Risco da radiação ionizante em mulheres férteis submetidas à ablação por radiofrequência

FUNDAMENTO: A Comissão Internacional de Radiologia indica rastreamento com teste de gravidez a todas pacientes do gênero feminino em período fértil que serão submetidas a exame radiológico. Sabe-se que a radiação é teratogênica e que seu efeito é cumulativo. O potencial teratogênico inicia-se com doses próximas às das utilizadas durante esses procedimentos. Não se sabe a prevalência de teste de gravidez positivo em pacientes submetidos a estudo eletrofisiológico e/ou à ablação por cateter em nosso meio. OBJETIVO: Avaliar a prevalência de teste de gravidez positivo em pacientes do gênero feminino encaminhadas para estudo eletrofisiológico e/ou ablação por radiofrequência. MÉTODOS: Estudo transversal com análise de 2.966 pacientes submetidos a estudo eletrofisiológico e/ou ablação por cateter, de junho 1997 a fevereiro 2013, no Instituto de Cardiologia do Rio Grande do Sul. Foram realizados 1.490 exames em mulheres sendo que, destas, 769 encontravam-se em idade fértil. Todas as pacientes foram rastreadas com teste de gravidez no dia anterior ao procedimento. RESULTADOS: Detectou-se positividade do teste em três pacientes, impossibilitando a realização do exame. Observou-se prevalência de 3,9 casos por 1.000 mulheres em idade fértil. CONCLUSÃO: Devido ao baixo custo e à segurança, indica-se a realização de teste de rastreamento para gravidez a todas pacientes em idade fértil, uma vez que o grau de radiação ionizante necessária nesse procedimento é muito próximo ao limiar de teratogenicidade, principalmente no primeiro trimestre, quando os sinais de gestação não são exuberantes.

Electrophysiological Studies and Radiofrequency Ablations in Children and Adolescents with Arrhythmia

Background:Radiofrequency ablation is the standard non-pharmacological treatment for arrhythmias in pediatric patients. However, arrhythmias and their associated causes have particular features in this population.Objective:To analyze the epidemiological characteristics and findings of electrophysiological diagnostic studies and radiofrequency ablations in pediatric patients referred to the Electrophysiology Unit at Instituto de Cardiologia do Rio Grande do Sul, in order to characterize the particularities of this population.Methods:Cross-sectional study with 330 electrophysiological procedures performed in patients aged less than 20 years between June 1997 and August 2013.Results:In total, 330 procedures (9.6% of the overall procedures) were performed in patients aged less than 20 years (14.33 ± 3.25 years, age range 3 months to 19 years), 201 of which were males (60.9%). A total of 108 (32.7%) electrophysiological diagnostic studies were performed and of these, 48.1% showed abnormal findings. Overall, 219 radiofrequency ablations were performed (66.3%) with a success rate of 84.8%. The presence of an accessory pathway was the most prevalent finding, occurring in 158 cases (72.1%), followed by atrioventricular nodal reentrant tachycardia (16.8%), typical atrial flutter (3.1%) and extrasystoles originating from the right ventricular outflow tract (2.7%). Three patients developed complications during ablation (1.4%). Among congenital heart diseases, which occurred in 51 (15.4%) patients, atrial sept defect was the most frequent (27.4%), followed by ventricular sept defect (25.4%) and Ebstein's anomaly (17.6%).Conclusion:Electrophysiological study and radiofrequency ablation are effective tools for diagnosis and treatment of arrhythmias in the pediatric population.

Clinical Differences between Subtypes of Atrial Fibrillation and Flutter: Cross-Sectional Registry of 407 Patients

