A study of infectious endocarditis in Ribeir��o Preto, SP - Brazil. Analysis of cases occurring between 1992 and 1997

OBJECTIVE: To analyze the epidemiology, diagnosis, clinical aspects causes and evolution of infectious endocarditis. METHODS: The patients analyzed were treated at the University Hospital of the Faculdade de Medicina of Ribeir��o Preto-USP and had a diagnosis of infectious endocarditis defined by Duke's criteria, which classifies infectious endocarditis as native, prosthetic valve or that occurring in intravenous drug users. RESULTS: One hundred and eighty episodes of infectious endocarditis in 168 patients were observed. Echocardiograms in 132 (73.3%) provided a diagnosis of infectious endocarditis in 111 (84%) patients; mitral valves were affected in 55 (30.5%), tricuspid valves in 30 (16.6%) and the aortic valve in 28 (15.5%) patients. Hemocultures were performed in 148 (93.8%) episodes of IE. The most commonly isolated infectious organisms were Staphylococcus aureus in 46 (27.2%) patients and Streptococcus viridans in 27 (15.9%). Complications occurred in 116 (64.4%) patients and 73 (40.5%) of the patients died. CONCLUSION: The general profile of the observed infectious endocarditis was similar to that reported in studies performed in other countries and included users of intravenous drugs. The high degree of mortality observed is not compatible with progress in diagnosis and treatment of infectious endocarditis and is probably due to the absence of diagnostic suspicion. The high frequency of fatal cases of septicemia (45.1% of deaths) in the patients studied indicates that unnoticed cases of infectious endocarditis had only been diagnosed at necropsy.

Peripheral arterial embolism. Report of hospitalized cases

OBJECTIVE: We analyzed the frequency of peripheral embolisms, the underlying heart disease,triggering factors, the sites of the emboli, and evolution of the patients. METHODS: We analyzed 29 cases of peripheral arterial embolism out of a total of 20,211 hospitalizations in a cardiology center in the city of S��o Paulo. The age was 51.89��18.66 years, and 15 were males. RESULTS: Embolism in the right lower limb occurred in 18 patients (62.0%),in the left lower 11(37.9%) and right upper 3 (10.3%) limbs, and in the left arm (1). Four patients had embolism in two limbs. The heart disease, mitral valvar heart disease (9 patients - 31.0%); infective endocarditis (7- 24.1%); dilated cardiomyopathy (6 - 20.6%); ischemic coronary heart disease (6 patients - 20.6%); and one patient with cor pulmonale. Atrial fibrillation was observed in 20 patients (68.9%), chronic in 12 patients (41.3% ) and acute in 8 (27.5%). All patients with mitral valvar heart disease had atrial fibrillation, chronic in 8 patients (88.8%); patients with cardiomyopathy and coronary heart disease, 4 in each group had atrial fibrillation, acute in 60% of the patients.Patients with infective endocarditis, 3 had staphylococcus and 2 Gram-negative bacteria. In the follow-up, 2 patients (6.8%) required limbs amputation, and 5 (17.2%) died due to embolism. CONCLUSION: Most of the time, embolism does not cause permanent complications. Our data highlight the importance of anticoagulation for patients acute atrial fibrillation in myocardial dysfunction and for patients with chronic atrial fibrillation in cases of mitral valvar heart disease to prevent peripheral embolism.

Cardiac tamponade in systemic lupus erythematosus. Report of four cases

OBJECTIVE: To report and assess the incidence of cardiac tamponade in systemic lupus erythematosus as a cardiac manifestation of the disease. METHODS: We reviewed the medical records of 325 patients diagnosed with systemic lupus erythematosus according to the American Rheumatism Association and their complementary laboratory tests compatible with cardiac tamponade. RESULTS: In the 325 medical recors reviewed, we found 108 patients with pericardial effusions corresponding to 33.2% of the total and 54% of the patients studied in the active phase of the disease. Clinical assessment and transthoracic echocardiogram allowed the clinical diagnosis of cardiac tamponade in only 4 (1.23%) patients, 3 of whom were females, white, with ages ranging from 25 to 44 years. The pericardial fluid was hemorrhagic or serosanguineous with high levels of FAN and positivity for LE cells. In the treatment, we successfully used pericardicentesis associated with high doses of corticosteroids. In clinical and laboratory follow-up performed for a period of 3 years, neither recrudescence of the pericardial effusion nor evolution to constriction occurred. CONCLUSION: Even though rare (1.23%), cardiac tamponade in patients with systemic lupus erythematosus has a benign evolution when properly treated, according to our experience.

