Associação entre doença arterial coronariana e as pregas lobular diagonal e anterotragal em homens

FUNDAMENTOS: Diversas alterações dermatológicas foram associadas à doença arterial coronariana, representando achados de fácil constatação que podem contribuir na estratificação não invasiva do risco cardíaco. OBJETIVOS: Avaliar comparativamente a prevalência de certos achados dermatológicos em pacientes com ou sem doença arterial coronariana. MÉTODOS: Estudo caso/controle envolvendo pacientes do sexo masculino submetidos à cineangiocoronariografia. Foram considerados aqueles casos com obstrução de mais de 50% em pelo menos uma coronária. Avaliou-se a presença da prega lobular diagonal, prega anterotragal, alopecia e presença de pêlos no tórax nos dois grupos. Os resultados foram ajustados para os fatores de risco: tabagismo, hipertensão, diabetes, idade, dislipidemia e índice de massa corporal. RESULTADOS: Analisaram-se 110 pacientes (80 casos e 30 controles). A prevalência da prega lobular diagonal nos casos (60,0%) foi maior do que no grupo controle (30,0%) (p<0,05). Alopecia androgenética e distribuição de pêlos no tórax não demonstraram associação positiva com coronariopatia neste estudo. O Odds Ratio (IC 95%), da prega lobular diagonal foi de 3,1 (1,2-8,3) e para prega anterotragal foi de 5,5 (1,9-16,3). A verificação simultânea da prega lobular diagonal e prega anterotragal representou valor preditivo positivo de 90%. CONCLUSÕES: Detectou-se associação positiva entre a presença da prega lobular diagonal bilateral e prega anterotragal bilateral com doença arterial coronariana, sendo que a presença simultânea das duas pregas apresenta alta preditividade para doença arterial coronariana.

Risk factors for acquisition of Methicillin-resistant Staphylococcus aureus among patients from a burn unit in Brazil

Methicillin-resistant Staphylococcus aureus (MRSA) is an important agent of colonization and infection in burn units. in order to identify risk factors for MRSA acquisition in a Brazilian burn unit, we performed two retrospective studies. In the first ("cohort" study), 175 patients who were not colonized with MRSA on admission were followed to assess risk factors for MRSA acquisition. in the second ("case-case-control" study), 143 individuals from the previous study who were negative for both MRSA and Methicillin-susceptible S. aureus (MSSA) on admission were followed. Case-control studies were performed to investigate risk factors for MRSA and MSSA acquisition. MRSA and MSSA were recovered from 75 and 23 patients, respectively. In the "cohort" study, only the number of wound excisions (Odds Ratio [OR] = 1.55, 95% Confidence Interval [CI] = 1.21-1.98, P = 0.001) was associated with MRSA acquisition. in the "case-case-control" study, burns involving head (OR=3.43, 95%CI = 1.50-7.81, P = 0.003) and the number of wound excisions (OR = 1.83, 95%CI = 1.27-2.63, P = 0.001) were significant risk factors for MRSA. Burns involving perineum were negatively associated with MSSA acquisition (OR = 0.16, 95%CI = 0.03-0.75, P = 0.02). In conclusion, the acquisition of MRSA was related to the site of the burn and to the surgical manipulation of tissues, but not to the use of antimicrobials. (C) 2009 Elsevier Ltd and ISBI. All rights reserved.

Genetic, epidemiological and biological analysis of interleukin-10 promoter single-nucleotide polymorphisms suggests a definitive role for-819C/T in leprosy susceptibility

Leprosy is a complex infectious disease influenced by genetic and environmental factors. The genetic contributing factors are considered heterogeneous and several genes have been consistently associated with susceptibility like PARK2, tumor necrosis factor (TNF), lymphotoxin-alpha (LTA) and vitamin-D receptor (VDR). Here, we combined a case-control study (374 patients and 380 controls), with meta-analysis (5 studies; 2702 individuals) and biological study to test the epidemiological and physiological relevance of the interleukin-10 (IL-10) genetic markers in leprosy. We observed that the -819T allele is associated with leprosy susceptibility either in the case-control or in the meta-analysis studies. Haplotypes combining promoter single-nucleotide polymorphisms also implicated a haplotype carrying the -819T allele in leprosy susceptibility (odds ratio (OR) = 1.40; P = 0.01). Finally, we tested IL-10 production in peripheral blood mononuclear cells stimulated with Mycobacterium leprae antigens and found that -819T carriers produced lower levels of IL-10 when compared with noncarriers. Taken together, these data suggest that low levels of IL-10 during the disease outcome can drive patients to a chronic and unprotective response that culminates with leprosy.

