O líquido cefalorraquiano inicial nas meningencefalites por Cryptococcus neoformans

A criptococose, conhecida desde 1905, é doença grave, causada pelo Cryptococcus neoformans. Nesta entidade o estudo do líquido cefalorraquiano é muito importante visto que o sistema nervoso está envolvido em 81% dos casos5. O propósito do presente trabalho é o de evidenciar as alterações do líquido cefalorraquiano inicial nas meningencefalites criptocócicas e demonstrar a importância de exame minucioso do líquido cefalorraquiano para o diagnóstico precoce desta doença. O material é constituído por 46 observações de pacientes com diagnóstico de meningencefalite criptocócica. O quadro inflamatório crônico, caracterizado por pleocitose predominantemente linfocitária, hiperproteinorraquia e glicose diminuída foi observado em 54% das amostras de líquido cefalorraquiano. Em 69% dos casos o líquido cefalorraquiano mostrava hipertensão. A glicose estava diminuída em 61% dos pacientes e a taxa de cloretos em 16%. Eosinófilos em baixa percentagem foram observados em 48% dos casos. O criptococo foi identificado no líquido cefalorraquiano de 98% dos pacientes; é salientada a importância da pesquisa a fresco do fungo pelo método da tinta da China, sempre que uma amostra de líquido cefalorraquiano revelar pleocitose. Esta é uma conduta básica para o diagnóstico precoce da criptococose do sistema nervoso.

IMPACTOS DA HIDRELÉTRICA SAMUEL SOBRE AS COMUNIDADES DE PEIXES DO RIO JAMARI (RONDÔNIA, BRASIL)

A Usina Hidrelétrica de Samuel está localizada no rio Jamari, primeiro afluente da margem direita do rio Madeira, cerca de 56 km abaixo de Porto Velho-RO. A hidrelétrica teve sua construção iniciada em abril/1982 e entrou em operação a partir de abril/89. O estudo comparativo da ictiofauna, na área de influência daquela hidrelétrica, nas fases de pré e pós-enchimento do reservatório, mostra que as comunidades de peixes sofreram profundas alterações pelo represamento: houve redução da diversidade no reservatório, bem como o aumento de pira-nha-preta (Serrasalmuts rhombeus),tucunaré (Cichla monoculus),aracu-comum (Schizodon fasciatus)e mapará (Hypophthalmus edentatus);imediatamente à jusante da represa houve um aumento de mandi (Pimelodus blochii)\além disso, houve redução dos peixes detritívoros e frugívoros e aumento dos piscivoros.As comunidades de peixes do canal principal do Jamari parecem ter sido mais influenciadas pelo represamento do rio do que aquelas dos lagos marginais. A atividade pesqueira, antes restrita à foz do Jamari, foi intensificada na área do reservatório e isso vem constituindo-se num sério obstáculo para o manejo da pesca. Estes aspectos são comentados e algumas ações são propostas para melhor gerenciamento da pesca c sustentabilidade dos recursos pesqueiros.

National alert campaign about increased cholesterol: determination of cholesterol levels in 81,262 Brazilians

OBJECTIVE: To determine the levels of total cholesterol in a significant sample of the Brazilian population. METHODS: Blood cholesterol was determined in 81.262 individuals > 18 years old (51% male, 44.7 ± 15.7 years), using Accutrend equipment, in the cities São Paulo, Campinas, Campos do Jordão, São José dos Campos, Santos, Santo André, Ribeirão Preto, Porto Alegre, Rio de Janeiro, Belo Horizonte, Curitiba, Brasília, Salvador and documented in the presence of other risk factors (RF) for coronary artery disease (CAD) (systemic hypertension, CAD in the family, smoking, and diabetes). Participants were classified according to sex, age, and the presence or absence of RF, respectively, as 0 RF, 1 RF and > 2 RF. The percentage of individuals with cholesterol > 200 mg/dL and > 240 mg/dL was evaluated. RESULTS: The prevalence of individuals with 0, 1, and > 2 risk factors was 30% (n = 24,589), 36% (n =29,324), and 34% (n = 27,349) respectively, (P=0.657), and the mean total cholesterol of the population was 199.0 ± 35.0 mg/dL. Cholesterol levels above 200 and 240 mg/dL were found, respectively, in 40% (n = 32,515) and 13% (10.942) of individuals. The greater the number of risk factors the higher the levels of cholesterol (P<0.0001) and the greater the proportion of individuals with cholesterol > 200 mg/dL (P=0.032). No difference existed in the proportion of individuals with cholesterol > 240 mg/dL (P=0.11). CONCLUSION: A great percentage of individuals with cholesterol levels above those recommended to prevent coronary artery disease was found.