Primary neoplasms of the heart. Clinical and histological presentation of 50 cases

OBJECTIVE: To analyze clinical and histologic findings of 50 patients with primary neoplams of the heart in a tertiary referral center. METHODS: From 1980 to 1998, we retrospectively analyzed 50 patients, 32 of whom were females, whose ages ranged from 9 to 73 years (mean age = 44.16��18 years). RESULTS: Most tumors were located in the left side of the heart (72%), myxoma being the most common (84%) histologic type. The other histologic types found were as follows: fibroma (4%), lipoma (2%), rhabdomyosarcoma (2%), hemangioma (2%), sarcoma (2%), angiosarcoma (2%), and lymphoma (2%). Diagnosis was established by echocardiography in 94% of the cases. Clinical findings were as follows: dyspnea (36%), weight loss (20%), palpitations (18%), chest pain (16%), fever (8%), and arthralgia (6%). All patients with thromboembolic phenomena (10%) had left atrial myxoma. Approximately 20% of the patients were asymptomatic at the initial clinical assessment. CONCLUSION: Primary cardiac tumors are a rare entity with diverse clinical and histologic findings, requiring, therefore, a high level of clinical suspicion.

Submitral left ventricular aneurysm. Case report and review of published Brazilian cases

Submitral left ventricular aneurysm is a cardiac pathology widely recognized, but relatively unknown, occurred almost exclusively in African black patients. Although still this idea of racial prevalence exists, cases have been described in patients of all the races. Ten Brazilian cases were reported. One of them was presented inside an Italian paper that refers the surgical treatment of a Brazilian patient of black race. We reported one more submitral left ventricular aneurysm case in a brown female patient, with antecedents of peripheral thromboembolism initially not identified as consequence of the cardiac pathology.

Effectiveness of primary angioplasty in the treatment of acute myocardial infarction. Analysis of in-hospital and late outcomes in 135 consecutive cases

OBJECTIVE: Evaluate early and late evolution of patients submitted to primary coronary angioplasty for acute myocardial infarction. METHODS: A prospective study of 135 patients with acute myocardial infarction submitted to primary transcutaneous coronary angioplasty (PTCA). Success was defined as TIMI 3 flow and residual lesion <50%. We performed statistical analyses by univariated, multivariated methods and survival analyze by Kaplan-Meier. RESULTS: PTCA success rate was 78% and early mortality 18,5%. Killip classes III and IV was associated to higher mortality, odds ratio 22.9 (95% CI: 5,7 to 91,8) and inversely related to age <75 years (OR = 0,93; 95% CI: 0.88 to 0.98). If we had chosen success flow as TIMI 2 and had excluded patients in Killip III/IV classes, success rate would be 86% and mortality 8%. The survival probability at the end or study, follow-up time 142 �� 114 days, was 80% and event free survival 35%. Greater survival was associated to stenting (OR = 0.09; 0.01 to 0.75) and univessel disease (OR = 0.21; 0.07 to 0.61). CONCLUSION: The success rate was lower and mortality was higher than randomized trials, however similar to that of non randomized studies. This demonstrated the efficacy of primary PTCA in our local conditions.

