Doenças intestinais em cidades brasileiras: associação com elementos climáticos

Enteric fevers and dysenteries showed, during the period 1940-44, a summer prevalence in brazilian cities of the temperate zone. The distribu¬tion of the diseases by four-months periods, selected in acordance with the highest of lowest values of rainfall, mean temperature and absolute humidity induced to suppose that, in those cities, and also in tropical ones, both enteric fevers and dysenteries were closely associated with such climatic factors: enteric fevers mainly with absolute humidity and temperature, and dysenteries with humidity and rainfall. Correlation coefficients, statistically significant, have been obtained comparing monthly waves of climatic factors and corresponding waves of prevalence of the diseases. For enteric fevers, clear associations have been disclosed: with temperature variations in all temperate cities (coefficients ranging from + 0.42 to + 0.75, higher with mean temperature in the previous month) and in two of the four tropical cities (from + 0.26 to ± 0.30); with absolute humidity variations in cities of the first group (from + 0.51 to 0.71) and in the tropical city of Rio ( + 0.26 ± 0.12 and + 0.28 ± 0.12); and also with rainfall variations but only in two temperate cities (from + 0.28 to + 0.64). For dysenteric diseases, in cities of temperate zone similar associations have been found with absolute humidity (values of r, ranging from + 0.32 to + 0.45), with temperature (from + 0.26 to + 0.44); and with rainfall only in Curitiba ( + 0.25 ± 0.12). Recife (tropical city) yielded two significant values : r = — 0.27 ± 0.12 (correlation with mean temperature in the same month) and r = + 0.40 ± 0.11 and -h 0.37 ± 0.11 (between monthly morbidity rates and rainfall, respectively in the same month and in the previous one). Deaths by diarrhea and enteritis, in the cities of the temperate zone, prevailed in spring-summer seasons, also in four-months periods of highest temperature and humidity, for those cities and for the tropical ones, with the exception of Belem in which percentages were identical to those of opposite periods. Still with the exception of Belem, in all cities studied positive correla¬tion coefficients, statistically significant, have been obtained with temperature variations (ranging from + 0.25 to + 0.65 in tropical cities, and from + 0.47 to + 0.76 in temperate zone) and with humidity variations (from + 0.34 to + 0.44 in the first group, and from + 0.43 and + 0.74 in the second) . With rainfall, only Rio (in the tropical region) showed a significant value for r ( + 0.26 ±0:12); similarly in S. Paulo and Curitiba, the values ranged from + 0.46 to + 0.56, while in Porto Alegre there were found — 0.26 ± 0.12 and — 0.32 ± 012, for rainfall variations in the same and previous months.

Alterações dos folículos pilo-sebáceos em um caso de sindromo bolhoso do grupo pênfigo: presença de inclusões intranucleares das doenças por virus filtraveis

Tendo a oportunidade de estudar fragmentos de pele retirados de diversas regiões, algumas providas de abundante revestimento capilar, em um caso de autopsia de doente com sindromo bolhoso do grupo pênfigo, chamaram a nossa atenção as alterações histologicas dos folículos pilo-sebaceso, sôbre as quais não encontramos referencia especial na literatura que nos foi dado consultar.

Temperatura, humidade e pluviosidade nas suas relações com doenças respiratórias, em cidades brasileiras

During the period 1940-44, deaths by respiratory diseases and particularly by influenza and pneumonias prevailed during the winter in brazilian cities of the temperate zone (S. Paulo, Curitiba, Porto Alegre) and, with the exception of Rio de Janeiro, in tropical ones (Belem, Recife, Salvador) particularly during the four-months period of highest absolute humidity. For the first group of cities, negative correlation coefficients, statistically significant, have been uniformly obtained comparing monthly death-rates both with temperature - in the same month and in the previous one (values of r ranging from - 0.36 to - 0.640 - and with similar humidity variations (values of r from - 0.33 to - 0.59); also with rainfall, but only in S. Paulo and Curitiba (values of r from - 0.33 to - 0.61). Such associations have been disclosed irregularly and less frequently for the group of tropical cities: statistically significant values of r, in the death-rates correlations with temperature and humidity variations, have been eventually either positive (Recife, Salvador) or negative (Belem, Rio). Whooping cough showed during the same period a winter incidence in Curitiba and Porto Alegre: the compulsory notification of the disease is not required in S. Paulo, a third one brazilian city of the temperate zone. In the brazilian tropical cities of Belem, Recife, Salvador and Rio, the whooping cough distribution by four-months periods - selected in accordance with the highest or lowest values of rainfall, mean temperature and absolute humidity - induced to suppose that the disease was associated more uniformly with a high rainfall than with a low temperature or a low absolute humidity. However, only a few correlation coefficients statistically significant have been found out: between monthly morbidity rates and mean humidity in the same month and in the previous one in recife (-0.43 and - 0.39), and in Porto Alegre (-0.35 and - 0.46); and between the same rates and temperature variations in this last city (-0.28 and - 0.43).

