a) an increase in the number of mast cells, CD68+ and Mac387+ macrophages; (b) a diffuse augment of collagen III, elastic fibers, laminin, fibronectin and proteoglycans; (c) maintenance of Factor VIII - related antigens in the vascular endothelial cells, with decrease in the expression of Ulex-Europeus I lectin. Follicular hyperplasia (FH-FF or FH+FF) was the most common histologic pattern recognized in the lymph nodes of patients without AIDS and follicular involution and difuse pattern were seen in those who had AIDS. The results indicate that the lymph node biopsies may provide important information about the evolutive stage of the disease and its prognosis.

Comparison of dengue infection in human mononuclear leukocytes with mosquito C6/36 and mammalian Vero cells using flow cytometry to detect virus antigen

Fluorescent activated cell sorter (FACS) analysis is useful for the detection of cellular surface antigens and intracellular proteins. We used this methodology in order to detect and quantify dengue antigens in highly susceptible cells such as clone C6/36 (Aedes albopictus) and Vero cells (green monkey kidney). Additionally, we analyzed the infection in vitro of human peripheral blood mononuclear leukocytes (PBML). FACS analysis turned out to be a reliable technique to quantify virus growth in traditional cell cultures of C6/36 as well as Vero cells. High rates of infection were achieved with a good statistical correlation between the virus amount used in infection and the percentage of dengue antigen containing cells detected in infected cultures. We also showed that human monocytes (CD14+) are preferred target cells for in vitro dengue infection among PBML. Monocytes were much less susceptible to virus infection than cell lines but they displayed dengue antigens detected by FACS five days after infection. In contrast, lymphocytes showed no differences in their profile for dengue specific immunofluorescence. Without an animal model to reproduce dengue disease, alternative assays have been sought to correlate viral virulence with clinical manifestations and disease severity. Study of in vitro interaction of virus and host cells may highlight this relationship.

A Heminested Polymerase Chain Reaction for the Detection of Brazilian Rabies Isolates from Vampire Bats and Herbivores

A heminested-PCR (hn-PCR) using primers to the nucleoprotein-coding gene in a nested set was evaluated in the detection of Brazilian strains of rabies virus (RV). A representative number of RV nucleoprotein sequences belonging to genotype 1 were aligned. Based on such alignment, primers were directed to highly conserved regions. All 42 clinical samples positive by both fluorescent antibody and mouse inoculation tests were also positive by the hn-PCR. Brain tissue that had been left to decompose, obtained from an experimentally inoculated mouse was tested by hn-PCR and yielded positive results. In conclusion, primers designed here were capable of amplifying Brazilian RV isolates obtained from a rural epidemiological cycle.

Optimisation of a quantitative polymerase chain reaction-based strategy for the detection and quantification of human herpesvirus 6 DNA in patients undergoing allogeneic haematopoietic stem cell transplantation

Human herpesvirus 6 (HHV-6) may cause severe complications after haematopoietic stem cell transplantation (HSCT). Monitoring this virus and providing precise, rapid and early diagnosis of related clinical diseases, constitute essential measures to improve outcomes. A prospective survey on the incidence and clinical features of HHV-6 infections after HSCT has not yet been conducted in Brazilian patients and the impact of this infection on HSCT outcome remains unclear. A rapid test based on real-time quantitative polymerase chain reaction (qPCR) has been optimised to screen and quantify clinical samples for HHV-6. The detection step was based on reaction with TaqMan® hydrolysis probes. A set of previously described primers and probes have been tested to evaluate efficiency, sensitivity and reproducibility. The target efficiency range was 91.4% with linearity ranging from 10-106 copies/reaction and a limit of detection of five copies/reaction or 250 copies/mL of plasma. The qPCR assay developed in the present study was simple, rapid and sensitive, allowing the detection of a wide range of HHV-6 loads. In conclusion, this test may be useful as a practical tool to help elucidate the clinical relevance of HHV-6 infection and reactivation in different scenarios and to determine the need for surveillance.

Professional knowledge in primary health care of the person/family in mental distress: Le Boterf perspective

Aim of this study was to identify knowing-doing actions constituted the practice of Family Health (FH), in view of nurses in relation to the person and family care in mental distress in terms of professional knowledge of Le Boterf. Method: Descriptive exploratory qualitative study, to deepen contruction of nurse in FH. The survey was conducted in 3 Units FH. Result: Doing a thematic analysis, came to the following categories: “Knowing how to act and react with relevance”; “Knowing how to combine resources and mobilize them in a professional context”; “Knowing how to interact with multiple knowledges”; “Knowing how to transpose”; “Knowing how to learn and knowing how to learn to learn”; “Knowing how to engage”. Final considerations: the greatest difficulty was "be able to transpose," and that the daily demand of the FH teams requires a lot of this knowledge. Little transposition of knowing-doing in real situations has been verified.