Epidemiological study of congenital heart defects in children and adolescents: analysis of 4,538 cases

OBJECTIVE: To analyze the frequency and prevalence of congenital heart defects in a tertiary care center for children with heart diseases. METHODS: We carried out an epidemiological assessment of the first medical visit of 4,538 children in a pediatric hospital from January 1995 to December 1997. All patients with congenital heart defects had their diagnoses confirmed at least on echocardiography. The frequency and prevalence of the anomalies were computed according to the classification of sequential analysis. Age, weight, and sex were compared between the groups of healthy individuals and those with congenital heart defects after distribution according to the age group. RESULTS: Of all the children assessed, 2,017 (44.4%) were diagnosed with congenital heart disease, 201 (4.4%) with acquired heart disease, 52 (1.2%) with arrhythmias, and 2,268 (50%) were healthy children. Congenital heart diseases predominated in neonates and infants, corresponding to 71.5% of the cases. Weight and age were significantly lower in children with congenital heart defects. Ventricular septal defect was the most frequent acyanotic anomaly, and tetralogy of Fallot was the most frequent cyanotic anomaly. CONCLUSION: Children with congenital heart defects are mainly referred during the neonatal period and infancy with impairment in gaining weight. Ventricular septal defect is the most frequent heart defect.

Study of the cardiac alterations in HIV-infected children consequent to the antiretroviral therapy: prospective study of 47 cases

OBJECTIVE: Detect of cardiac alterations in children with AIDS and compare their evolution with the administration of only one anti-retroviral and the recent cases who received drugs in combination. METHODS: We prospectively studied 47 children in 3 groups: group 1, 20 cases treated only with zidovudine; group 2, 10 patients treated initially with zidovudine and later with a combination of drugs and in group 3, 17 patients, who receiced two or three since the beginning. In all patients it was done chest X-ray, EKG and echocardiography every 6 months and after death complete pathological study. RESULTS: Among the 45 patients cases 26 (57%) were index cases. Malnutrition, diarrhea tachycardia, signs of congestive heart failure, pericardial effusion, abnormal ventricular repolarization and arrhythmias were more frequent in group 1. Echocardiographic abnormalities were present in 10 (50%) children of group 1. They were less frequent in the others two groups. In regard to the outcome in group 1, two patients had worsening of sings of cardiomyopaty and 4 died. Cardiac dysfunction in all cases of group 2 and 3 improved with the medication. CONCLUSION:- The children who received combination and their cardiac alterations had more favorable outcome than those who received only one drug.

Intrauterine ductus arteriosus constriction: analysis of a historic cohort of 20 cases

OBJECTIVE: To describe the relative incidence, presentation, and evolvement of fetuses with early ductus constriction. METHODS: Twenty fetal echocardiograms indicating ductus constriction were reviewed in a population of 7000 pregnants. RESULTS: The cases were divided into group A (related to maternal use of cyclooxygenase inhibitors [n=7] and group B (idiopathics [n=13]). Mean gestational age was 32.5��3.1 (27-38) weeks and maternal age was 28.2��8.5 (17-42) years. Mean systolic velocity in the ductus was 2.22��0.34 (1.66-2.81) m/s, diastolic velocity 0.79��0.28 (0.45-1.5) m/s, and pulsatility index 1.33��0.36 (0.52-1.83). Two cases of ductal occlusion were noted. In 65% of the cases, an increase occurred in the right cavities; in 90% of the cases, tricuspid or pulmonary regurgitation, or both, occurred, with functional pulmonary atresia in 1 case. Diastolic velocity was greater in group A (1.13��0.33) than in group B (0.68��0.15) (P=0.008). The other data were similar in the 2 groups. The evolvement was not favorable in 4 patients from group B, including 1 death and 2 cases of persistent pulmonary hypertension. CONCLUSION: The high incidence of idiopathic constriction of the ductus arteriosus suggests that its diagnosis is underestimated and that many cases of persistence of fetal circulation in newborns may be related to constriction of the ductus arteriosus not diagnosed during intrauterine life. Group B had a lower severity but a risk of an unfavorable evolvement, suggesting a distinct alteration.