Introduction:Atrial fibrillation and atrial flutter account for one third of hospitalizations due to arrhythmias, determining great social and economic impacts. In Brazil, data on hospital care of these patients is scarce.Objective:To investigate the arrhythmia subtype of atrial fibrillation and flutter patients in the emergency setting and compare the clinical profile, thromboembolic risk and anticoagulants use.Methods:Cross-sectional retrospective study, with data collection from medical records of every patient treated for atrial fibrillation and flutter in the emergency department of Instituto de Cardiologia do Rio Grande do Sul during the first trimester of 2012.Results:We included 407 patients (356 had atrial fibrillation and 51 had flutter). Patients with paroxysmal atrial fibrillation were in average 5 years younger than those with persistent atrial fibrillation. Compared to paroxysmal atrial fibrillation patients, those with persistent atrial fibrillation and flutter had larger atrial diameter (48.6 ± 7.2 vs. 47.2 ± 6.2 vs. 42.3 ± 6.4; p < 0.01) and lower left ventricular ejection fraction (66.8 ± 11 vs. 53.9 ± 17 vs. 57.4 ± 16; p < 0.01). The prevalence of stroke and heart failure was higher in persistent atrial fibrillation and flutter patients. Those with paroxysmal atrial fibrillation and flutter had higher prevalence of CHADS2 score of zero when compared to those with persistent atrial fibrillation (27.8% vs. 18% vs. 4.9%; p < 0.01). The prevalence of anticoagulation in patients with CHA2DS2-Vasc ≤ 2 was 40%.Conclusions:The population in our registry was similar in its comorbidities and demographic profile to those of North American and European registries. Despite the high thromboembolic risk, the use of anticoagulants was low, revealing difficulties for incorporating guideline recommendations. Public health strategies should be adopted in order to improve these rates.

New species of Cyclodontina from Bahia, Brazil (Gastropoda, Pulmonata, Odontostomidae)

A new species of pulmonate snail was recently collected in a small forest fragment in the city of Bom Jesus da Lapa, Bahia state, Brazil. Bahia is known for a high diversity of land snails and Bom Jesus da Lapa is an interesting locality, since it is close to the interface between two major Brazilian biomes: Cerrado and Caatinga. The new species is described as Cyclodontina tapuia sp. nov. and can be easily identified by its brown shell, conical spire, convex whorls, a sculpture comprised of strong ribs, and an aperture with four barriers: a median parietal tooth, a median palatal tooth, a median basal tooth and a strong columellar lamella. This discovery is also a reminder of how little the Brazilian continental molluscan fauna is known and of the urgency in studying and preserving the rich (though usually overlooked) fauna of the Caatinga.

Morbidade da doença de Chagas. II. Estudos seccionais em quatro áreas de campo no Brasil

Foi realizado um estudo seccional de campo do tipo "caso controle" sobre a morbilidade da doença de Chagas em quatro áreas endêmicas no Brasil, duas no Estado de Minas Gerais, uma no Estado do Piauí e outra no Estado da Paraíba, incluindo 716 pares de indivíduos da mesma idade e sexo, cada par constando de um indivíduo com sorologia positiva e outro com sorologia negativa para a infecção chagásica. Com esse tipo de estudo procurou-se determinar o componente exclusivamente chagásico na morbidade da doença em diferentes áreas do país. O gradiente de manifestações clínicas e alterações eletrocardiográficas entre o grupo com sorologia positiva e outro com sorologia negativa, estudado em 264 pares na área de Iguatama-Paris e 274 em Virgem da Lapa, ambas em Minas Gerais, e em 109 pares estudados nas localidades de Colônia e Oitis, em Oeiras, Piauí e em 69 nos municípios de Aguiar e Boqueirão dos Cochos na Paraíba, mostra nitidas diferenças regionais na morbilidade da doença. Nas áreas de Minas Gerais, embora a transmissão natural da infecção estivesse interrompida há 15 e 5 anos, respectivamente, o grau de morbilidade cardiológica pelo componente chagásico, considerando apenas as alterações eletrocardiográficas mais expressivas e específicas, no momento do estudo, foi de aproximadamente 30%, enquanto em Oeiras, no Piauí e em Aguiar e Boqueirão dos Cochos, na Paraíba, mesmo com transmissão ativa da infecção, a morbidade cardiológica pelo componente chagásico foi inferior a 15 e 10%, respectivamente