Short- and midterm follow-up results of valvuloplasty with balloon catheter for congenital aortic stenosis

OBJECTIVE: To report short and midtem follow-up results of balloon aortic valvuloplasty to treat congenital aortic stenosis. METHODS: Seventy-five patients (median age: 8 years) underwent the procedure through the retrograde femoral or carotid route. RESULTS: The procedure was completed in 74 patients (98.6%). The peak-to-peak systolic gradient dropped from 79.6±27.7 to 22.3±17.8 mmHg (P<0.001), the left ventricular systolic pressure dropped from 164±39.1 to 110±24.8 mmHg (P<0.001), and the left ventricular end diastolic pressure dropped from 13.3±5.5 to 8.5±8.3 mmHg (P< 0.01). Four patients (5.3%) died due to the procedure. Aortic regurgitation (AoR) appeared or worsened in 27/71 (38%) patients, and no immediate surgical intervention was required. A mean follow-up of 50±38 months was obtained in 37 patients. Restenosis and significant AoR were observed in 16.6% of the patients. The estimates for being restenosis-free and for having significant AoR in 90 months were 60% and 50%, respectively. CONCLUSION: Aortic valvuloplasty was considered the initial palliative method of choice in managing congenital aortic stenosis, with satisfactory short- and midterm results.

Subclinical Ventricular Dysfunction Detected by Speckle Tracking Two Years after Use of Anthracycline

Background: Heart failure is a severe complication associated with doxorubicin (DOX) use. Strain, assessed by two-dimensional speckle tracking (2D-STE), has been shown to be useful in identifying subclinical ventricular dysfunction. Objectives: a) To investigate the role of strain in the identification of subclinical ventricular dysfunction in patients who used DOX; b) to investigate determinants of strain response in these patients. Methods: Cross-sectional study with 81 participants: 40 patients who used DOX ±2 years before the study and 41 controls. All participants had left ventricular ejection fraction (LVEF) ≥55%. Total dose of DOX was 396mg (242mg/ms2). The systolic function of the LV was evaluated by LVEF (Simpson), as well as by longitudinal (εLL), circumferential (εCC), and radial (εRR) strains. Multivariate linear regression (MLR) analysis was performed using εLL (model 1) and εCC (model 2) as dependent variables. Results: Systolic and diastolic blood pressure values were higher in the control group (p < 0.05). εLL was lower in the DOX group (-12.4 ±2.6%) versus controls (-13.4 ± 1.7%; p = 0.044). The same occurred with εCC: -12.1 ± 2.7% (DOX) versus -16.7 ± 3.6% (controls; p < 0.001). The S’ wave was shorter in the DOX group (p = 0.035). On MLR, DOX was an independent predictor of reduced εCC (B = -4.429, p < 0.001). DOX (B = -1.289, p = 0.012) and age (B = -0.057, p = 0.029) were independent markers of reduced εLL. Conclusion: a) εLL, εCC and the S’ wave are reduced in patients who used DOX ±2 years prior to the study despite normal LVEF, suggesting the presence of subclinical ventricular dysfunction; b) DOX was an independent predictor of reduced εCC; c) prior use of DOX and age were independent markers of reduced εLL.