Risk factors for Hospital-Acquired Pneumonia in nonventilated adults

Although most recent publications focus on Ventilator-associated Pneumonia, Non-Ventilator-associated Hospital-acquired pneumonia (NVHAP) is still worrisome. We studied risk factors for NVHAP among patients admitted to a small teaching hospital. Sixty-six NVHAP case patients and 66 controls admitted to the hospital from November 2005 through November 2006 were enrolled in a case-control study. Variables under investigation included: demographic characteristics, comorbidities, procedures, invasive devices and use of medications (Sedatives, Antacids, Steroids and Antimicrobials). Univariate and multivariable analysis (hierarchical models of logistic regression) were performed. The incidence of NVHAP in our hospital was 0.68% (1.02 per 1,000 patients-day). Results from multivariable analysis identified risk factors for NVHAP: age (Odds Ratio[OR]=1.03, 95% Confidence Interval[CI]=1.01-1.05, p=0.002), use of Antacids (OR=5.29, 95%CI=1.89-4.79, p=0.001) and Central Nervous System disease (OR=3.13, 95%CI=1.24-7.93, p=0.02). Although our findings are coherent with previous reports, the association of Antacids with NVHAP recalls a controversial issue in the physiopathology of Hospital-Acquired Pneumonia, with possible implications for preventive strategies.

Interleukin 18 messenger RNA and proIL-18 protein expression in chorioamniotic membranes from pregnant women with preterm prelabor rupture of membranes

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Clinical features associated to refractory obsessive-compulsive disorder

Some patients with obsessive-compulsive disorder (OCD) exhibit an unsatisfactory reduction in symptom severity despite being treated with all the available therapeutic alternatives. The clinical variables associated with treatment-refractoriness in OCD are inconsistently described in the literature.Methods: To investigate factors associated with treatment-reftactoriness of patients with OCD, we conducted a case-control study, comparing 23 patients with treatment-refractory OCD to 26 patients with treatment-responding OCD.Results: the factors associated with refractoriness of OCD were higher severity of symptoms since the onset of OCD (P < 0.001), chronic course (p=0.003), lack of a partner (p=0.037), unemployment (p=0.025), low economic status (p=0.015), presence of obsessive-compulsive symptoms of sexual/religious content (p=0.043), and higher scores on family accommodation (P < 0.001). Only the three latter variables remained significantly associated with treatment-reftactoriness after regression analyses. Limitations: small sample size, the biases and drawbacks inherent to a case-control study, and the inclusion criteria used to define the study groups may have limited the generalisation of the results.Conclusion: A major strength of this study is the systematic and structured evaluation of a vast array of variables related to the clinical expression of OCD, including epigenetic factors and ratings derived from instruments evaluating family accommodation. The presence of sexual/religious symptoms, low economic status and high modification on family function due to OCD were independently associated with, treatment-refractoriness. Future longitudinal studies are warranted to verify if these variables represent predictive factors of treatment non-response. (c) 2006 Elsevier B.V. All rights reserved.

Avaliação audiológica em pacientes com doenças reumáticas pediátricas

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Microbiological characteristics and inflammatory cytokines associated with preterm labor

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Respiratory muscular strength decrease in children with mylomeningocele

Study Design. Case-control study.Objective. To evaluate respiratory muscle force in children with myelomeningocele. Summary of Background Data. Myelomeningocele is a common spinal cord malformation with limitations linked to central nervous system lesions and abnormalities in respiratory movements. Despite this, little attention has been given to evaluating respiratory muscle force in these patients.Methods. Children with myelomeningocele aged between 4 and 14 years ( myelomeningocele group; MG, n = 20) were studied and compared with healthy children ( control group; CG, n = 20) matched for age and gender. Respiratory muscular force was evaluated by maximum inspiratory ( Pimax) and expiratory ( Pemax) pressures.Results. Groups were similar for age [ CG = 8 ( 6 - 13) = MG = 8 ( 4 - 14), P > 0.05]; gender, and body mass index [ CG = 17.4 ( 14.1 - 24.7) x MG = 19.2 ( 12.6 - 31.9), P > 0.05]. The lumbosacral region was predominantly affected ( 45%). Maximum respiratory pressures were significantly higher in CG than MG ( Pimax = CG: similar to 83 +/- 21.75 > MG: -54.1 +/- 23.66; P < 0.001 and Pemax = CG: + 87.4 +/- 26.28 > MG: + 64.6 +/- 26.97; P = 0.01). Patients with upper spinal lesion ( UL) had lower maximum respiratory pressure values than those with lower spinal lesion ( LL), [Pimax ( UL = - 38.33 +/- 11.20 cm H2O x LL = - 60.85 +/- 24.62 cm H2O), P < 0.041 and Pemax ( UL = + 48 +/- 20.82 cm H2O x LL + 71.71 +/- 26.73 cm H2O), P = 0.067]).Conclusion. Children with myelomeningocele at the ages studied presented reduced respiratory muscle force with more compromise in upper spinal lesion.