Frações da matéria orgânica do solo após três décadas de cultivo de eucalipto no Vale do Rio Doce-MG

As mudanças nas distintas frações da matéria orgânica do solo (MOS) sob cultivo do eucalipto são pouco conhecidas. Assim, o presente trabalho teve como objetivo avaliar o impacto do cultivo do eucalipto nos estoques de C das diversas frações da MOS, em solos ocupados anteriormente por pastagens degradadas, bem como verificar qual fração da MOS constitui-se um indicador mais sensível à mudança de uso do solo. O estudo foi realizado em plantações comerciais de eucalipto em dois locais na região do Vale do Rio Doce-MG (Belo Oriente e Virginópolis), onde foram determinados em amostras dos solos: C orgânico total (COT), C da fração leve (leve livre - FLL e leve oclusa - FLO), da fração pesada (areia - AR, silte + argila - S + A e argila - ARG), da biomassa microbiana (BM) e das frações húmicas (ácidos fúlvicos - FAF, ácidos húmicos - FAH e huminas - FH). Os resultados indicaram que, de maneira geral, os solos sob os diferentes tipos de uso em Virginópolis, em virtude da menor temperatura média anual e maior teor de argila, apresentaram maiores estoques de C em todas as frações da MOS em relação a Belo Oriente. Assim, o seqüestro de C no solo pelo cultivo do eucalipto foi maior em Virginópolis (14,2 t ha-1) que em Belo Oriente (10,0 t ha-1), resultando numa taxa de seqüestro de C de aproximadamente 0,42 e 0,29 t ha-1 ano-1 , respectivamente. Em Belo Oriente, o cultivo do eucalipto favoreceu o aumento no estoque de C das frações ARG, S + A e FH no solo. Comportamento semelhante foi observado para o C das FLL, FAF e FAH, em Virginópolis. Dentre todas as frações da MOS analisadas, a BM e a FLO foram indicadores menos sensíveis às alterações na MOS após três décadas da mudança de uso do solo. Com isso, o COT e a fração leve livre, ácidos fúlvicos, ácidos húmicos e humina foram mais eficientes nesse sentido.

Ácidos Húmicos em solo fertirrigado no Vale do São Francisco

A aplicação de ácidos orgânicos, principalmente húmicos (AH), associada à adubação mineral e orgânica pode levar a alterações nas propriedades dos AH do solo. No Vale do São Francisco, o uso de ácidos orgânicos vem despertando o interesse de produtores que usam sistema de irrigação. Entretanto, não são conhecidas as modificações que podem ocorrer nas características das substâncias húmicas do solo quando são aplicados ácidos orgânicos associados à fertilização mineral e estercos. Os objetivos deste trabalho foram avaliar e caracterizar, por métodos espectroscópicos (UV-Vis, Infravermelho, Fluorescência e RPE), as possíveis mudanças qualitativas no AH extraído de solo fertirrigado com duas fontes de fertilizantes (orgânica e mineral), associadas à aplicação de ácidos orgânicos comerciais na cultura da goiabeira. O experimento foi conduzido na Embrapa Semiárido, em Petrolina - PE. Os tratamentos utilizados foram: F - fertirrigação com fertilizantes minerais (ureia, fosfato monoamônio, cloreto de potássio); FE - F + aplicação de 20 dm³/planta de esterco; FH - F + fertirrigação com 30 dm³ ha-1 de Codahumus 20®; FEH - fertirrigação mineral + aplicação de 20 dm³/planta de esterco + fertirrigação com 30 dm³ ha-1 de Codahumus 20®, e R- tratamento testemunha, sem adubação. A relação E4/E6 dos AH variou de 4,8 a 5,4 para os tratamentos FEH e F. Os dados obtidos por meio da espectroscopia FTIR sugerem mistura de características aromático-alifáticas, grande quantidade de grupos carboxílicos e menor número de grupos nitrogenados para os AH dos tratamentos FEH, FH e FE. Os valores obtidos do índice A465 variaram de 1,04 a 1,74, referentes aos AH dos tratamentos FEH e FE. Verificou-se uma concentração de radicais livres orgânicos no AH do tratamento FEH (2,66 spins g-1 10(17)) três vezes maior do que o AH do tratamento F (0,95 spins g-1 10(17)). O esterco foi o responsável pelo maior de policondensação e grau de humificação do ácido húmico dos tratamentos FE e FHE.