Dados estatísticos de viscerotomia sobre doenças e condições mórbidas do homem no Brasil: I. Schistosomose Mansônica no período de 1937-1946

Examination of 267.107 liver specimens obtained in Brazil by viscerotomy during from 1937 to 1946 inclusive revealed 5,953 Schistosoma mansoni infe¬ctions. This represents 2.23% ± 0.019 of the total number of livers studied. Data on the incidence of the disease is tabulated by states and municipios. Infected livers were found in all of the states and territories except the Territory of Amapá. Schistosomiasis is widespread in Brazil with highest incidence in the states of the Northeast. The disease is quite common in Espírito Santo and Minas Gerais as well. A study of the age distribution of cases of intestinal schistosomiasis observed among liver specimens obtained in the year 1938 showed a low inci¬dence on young children with a peak of prevalence in the 10 to 19 year age group. The purpose of this contribution is to call attention of the health autho¬rities to the extent and gravity of the problem of intestinal schistosomiasis in Brazil.

Subsídio para o conhecimento e diagnóstico das doenças do grupo tifo exantemático no Brasil

Os autores estudaram comparativamente o valor da reação de Weil-Felix e de Fixação do Complemento nas doenças do grupo Tifo exantemático. Concluém que ambas têm qualidades e defeitos. Na doença precoce, ambos falharam. No período de estado da doença, os resultados são não raro, decisivos com as duas provas sorológicas. Dos ciqüenta (50) dias em diante, da doença natural, a reação de fixação do complemento é mais precisa, ao apurar os casos antigos de indivíduos afastados de constantes e repetidas injeções de virus, pelos hematofagos portadores. Naqueles pacientes que permanecem nos fócos conhecidos da doença, sujeitos a inoculações constantes de virus, o Weil-Felix é também de grande valor diagnóstico. Mostraram os autores que o carneiro (Ovisa aries) é pouco sensível á raça V. B do Brasil e que o tatu (Tatus novencintus) não é sensível á mesma raça. Repetindo dados já antigo, apurados em Belo Horizonte, os autores verificaram que a raça V. B. do virus brasileiro atravessa a placenta e infecta o organismo dos fetos.

Contribuição para o conhecimento das doenças do grupo tifo exantemático do Brasil

In this work the author publishes an observation of a human case, which he believes to be the second in South America, of "Q" fever in Minas Gerais. The first positive data and the first observation were made in S. Paulo by Dr. Helvecio Brandão and there communicated to the S. Paulo Medical Association in 1951 and 1954. The first part was published in 1953; the second part is yet unpublished. The author of the present work cured his patient with Terramycine. He thinks that greater research should be made amongst the workpeople who have to do with cattle in the pastures and slaughterhouses in order to verify the extent of the disease amongst us. Belo Horizonte Dezembro de 1954

Contribuição para o conhecimento das doenças do grupo tifo exantemático no Brasil

In this work, the author considers that in Brazil, there exist three forms of the disease of the Exanthematic Typhus group, that have been well studied: Neotropic Exanthematic Typhus, Murine Typhus and "Q" fever. The first of these forms has existed in this country, perhaps, for over five hundred years. He says that modern antibiotic, Aureomycin, Chloromycetin and, principally, Terramcin have resolved the problem of the therapeutic treatment of the disease. The modern insecticides, D. D. T., Gammexane and Toxafeno have resolved the prophylactic problem. The author studies minutely the question of denomination, showing, by means of drawing and history, the origin of the diseases, both Norte American and Brazilian. The name Neotropic Exanthematic Typhus (in BRazil, Colombia, United States or India) should substitute the erroneous anme "Spotted Fever"; the disease is exanthematic, a very different thing. He formulates two hypotheses about these diseases: first - it passed from the neotropic to the neartic region, where it acquired individual properties; second - they developed independently in a more rmeote epoch, acquiring each its own characteristics. The disease is today rather of the neotropic than of the neartic region. As it also exists in India it cannot be named American exanthematic Typhus. The author finds it unnecessary to change the name to "Rikettsioses"; we do not call bacillar dysentery "Schigeloses"or malignant edema "Chlostridiose". The name exanthematic typhus is classic, precise, scientific, expressive and the denomination "neotropical" completes the localisation. The author thinks that all the diseases of the exanthematic typhus group, in the world had a simple primitive common origin. At first, the rickettsias or the virus had a free life, perhaps in the waters of the marshes or grass-lands. Later, in the struggle for life, came the parasitism of the plants. They became fitoparatifs. The mode of life...