Dosagem dos n��veis de NT pro-BNP nas afec����es peric��rdicas e sua utilidade como m��todo complementar de avalia����o de restri����o diast��lica. Experi��ncia inicial de 25 casos: 25 cases

OBJETIVO: Determinar se os n��veis de NT pro-BNP encontram-se elevados em pacientes com afec����es peric��rdicas e avaliar a sua rela����o com medidas ecocardiogr��ficas de disfun����o diast��lica. M��TODOS: Vinte e cinco pacientes foram divididos em dois grupos: 1) derrame peric��rdico (DP), 15 pacientes; 2) pericardite constritiva (PC), 10 pacientes. Foi constitu��do um grupo controle de 30 indiv��duos sem doen��a card��aca. O grau de derrame peric��rdico foi avaliado pelo ecocardiograma bidimensional e a restri����o avaliada pelo Doppler puls��til do fluxo mitral. O diagn��stico de PC foi confirmado por meio da resson��ncia magn��tica. Os n��veis de NT pro-BNP foram medidos por imunoensaio com detec����o por eletroquimioluminesc��ncia. RESULTADOS: Dos 15 pacientes com DP, 14 apresentavam DP importante e apenas 1, moderado. Log NT pro-BNP esteve aumentado no DP (p <0,05), com m��dia de log 2,31 pg/ml e PC (p <0,05), com m��dia de log 2,67 pg/ml, quando comparados ao grupo controle, m��dia de log 1,32 pg/ml. N��o houve diferen��a entre DP e PC (p = 0,149). O log NT pro-BNP correlacionou-se com o pico de velocidade da onda E (r = 0,845; p = 0,001) e com a rela����o E/A (r=0,717; p= 0,003). CONCLUS��O: O NT pro-BNP encontra-se aumentado nas afec����es peric��rdicas e apresenta rela����o com o grau de disfun����o diast��lica, podendo servir como m��todo adicional na quantifica����o de restri����o.

Po��ticas y pol��ticas de los cuerpos juveniles. Tres estudios en caso en C��rdoba. The poetics and politics of youths' bodies.Three cases studies.