Inhibition of gastric secretion by a water extract from Baccharis triptera, Mart

Baccharus triptera Mart, is a widespread Compositae used in Brazilian folk medicine to treat gastrointestinal disturbances, rheumatic disease, mild fever, diabetes and as an anti-helminthic. Water extract of small branches of the plant (WE) administered to mice and rats (0.1 to 2 g/Kg, p.o) did not alter spontaneous motor activity, sleeping time induced by barbiturates or the tailflick response in mice. The extract decreased by 40 por cento the number of writhings induced by 0.8 por cento scetic acid, i.p., but did not influence paw edema induced by carrageenan or dextran in rats WE (2g/Kg, p.o.) decreased the intestinal transit of charcoal in mice by 20//. Gastric secretion in pylorus ligated rats was reduced after treatment with WE (1 and 2 g/Kg. i.p. or intraduodenal and the gastric pH was raised. The extract (1 g/Kg, p.o.) prevented gastric ulcers induced in rats by immobilization at 4ºC, but not those induced by indomethacin (10 mg/Kg, s.c.). The results indicate that WE may relieve gastrointestinal disorders by reducing acid secretion and gastrointestinal hiperactivity. Neither analgesic nor anti-inflammatory activities were detectable.

The water extract of Coleus barbatus Benth decreases gastric secretion in rats

Coleus barbatus (Labiatae) Benth is popularly used in Brazil "for the healing of liver and stomach diseases". The water extract (WE 1 to 10 g/Kg, p.o.) of stem and leaves given to rats and mice did not induce signs of intoxication. Preveious treatment of mice with WE (1 g/kg, p.o.) shortened the sleeping time induced by pentobarbital (50 mg/Kg, i.p.) by 37 por cento, althoyugh the extract alone did not increase the spontaneous activity nor did it induce hyperexcitability. In mice WE (2 g/Kg, p.o.) increased the intestinal transit of charcoal by 30 por cento, while reduced gastric secretions ion rats treated with WE (2g/Kg intraduodenal) 3,9 ± 1.0 to 0.5 ± 0.2 ml/4h, respectively). The treatment also reduced the total acid secretion from 34.4 ± 11.0 to 2.7 ± 0.5 mEq/l and raisedgastric pH from 2.2 ± 0.3 to 6.5 ± 0.8. Treatment with WE (2g/Kg, p.o.) protected against gastric ulcers induced by stress (5.3 ± 1.6 and 1.5 ± 0.5 ulcers/cm²), but did nor protect against indonethacin induced ulcers. The results show that the water extract of C barbatus Benth produces mild stimulation of thecentral nervous system and increases intestinal movements. The extract also reduces gastric secretion indicating an antidyspeptic activity, and protects against gastric ulcers induced by stress.

Pharmacological screening of Ageratum conyzoides L. (mentrasto)

The pharmacological activities of a water extract (WE) of Ageratum conyzoides L, a plant populary known for its analgesic and anti-inflamatory properties, were studied in vivo and in vitro preparations. Oral administration (p.o.) of the water extract (WE, 0.1 to 5 g/Kg) to rats and mice induced quietness and reduced the spontaneous motility. the sleeping time induced by sodium pentobarbital (50 mg/Kg, i.p.) in mice was not altered by previous treatment with We (2 g/Kg, p.o.). The same treatment did not influence the paw edema induced by carrageenan or dextran, nor did it reduce the chronic paw edema induced by complete Freund's adjuvant or formaldehyde in rats. The tail flick response in immersion test and writhings induced by 0.8%acetic acid in mice were not altered by WE either. In isolated guinea-pig ilea WE (0.4 to 4 mg/ml) did not alter the EC50 values of histamine or acetylcholine, but reduced the maximal response to the agonists by 20 to 50%. We (0.01 to 10 mg/ml) produced tonic contractions of the ileal smooth muscle proportional to the doses, reaching a maximum of 75% relatively to the maximum obtained with histamine. Those contractions were blocked by diphenhydramine (10 nM) and reduced by 32% in presence of atropine (10 nM). The results indicated that oral treatment of rodents with A. conyzoides L neither reduced the inflammatory edema nor did it decrease the reaction to pain stimuli. In vitro the extract presented an unexpected histamine-like activity characteristic of a partial agonist. The results did not confirm the popular medicinal indications of the plant.