Contribuição para o conhecimento das doenças do grupo "Tifo Exantemático" do Brasil: (Tifo Exantemático Neotrópico)

O A. recapitula os dados já conhecidos sôbre a filtrabilidade de muitas Rickettsias e sôbre o que êle chama o ciclo evolutivo das mesmas, citando os trabalhos de S. B. Dulky e E. Gordon sôbre a Coxiella papilliae e a observação de A. Donatien e F. Lestoquard bem como os de P. Giraud. Refere-se à filtrabilidade do agente da febre "Q". Reporta-se depois aos trabalhos de Mme. Ruth Rein Gutfreund sôbre os achados de Rickettsia prowazedi em animais domésticos na Etiópia e a transmissão dos mesmos pelos carrapatos, dizendo que isto confirma suas próprias idéias, de há muito emitidas, de que não há no grupo tifo exantemático, de regra, especificidade estrita para os transmissores, não podendo êste carácter servir de base para classificações racionais. Descreve um caso clínico, mostrando a dificuldade de diagnóstico cofundido com a febre tifóide, mesmo com longa prática do exame na doença e que só a inoculação em animais sensíveis - aqui os cobaios - pode decidir a questão. Estuda depois dois surtos epidêmicos de tifo exantemático neotrópico - em 1950 em Carmópolis (Minas Gerais); outro em 1956, Mucuri (Bahia). Em ambos, a percentagem de mortes dos casos graves, não tratados, foi elevada e a terapêutica pelos antibióticos, principalmente a Cloromicetina e Terramicina foi brilhante. Nestes dois surtos epidêmicos com já se vira em 1941 (4 casos na mesma residência) e 1948 (6 casos na mesma moradia), apuraram-se 2 e 3 casos da doença na mesma casa. As reações de Fixação de Complemento (R.F.C.), Weil-Feliz (W.F.) e Widal - confirmam o diagnóstico de tifo exantemático neotrópico.

Patobiologia da desnutrição nas doenças parasitárias

A aplicação da teoria dos sistemas gerais ao estudo das doenças parasitárias tem permitido uma melhor compreensão das relações hospedeiro-parasito e das diferentes variações da morbidade e da biologia das doenças parasitárias. O meio ambiente, considerado como ecossistema do indivíduo, é capaz de atuar sobre ele, por um duplo mecanismo: através da agressão direta do parasito e como elemento condicionante da deficiência alimentar. Os resultados do impacto do processo infeccioso (parasitário) sobre o estado nutricional do hospedeiro, compreendem efeitos catabólicos generalizados. Síndromes secundárias de má-absorção e alterações hematológicas do tipo das anemias, também podem ocorrer, por mecanismos diversos. Os efeitos da desnutrição sobre a biologia dos parasitos são ainda melhor conhecidos, tendo-se, na presente revisão, tomado a Esquistossomose como exemplo, devido á sua importância médico-sanitário, no quadro da nosologia nacional. A patobiologia da desnutrição na esquistossomose mansônica foi estudada em camundongos, utilizando dietas semipurificadas e dietas "naturais" (isto é, semelhantes ás do homem nas áreas rurais da Zona da mata do Nordeste do Brasil, onde existem importantes focos endêmicos da parasitose). Por fim, é feita uma apreciação da resposta imunológica na patobiologia das relações nutrição x infecção, enfatizando-se, sobretudo, o papel negativo das deficiências de proteína e de ferro sobre a imunidade celular.

Development and preclinical assessment of a bioartificial pancreas.