��Qu�� formas adquieren los cuerpos de los j��venes bajo las actuales condiciones de producci��n? ��Cu��les son sus po��ticas? ��Qu�� relaciones de fuerza se realizan en estas formas? ��C��mo se inscriben en los cuerpos las relaciones de dominaci��n, el "ethos" y la cosmovisi��n de un grupo social? Estas son algunas de las cuestiones que orientan el presente proyecto, interesado en explorar y describir sistem��ticamente los procesos sociales del devenir "joven" en C��rdoba. La investigaci��n aborda algunas de las problem��ticas propias de los j��venes en tanto grupo social heterog��neo y diferenciado a partir del an��lisis de las pr��cticas de producci��n, consumo, interpretaci��n y circulaci��n de bienes culturales asociados con la diversi��n y el tiempo libre. Los tres objetos emp��ricos, localizados en la ciudad de C��rdoba, son:o las salidas nocturnas de j��venes estudiantes universitarios o la formaci��n y el entrenamiento de los bailarines cl��sicos en el Teatro del Libertador Gral. San Mart��n. o las pr��cticas de entretenimiento y socializaci��n l��dica entre los j��venes de la comunidad de sordos de C��rdoba.La hip��tesis central de la investigaci��n sostiene que la m��sica y el baile tienen la capacidad de producir las identidades que nombran. Esta producci��n de cuerpos y subjetividades se realizar��a en las performances sociales ("las salidas nocturnas" y "fiestas de la comunidad sorda") y las performances art��sticas (clases, ensayos y funciones de ballet) donde se da la interacci��n entre las identidades actuadas por los sujetos y las ofrecidas por las diferentes m��sicas, bailes y movimientos corporales. En este sentido, proponemos que las performances articulan una particular identidad cuando quienes la protagonizan experimentan que la m��sica y el baile se "ajusta" a la trama argumental que organiza sus narrativas identitarias.ObjetivosGENERAL:o Describir, de modo denso, las pr��cticas y representaciones implicadas en el proceso de materializaci��n de los cuerpos y relacionarlas con los procesos de subjetivaci��n y formaci��n de identidades juveniles. ESPEC��FICOS.o Explorar la relaci��n entre las diversas formas de consumo cultural en la formaci��n de un estilo de vida y en la formaci��n de identidades colectivas. o Describir los procesos de entrenamiento de los bailarines de m��sica cl��sica.o Analizar los procesos de comunicaci��n no verbal entre j��venes de la comunidad sorda.Materiales y m��todos.Para realizar esta investigaci��n se construir�� por medio de t��cnicas cuali y cuantitativas un corpus heterog��neo de materiales textuales, gr��ficos y audiovisuales, as�� como de entrevistas en profundidad, de experiencias etnogr��ficas de observaci��n participante y de investigaci��n cuantitativa. Dicho corpus recibir�� un tratamiento diferencial seg��n el soporte y g��nero, pero en todos los casos trabajando desde una matriz de an��lisis que considere los procesos de construcci��n de sentido y las relaciones entre cuerpo, subjetividad e identidad. En el an��lisis de los datos se pondr��n en juego herramientas conceptuales tomadas de la Antropolog��a Simb��lica, la Antropolog��a de la Danza, el An��lisis del Discurso, la Sociolog��a del Arte y los Estudios de la Performance. Resultados esperados.Se espera elaborar indicadores para medir la producci��n, circulaci��n y consumo de bienes simb��licos. El desenvolvimiento del proyecto permitir�� tambi��n la formaci��n de recursos humanos en investigaci��n y se contempla presentaciones a reuniones cient��ficas, publicaci��n en revistas nacionales e internacionales y la elaboraci��n de dos libros. Por ��ltimo se implementar��n actividades de capacitaci��n y asesoramiento para instituciones relacionados con los j��venes. Importancia del ProyectoLos resultados de la investigaci��n permitir��n una interpretaci��n m��s comprehensiva de los sentidos que poseen para j��venes cordobeses problem��ticas sociales como las adicciones, el alcoholismo, la salud sexual y reproductiva, las pr��cticas discriminatorias o los usos de las nuevas tecnolog��as.

Desarrollo tecnol��gico de germoplasma a partir de plantas nativas ornamentales: los casos de <i>Glandularia</i> y <i>Solidago</i>. Technological development of native ornamental germoplasm: the cases of <i>Solidago</i> and <i>Glandularia genera</i>.

Un importante n��mero de especies ornamentales que se cultivan en el mundo derivan de germoplasma Sudamericano. El uso de Recursos Gen��ticos nativos para el desarrollo de plantas ornamentales ha sido escasamente explotado en Argentina, por lo que el pa��s no ha tenido beneficio alguno. El sector depende de variedades desarrolladas en el exterior lo que implica el pago de regal��as inclusive para el caso de variedades derivadas de especies nativas argentinas. Las poblaciones naturales (distintas especies de <i>Glandularia</i>, distintos ecotipos de <i>Solidago</i>) presentan, una considerable variabilidad en distintos caracteres vegetativos y reproductivos que les permiten sobrevivir en ambientes con distintas condiciones clim��ticas, ed��ficas, bi��ticas, etc. Es por ello que, a partir de dicha variabilidad existente en las poblaciones naturales, ser�� posible seleccionar individuos con caracteres de alto valor ornamental. Si bien el valor ornamental de los g��neros <i>Glandularia</i> y <i>Solidago</i> es reconocido, no se han realizado avances en el conocimiento de su biolog��a floral o su potencialidad para generar variabilidad en el pa��s, aunque se conoce el ��xito econ��mico de las variedades comerciales desarrolladas en el exterior. Los objetivos del presente proyecto ser��n lograr avances en la obtenci��n de variedades ornamentales o clones noveles a partir de especies nativas a trav��s de la selecci��n de genotipos superiores e hibridaciones interespec��ficas en <i>Glandularia</i> y la domesticaci��n, caracterizaci��n y selecci��n de clones superiores y/o noveles en <i>Solidago</i>. La metodolog��a para lograr dichos objetivos ser��: recolecci��n de germoplasma en zonas de distribuci��n, identificaci��n taxon��mica, domesticaci��n, caracterizaci��n y mejoramiento gen��tico cl��sico. Los resultados obtenidos permitir��n determinar la aptitud combinatoria de las especies del g��nero <i>Glandularia</i>, como as�� tambi��n aportar elementos cient��ficos b��sicos para encarar futuros trabajos de mejoramiento, entre ellos, se deber�� poder identificar las barreras a la hibridaci��n interespec��fica (pre o post cig��ticas). Estos conocimientos resultan b��sicos e indispensables en el momento de establecer estrategias racionales para la superaci��n de las barreras a la hibridaci��n. En el g��nero <i>Solidago</i>, los resultados obtenidos son permitir��n establecer una base gen��tica lo suficientemente amplia como para establecer los lineamientos necesario para el logro de nuevas variedades ornamentales. A partir de este proyecto se podr�� disponer de material con distintos grados de desarrollo: colecciones de los g��neros <i>Glandularia</i> y <i>Solidago</i> caracterizadas, domesticadas y materiales avanzados en el mejoramiento. Estos productos contribuir��n al mayor conocimiento de la flora nativa ornamental, colaborar��n con la sustentabilidad del sistema agroecol��gico, permitir��n la formaci��n de recursos humanos, el fortalecimiento del grupo y su integraci��n con el sector productivo.