4-Second Exercise Test: Reference Values for Ages 18–81 Years

Background: Physiological reflexes modulated primarily by the vagus nerve allow the heart to decelerate and accelerate rapidly after a deep inspiration followed by rapid movement of the limbs. This is the physiological and pharmacologically validated basis for the 4-s exercise test (4sET) used to assess the vagal modulation of cardiac chronotropism. Objective: To present reference data for 4sET in healthy adults. Methods: After applying strict clinical inclusion/exclusion criteria, 1,605 healthy adults (61% men) aged between 18 and 81 years subjected to 4sET were evaluated between 1994 and 2014. Using 4sET, the cardiac vagal index (CVI) was obtained by calculating the ratio between the duration of two RR intervals in the electrocardiogram: 1) after a 4-s rapid and deep breath and immediately before pedaling and 2) at the end of a rapid and resistance-free 4-s pedaling exercise. Results: CVI varied inversely with age (r = -0.33, p < 0.01), and the intercepts and slopes of the linear regressions between CVI and age were similar for men and women (p > 0.05). Considering the heteroscedasticity and the asymmetry of the distribution of the CVI values according to age, we chose to express the reference values in percentiles for eight age groups (years): 18–30, 31–40, 41–45, 46–50, 51–55, 56–60, 61–65, and 66+, obtaining progressively lower median CVI values ranging from 1.63 to 1.24. Conclusion: The availability of CVI percentiles for different age groups should promote the clinical use of 4sET, which is a simple and safe procedure for the evaluation of vagal modulation of cardiac chronotropism.

Studies on the sandfly fauna of Samuel Ecological Station, Porto Velho Municipality, Rondônia State, Brazil

In a study of sandfly species in the Samuel Ecological Station, in Porto Velho, Rondônia State, the following species were identified: Lutzomyia brasiliensis, L. evangelistai, L. gomezi, L. anduzei, L. flaviscutellata, L. richardwardi, L. shawi, L. umbratilis, L. yuilli yuilli, L. dendrophyla, L. puctigeniculata, L. shannoni, L. amazonensis, L. ayrozai, L. carrerai carrerai, L. claustrei, L. davisi and L. lainsoni. L. richardwardi, L. umbratilis and L. c. carrerai were the predominant species captured of man forming 60.30% of the total catch. L. richarwardi was the most frequent at ground level (29.9%), while L. umbratilis predominated in the canopy (48.5%).

Forest culicinae mosquitoes in the environs of samuel hydroeletric plant, state of Rondônia, Brazil

Data on frequency and seasonal distribution of culicinae were recorded in the forest near a recently constructed hydroelectric plant - Samuel, in the State of Rondônia, Brazilian Amazon. Collections were performed almost daily from August 1990 to July 1991, between 6 and 9 p.m., using human bait. A total of 3,769 mosquitoes was collected, representing 21 species, including seven new records for the State of Rondônia. The most frequently collected species were Aedes fulvus (25%) and Ae. pennai (12.3%). The highest density for the majority of mosquito species coincided with the rainy season.

Genetic variability of the Brazilian hair sheep breeds

The objectives of this work were to investigate the genetic structure of the Brazilian hair sheep breeds and to determine the origin of the Santa Inês breed. Molecular similarity was determined using Randomly Amplified Polymorphic DNA - Polymerase Chain Reaction markers in 238 individuals from five naturalized sheep breeds: Santa Inês (48 animals), Rabo Largo (48), Somali (48), Morada Nova (48) and Bergamasca (46), collected in Goiás, Sergipe, Bahia, and Ceará States as well as in the Federal District. Fifty-four loci were selected from 19 primers, after a pilot test using 140 primers. Qualitative analyses indicate diagnostic markers for all breeds. All breeds were significantly different from each other. Interbreed differences were explained by 14.92% of the total variation. Santa Inês clustered with Bergamasca (97% bootstrap) and with Rabo Largo, composing the third member of the group (81% bootstrap) while Morada Nova and Somali breeds clustered separately. Each breed should be considered as a separate management and conservation unit, and special care should be taken with Rabo Largo, Morada Nova and Somali breeds, represented by small herds in Brazil.