Analgesic activity of a triterpene isolated from Scoparia dulcis L. (vassourinha)

Analgesic and anti-inflammatory activities of water (WE) and ethanolic (EE) extracts of Scoparia dulcis L. were investigated in rats and mice, and compared to the effects induced by Glutinol, a triterpene isolated by purification of EE. Oral adminsitration (p.o.) of either WE or EE (up to 2 g/Kg) did not alter the normal spontaneous activity of mice and rats. The sleeping time induced by sodium pentobarbital (50 mg/Kg, i.p.) was prolonged by 2 fold in mice pretreated with 0.5 g/Kg EE, p.o. Neither extract altered the tail flick response of mice in immersion test, but previous administration of EE (0.5 g/Kg, p.o.) reduced writhings induced by 0.8% acetic acid (0.1 ml/10 g, i.p.) in mice by 47% EE (0.5 and 1 g/Kg, p.o.) inhibited the paw edema induced by carrageenan in rats by respectively 46% and 58% after 2 h, being ineffective on the paw edema induced by dextran. No significant analgesic or anti-edema effects were detected in animals pretreated with WE (1 g/Kg, p.o.). Administration of Glutinol (30 mg/Kg, p.o.) reduced writhing induced by acetic acid in mice by 40% and the carrageenan induced paw edema in rats by 73%. The results indicate that the analgesic activity of S dulcis L. may be explained by explained by an anti-inflammatory activity probably related to the triterpene Glutinol.

Cardiac glycosides isolated from the Indian-snuff, Maquira sclerophylla Ducke

The hydroalcoholic extract of the powdered bark of the Indian-snuff Maquira sclerophylla Ducke was purified by column chromatography in silica-gel and the major cardenolide isolated from preparative TLC was identified by 1H-NMR, 1 2 C-NMR and IR analyses. The spectra showed that the active substance has strophanthidin as aglicone.

Phenotypes of lung mononuclear phagocytes in HIV seronegative tuberculosis patients: evidence for new recruitment and cell activation

Mycobacterium tuberculosis preferentially resides in mononuclear phagocytes. The mechanisms by which mononuclear phagocytes keep M. tuberculosis in check or by which the microbe evades control to cause disease remain poorly understood. As an initial effort to delineate these mechanisms, we examined by immunostaining the phenotype of mononuclear phagocytes obtained from lungs of patients with active tuberculosis. From August 1994 to March 1995, consecutive patients who had an abnormal chest X-ray, no demostrable acid-fast bacilli in sputum specimens and required a diagnostic bronchoalveolar lavage (BAL) were enrolled. Of the 39 patients enrolled, 21 had microbiologically diagnosed tuberculosis. Thirteen of the 21 tuberculosis patients were either HIV seronegative (n = 12) or had no risk factor for HIV and constituted the tuberculosis group. For comparison, M. tuberculosis negative patients who had BAL samples taken during this time (n = 9) or normal healthy volunteers (n = 3) served as control group. Compared to the control group, the tuberculosis group had significantly higher proportion of cells expressing markers of young monocytes (UCHM1) and RFD7, a marker for phagocytic cells, and increased expression of HLA-DR, a marker of cell activation. In addition, tuberculosis group had significantly higher proportion of cells expressing dendritic cell marker (RFD1) and epithelioid cell marker (RFD9). These data suggest that despite recruitment of monocytes probably from the peripheral blood and local cell activation, host defense of the resident lung cells is insufficient to control M. tuberculosis.

Epidemiological study of bancroftian filariasis in Recife, Northeastern Brazil

Wuchereria bancrofti in Pernambuco was first documented in 1952 (Azevedo & Dobbin 1952), and since then it has been reported in surveys carried out in selected areas of Recife. Several surveys were carried out from 1981 to 1991 by SUCAM. In the 1985 SUCAM's report the disease is considered under control. The CPqAM Filariasis Research Program was established in 1985 and a filarial survey was carried out in the town of Olinda, Greater Recife. In order to verify the real epidemiological situation, a study was conducted in the city of Recife. 21/36 of the Special Zones of Social Interest (ZEIS), were randomly selected for the present study. From 10,664 persons screened, 683 were positive and the prevalence rate for microfilaraemia (mf) varied from 0.6% to 14.9%. A mean mf prevalence of 6.5%, showed that the infection occurs in a wide geographic distribution in Greater Recife and that the intensity of transmission is a real and potential threat to public health in affected communities. Mf rate among males and females differed significantly. Due to the rapid increase in population, unplanned urban settlements, poor sanitary facilities and the favorable geographical conditions to the development of the vector, filariasis may actually be increasing in Recife.