Compartimentos de carbono em latossolo vermelho sob cultivo de eucalipto e fitofisionomias de cerrado

Os objetivos deste trabalho foram avaliar o impacto do cultivo do eucalipto, em diferentes idades, e de fitofisionomias de Cerrado sobre os estoques de C orgânico total e de seus compartimentos e verificar qual dessas frações constitui-se em indicador mais sensível às mudanças de uso do solo. O estudo foi realizado em Brasília, DF, em Latossolo Vermelho distroférrico sob plantio de eucalipto com três (PEUC-3), seis (PEUC-6) e sete (PEUC-7) anos de idade e sob Cerrado senso stricto, Cerrado denso e campo sujo. Nessas áreas, amostras de solo foram coletadas nas camadas de 0-10 e 10-20 cm, para determinação dos estoques de C orgânico total (COT), carbono da fração leve livre (FLL) e carbono das frações húmicas (ácidos fúlvicos - FAF, ácidos húmicos - FAH e huminas - FH). Em ambas as camadas de solo, observaram-se maiores estoques de COT e de C nos compartimentos, nas áreas sob Cerrado denso e Cerrado, comparativamente àquelas cultivadas com eucalipto; houve recuperação dos estoques de C em todos os compartimentos, com o aumento do tempo de cultivo do eucalipto. O C-FLL, seguido do C-FAF e C-FAH, foram considerados os compartimentos mais sensíveis às mudanças no uso do solo, uma vez que as reduções em estoque foram de maior amplitude do que as observadas no COT e C-FH. A análise multivariada, que considera todos os compartimentos conjuntamente, evidenciou maior similaridade entre o Cerrado denso e Cerrado, bem como entre o campo sujo, PEUC-3, PEUC-6 e PEUC7, nas camadas de 0-10 e 10-20 cm.

Agregação e frações físicas da matéria orgânica de um argissolo vermelho sob sistemas de uso no bioma Pampa

O emprego de sistemas agrossilvipastoris tem sido importante estratégia de uso de solos, principalmente arenosos pertencentes ao bioma Pampa. Objetivou-se, neste estudo, avaliar a agregação, o teor de C orgânico total (COT) e de N total (NT), o teor de C nas frações físicas e o grau de humificação da MO em um Argissolo Vermelho eutrófico arênico submetido a diferentes sistemas de uso no município de Alegrete, RS. As avaliações foram desenvolvidas em uma floresta homogênea de eucalipto (FH), na entrelinha do sistema agrossilvipastoril sob pastagem (SA) e em campo nativo (CN), nas camadas de 0,000-0,025 m; 0,025-0,075 m; 0,075-0,125 m; e de 0,125-0,225 m. Foram coletadas amostras deformadas de solo para a avaliação de agregados estáveis em água (AEA, %) e dos teores de COT e de NT. Foi realizado o fracionamento físico granulométrico e densimétrico da MO, sendo as frações leve livre (FLL) e fração leve oclusa (FLO) da camada superficial submetidas às análises de Infravermelho com Transformada de Fourier (FTIR) e Ressonância Paramagnética Eletrônica (EPR). Os AEA em todas as camadas e o diâmetro médio ponderado na camada de 0,025-0,075 m indicaram maior degradação estrutural do solo na entrelinha do SA. Teores mais elevados de COT, NT, C da fração grosseira (CFG), C associado aos minerais (CAM), FLL e FLO na camada superficial foram observados na FH. Entre os usos do solo, os espectros de FTIR foram semelhantes, contudo a FLL apresentou bandas mais intensas na região de 1.072 cm-1, sugerindo maiores quantidades de polissacarídeos em relação à FLO. As densidades de spins obtidas por EPR na FLO foram maiores em relação à FLL, indicando maior humificação desta fração.

Yield gains of coffee plants from phosphorus fertilization may not be generalized for high density planting

Inconclusive responses of the adult coffee plant to phosphorus fertilization have been reported in the literature, especially when dealing with application of this nutrient in high density planting systems. Thus, this study was carried out for the purpose of assessing the response of adult coffee plants at high planting density in full production (in regard to yield and their biennial cycle/stability) to the addition of different sources and application rates of P in the Zona da Mata region of Minas Gerais, Brazil. The experiment with coffee plants of the Catucaí Amarelo 6/30 variety was carried out over four growing seasons. Treatments were arranged in a full factorial design [(4 × 3) + 1] consisting of four P sources (monoammonium phosphate, simple superphosphate, natural reactive rock phosphate from Algeria (Djebel-Onk), and FH 550®), three P rates (100, 200, and 400 kg ha-1 year-1 of P2O5), and an additional treatment without application of the nutrient (0 kg ha-¹ year-¹). A randomized block experimental design was used with three replicates. The four seasons were evaluated as subplots in a split plot experiment. The P contents in soil and leaves increased with increased rates of P application. However, there was no effect from P application on the yield and its biennial cycle/stability regardless of the source used over the four seasons assessed.

Determinação de heparina fracionada em preparações farmacêuticas utilizando turbidimetria

A turbidimetric method has been used for quantification of fractionated heparin (FH) in pharmaceutical dosage. The UV detection at two wavelengths (290 and 500 nm) showed a significant increase in sensitivity of the method, specificity, and linearity to range 5.0-50.0 µg mL-1 and 50.0-200.0 µg mL-1, respectively (r < 0.99). At both wavelengths, the method was precise (inter-assay CV < 5.0%, and intra-assay CV < 3.0%), accurate (maximum deviation of ± 12%), and robust to the parameters evaluated. Turbidimetry proved to be easy, inexpensive and relatively fast. The results obtained attest to the reliability of the method.