Payments for environmental services in watersheds: insights from a comparative study of three cases in Central America

We have compared three cases of payments for water-related environmental services (PES) in Central America, in terms of socioeconomic background, opportunity costs of forest conservation and stakeholders��� perceptions on the conditions of water resources and other issues. We found that, in general, the foregone benefits from land uses alternative to forest cover are larger than the amount paid, which apparently contradicts the economic foundation of PES schemes. A number of possible explanations are explored. The results also suggest that trade-offs between different environmental and social goals are likely to emerge in PES schemes, posing some doubts on their ability to be multipurpose instruments for environmental improvement and rural development. We also found that PES schemes may work as a conflictresolution instrument, facilitating downstream -upstream problem solving, though at the same time they might introduce changes in social perceptions of property rights.

The vertical dispersi��n of Anopheles (Kerteszia) cruzi in a forest in southern Brazil suggests that human cases of malaria of simian origin might be expected

By staining females of Anopheles cruzi with fluorescent coloured powders in a forest in the State of Santa Catarina, we showed that they move from canopy to ground and vice-versa to feed. This suggests that in areas where this mosquito is a vector of human and simian malarias sporadic infections of man with monkey plasmodia might be expected.

Death caused by cardioinhibitory reflex cardiac arrest--a systematic review of cases.

Forensic pathologists often refer to the cardioinhibitory reflex cardiac arrest (CiRCA) following short neck trauma as a mechanism of death. We sought via a systematic review of the literature to identify circumstances under which carotid bifurcation stimulation could lead to death. Two independent reviewers selected case studies or reports from Medline, ISI Web of Knowledge, and Embase. Circumstances and contributory factors were extracted for each case. From the available data, authors independently assessed whether CiRCA was highly probable (no alternative explanation possible), probable (alternative explanation possible), or unlikely (alternative explanation highly probable). A narrative approach was used to define circumstances in which CiRCA remained possible. From the 48 published cases evoking CiRCA as a possible cause of death between 1881 and 2009, 28 were most likely to result of other mechanism of death (i.e., cerebral hypoxia due to carotid compression, mechanical asphyxia, myocardial infarction). CiRCA remained possible for 20 cases (including five based on anecdotal evidence only) with only one case with no alternative explanation other than CiRCA. Our findings support the presumption that reflex cardiac arrhythmia due to carotid bifurcation stimulation cannot provoke death alone. Actual state of knowledge suggests CiRCA might be contributory to death in the presence of drug abuse and/or cardiac pathology, often associated with physical and/or mental excitation.