Attempts to Improve Xenodiagnosis: Comparative Test of Sensibility Using Rhodnius neglectus, Panstrongylus megistus, Triatoma vitticeps and Triatoma infestans in Endemic Areas of Brazil

From June 1984 to July 1992, 392 xenodiagnostic tests were applied on 264 patients with chronic Chagas disease from Brazilian endemic areas of Virgem da Lapa and Coronel Murta, situated in the Jequitinhonha Valley, in the State of Minas Gerais. The susceptibilities of Rhodnius neglectus, Panstrongylus megistus, Triatoma vitticeps and Triatoma infestans were compared. Most of the time 20 nymphs (fourth instar) of each species were applied to 161 women and 103 men aged between 5 and 83 years of age. The tests were prepared to compare the susceptibilities of two species at a time, using the same patients for each test. Results showed a xenopositiveness of 26.28% (103 tests) being 27.98% in women (68 positive in 243 applied tests) and 23.49% in men (35 positive in 149 applied tests). The relative frequency of xenopositiveness displayed a great superiority of P. megistus and T. vitticeps. In tests from type I, for example, P. megistus was the unique responsible for 10.73% of positive xenodiagnosis vs. only 0.98% in T. infestans. Other parameters analized in this work confirm this superiority, and corroborate that T. infestans can be replaced by P. megistus and /or T. vitticeps in order to upgrade the efficacy of xenodiagnosis

Role of eosinophilic airway inflammation in models of asthma

Eosinophils play a central role in the establishment and outcome of bronchial inflammation in asthma. Animal models of allergy are useful to answer questions related to mechanisms of allergic inflammation. We have used models of sensitized and boosted guinea pigs to investigate the nature of bronchial inflammation in allergic conditions. These animals develop marked bronchial infiltration composed mainly of CD4+ T-lymphocytes and eosinophils. Further provocation with antigen leads to degranulation of eosinophils and ulceration of the bronchial mucosa. Eosinophils are the first cells to increase in numbers in the mucosa after antigen challenge and depend on the expression of alpha 4 integrin to adhere to the vascular endothelium and transmigrate to the mucosa. Blockage of alpha4 integrin expression with specific antibody prevents not only the transmigration of eosinophils but also the development of bronchial hyperresponsiveness (BHR) to agonists in sensitized and challenged animals, clearly suggesting a role for this cell type in this altered functional state. Moreover, introduction of antibody against Major Basic Protein into the airways also prevents the development of BHR in similar model. BHR can also be suppressed by the use of FK506, an immunosuppressor that reduces in almost 100% the infiltration of eosinophils into the bronchi of allergic animals. These data support the concept that eosinophil is the most important pro-inflammatory factor in bronchial inflammation associated with allergy.

Intestinal Helminthiasis and Anaemia in Youngsters from Matriz da Luz, District of São Lourenço da Mata, State of Pernambuco, Brazil

A group of youngsters (4-18 years old) in northeast Brazil was studied to establish the prevalence of anaemia and intestinal parasitism, as well as to analyze the correlation between them. Two criteria were used to determine the state of anaemia, the level of haemoglobin and the mean of corpuscular volume. The first was considered a single criterion and the second an associated criteria, used in an attempt to correlate anaemia with iron deficiency. The prevalence of intestinal parasitism was 93%, while the prevalence of anaemia was 43.1% and 16.1% according to the criteria employed (single or associated respectively). Anaemia was significantly associated with both sex and age. No significant statistical difference was observed when the association was made between each parasite and anaemia even with those more related to anaemia.