Transplantation of insulin secreting cells is regarded as a possible treatment for type 1 diabetes. One major difficulty in this approach is, however, that the transplanted cells are exposed to the patient's inflammatory and autoimmune environment, which originally destroyed their own beta-cells. Therefore, even if a good source of insulin-secreting cells can be identified for transplantation therapy, these cells need to be protected against these destructive influences. The aim of this project was to evaluate, using a clonal mouse beta-cell line, whether genetic engineering of protective genes could be a viable option to allow these cells to survive when transplanted into autoimmune diabetic mice. We demonstrated that transfer of the Bcl-2 anti-apoptotic gene and of several genes specifically interfering with cytokines intracellular signalling pathways, greatly improved resistance of the cells to inflammatory stresses in vitro. We further showed that these modifications did not interfere with the capacity of these cells to correct hyperglycaemia for several months in syngeneic or allogeneic streptozocin-diabetic mice. However, these cells were not protected against autoimmune destruction when transplanted into type 1 diabetic NOD mice. This suggests that in addition to inflammatory attacks by cytokines, autoimmunity very efficiently kills the transplanted cells, indicating that multiple protective mechanisms are required for efficient transplantation of insulin-secreting cells to treat type 1 diabetes.

Agenesis of human pancreas due to decreased half-life of insulin promoter factor 1.

Neonatal diabetes mellitus can be transient or permanent. The severe form of permanent neonatal diabetes mellitus can be associated with pancreas agenesis. Normal pancreas development is controlled by a cascade of transcription factors, where insulin promoter factor 1 (IPF1) plays a crucial role. Here, we describe two novel mutations in the IPF1 gene leading to pancreas agenesis. Direct sequence analysis of exons 1 and 2 of the IPF1 gene revealed two point mutations within the homeobox in exon 2. Genetic analysis of the parents showed that each mutation was inherited from one parent. Mutations localized in helices 1 and 2, respectively, of the homeodomain, decreased the protein half-life significantly, leading to intracellular IPF1 levels of 36% and 27% of wild-type levels. Both mutant forms of IPF1 were normally translocated to the nucleus, and their DNA binding activity on different known target promoters was similar to that of the wild-type protein. However, transcriptional activity of both mutant IPF1 proteins, alone or in combination with HNF3 beta/Foxa2, Pbx1, or the heterodimer E47-beta 2 was reduced, findings accounted for by decreased IPF1 steady state levels and not by impaired protein-protein interactions. We conclude that the IPF1 level is critical for human pancreas formation.

Characterization of myelomonocytoid progenitor cells with mesenchymal differentiation potential obtained by outgrowth from pancreas explants.

Progenitor cells can be obtained by outgrowth from tissue explants during primary ex vivo tissue culture. We have isolated and characterized cells outgrown from neonatal mouse pancreatic explants. A relatively uniform population of cells showing a distinctive morphology emerged over time in culture. This population expressed monocyte/macrophage and hematopoietic markers (CD11b(+) and CD45(+)), and some stromal-related markers (CD44(+) and CD29(+)), but not mesenchymal stem cell (MSC)-defining markers (CD90(-) and CD105(-)) nor endothelial (CD31(-)) or stem cell-associated markers (CD133(-) and stem cell antigen-1; Sca-1(-)). Cells could be maintained in culture as a plastic-adherent monolayer in culture medium (MesenCult MSC) for more than 1 year. Cells spontaneously formed sphere clusters "pancreatospheres" which, however, were nonclonal. When cultured in appropriate media, cells differentiated into multiple mesenchymal lineages (fat, cartilage, and bone). Positive dithizone staining suggested that a subset of cells differentiated into insulin-producing cells. However, further studies are needed to characterize the endocrine potential of these cells. These findings indicate that a myelomonocytoid population from pancreatic explant outgrowths has mesenchymal differentiation potential. These results are in line with recent data onmonocyte-derivedmesenchymal progenitors (MOMPs).

Duodenal duplication cyst and pancreas divisum causing acute pancreatitis in an adult male acute pancreatitis in an adult male

Duodenal duplication cysts are rare congenital abnormalities which are more commonly diagnosed in infancy and childhood. However, in rare cases, these lesions can remain asymptomatic until adulthood. The combination of duplication cyst and pancreas divisum is extremely rare and both conditions have been linked with acute recurrent pancreatitis. We present the case of a 37 years-old patient who presented with repeated episodes of acute pancreatitis. By means of magnetic resonance imaging and endoscopic ultrasonography we discovered a duplication cyst whose cavity received drainage from the dorsal pancreas. After opening the cyst cavity to the duodenal lumen with a needle knife the patient presented no further episodes in the clinical follow-up. Comparable literature findings and therapeutic options for these abnormalities are discussed with regard to the presented case.