Correção endovascular do aneurisma da aorta abdominal: análise dos resultados de único centro

OBJETIVO: Avaliar os resultados clínicos imediatos e em médio prazo do tratamento endovascular em pacientes portadores de aneurisma da aorta abdominal em um centro de referência para doenças cardiovasculares. MATERIAIS E MÉTODOS: Estudo retrospectivo de uma série de pacientes submetidos a tratamento endovascular de aneurisma da aorta abdominal, no período de janeiro de 2009 a julho de 2010. Foram avaliados as características demográficas, o sucesso técnico, o sucesso terapêutico, a morbimortalidade, as complicações e a taxa de reintervenções perioperatórias imediatos, e após um ano de acompanhamento. RESULTADOS: Foram analisados 102 pacientes consecutivos com idade média de 72 ± 9 anos, sendo 79% deles do sexo masculino. Houve sucesso técnico em 97,1% e êxito terapêutico em 81% dos casos. A mortalidade perioperatória foi de 0,9% e a anual, de 7,8%. Foram necessárias reintervenções em 18,8% dos pacientes durante o seguimento. CONCLUSÃO: Em nosso estudo, os resultados obtidos justificam a realização desse procedimento nos pacientes com anatomia adequada.

Evaluation of preoperative computed tomography angiography in association with conventional angiography versus computed tomography angiography only, in the endovascular treatment of aortic diseases

Objective To evaluate the association of conventional angiography (AG) with computed tomography angiography (CTA) as compared with CTA only, preoperatively, in the treatment of aortic diseases. Materials and Methods Retrospective study involving patients submitted to endovascular treatment of aortic diseases, in the period from January 2009 to July 2010, with use of preoperative CTA + conventional AG or CTA only. The patients were divided into two groups, namely: G1 – thoracic aortic diseases; and G2 – abdominal aortic diseases. G1 was subdivided into 1A (preoperative AG + CTA) and 1B (preoperative CTA). G2 was subdivided into 2C (CTA + AG) and 2D (CTA only). Results The authors evaluated 156 patients. In subgroups 1A and 1B, the rate of technical success was, respectively, 100% and 94.7% (p = 1.0); and the rate of therapeutic success was, respectively, 81% and 58% (p = 0.13). A higher number of complications were observed in subgroup 1B (p = 0.057). The accuracy in the calculation of the prosthesis was higher in subgroup 1A (p = 0.065). In their turn, the rate of technical success in subgroups 2C and 2D was, respectively, 92.3% and 98.6% (p = 0.17). The rate of therapeutic success was 73% and 98.6% (p = 0.79). Conclusion Preoperative conventional AG should be reserved for cases where CTA cannot provide all the information in the planning of a therapeutic intervention.

Estabilização química do subleito de estradas: influência do tempo decorrido entre a mistura e a compactação na resistência mecânica de misturas solo-RBI Grade 81

Este artigo aborda o estudo da influência do tempo decorrido entre mistura e compactação na resistência mecânica de três solos da Zona da Mata Norte de Minas Gerais, Brasil, quando estabilizados com 4% de RBI Grade 81, em relação ao peso de solo seco. Um solo residual maduro (solo 1) e dois solos residuais jovens (solos 2 e 3) de gnáisse foram utilizados no presente estudo. O programa de ensaios de laboratório englobou: (i) tempos decorridos entre mistura e compactação: 0, 4, 8 e 24 horas; (ii) energia de compactação: Proctor Modificado; (iii) período de cura das misturas: 7 dias; e (iv) determinação da resistência mecânica: média de três determinações da resistência à compressão não-confinada. Os resultados desta pesquisa indicam que: (i) o tempo decorrido entre mistura e compactação dos corpos-de-prova influenciou significativamente o parâmetro resistência à compressão não confinada das misturas; (ii) 4 horas foi o tempo ótimo entre mistura e compactação para as misturas dos solos 1 e 2 com RBI Grade 81; e (iii) no solo 3, foi observado um melhor resultado para a compactação imediatamente após a mistura.