Association between distressing non-work-related events and occupational injuries

The following is a report on a case-control study whose objective was to investigate the association between distressing non-work-related events and occupational injures. Ninety three injured workers (cases) were matched with 372 non-injured controls in a large metallurgical factory in southeastern Brazil. Exposure to distressing non-work-related events was measured through a questionnaire focusing on situations pertaining to personal problems unrelated to work activities. The data were analyzed by adjusting a conditional logistic regression model, where occurrence of the work injury was the dependent dichotomous variable and answers from the questionnaire were independent continuous variables. The analysis showed an association between some distressing non-work-related events and occupational injuries. These findings imply expanding the horizon of preventive measures used in targeting. work injuries which have traditionally been focused on the control of strictly workplace risks.

Fraction of work-related accidents attributable to occupational noise in the city of Botucatu, São Paulo, Brazil

Background: Noise is the most common agent of occupational exposure. It may induce both auditory and extraauditory dysfunction and increase the risk of work accidents. The purpose of this study was to estimate the fraction of accidents attributable to noise occupational exposure in a mid-size city located in southeastern Brazil. Materials and Methods: In this population case-control study, which included 108 cases and 324 controls, the incidence rate ratio of work accidents controlled for several covariables was obtained by classifying occupational noise exposure into three levels, as well as determining the prevalence in each level. Results: Based on these data, the attributable fraction was estimated as 0.6391 (95 CI = 0.2341-0.3676), i.e., 63 of the work accidents that took place in the study site were statistically associated with occupational noise exposure. Discussion: The causes of this association as well as its implications in the prevention of work accidents are discussed.

Acute bacterial cystitis does not cause deoxyribonucleic acid damage detectable by the alkaline comet assay in urothelial cells of dogs

Considering the high incidence of dogs with acute bacterial cystitis (BC) and the relationship among inflammation, genotoxicity, and carcinogenesis, we conducted a case-control study comparing the frequency of deoxyribonucleic acid (DNA) lesions assessed by the comet assay between disease-free animals (13 males and 13 females) and cytology-confirmed cases of acute BC (12 males and 12 females), which was mainly caused by Staphylococcus sp. (40%) and Escherichia coli (35%). The results show no increase in DNA damage in cells obtained by bladder washings and no influence of age, sex, and breed due to acute BC. In conclusion, DNA damage was seemingly not associated with the infection by specific bacteria.

Canine Subcutaneous Mast Cell Tumors: Cellular Proliferation and KIT Expression as Prognostic Indices

Molecular assays are widely used to prognosticate canine cutaneous mast cell tumors (MCT). There is limited information about these prognostic assays used on MCT that arise in the subcutis. The aims of this study were to evaluate the utility of KIT immunohistochemical labeling pattern, c-KIT mutational status (presence of internal tandem duplications in exon 11), and proliferation markers-including mitotic index, Ki67, and argyrophilic nucleolar organizing regions (AgNOR)-as independent prognostic markers for local recurrence and/or metastasis in canine subcutaneous MCT. A case-control design was used to analyze 60 subcutaneous MCT from 60 dogs, consisting of 24 dogs with subsequent local recurrence and 12 dogs with metastasis, as compared to dogs matched by breed, age, and sex with subcutaneous MCT that did not experience these events. Mitotic index, Ki67, the combination of Ki67 and AgNOR, and KIT cellular localization pattern were significantly associated with local recurrence and metastasis, thereby demonstrating their prognostic value for subcutaneous MCT. No internal tandem duplication mutations were detected in exon 11 of c-KIT in any tumors. Because c-KIT mutations have been demonstrated in only 20 to 30% of cutaneous MCT and primarily in tumors of higher grade, the number of subcutaneous MCT analyzed in this study may be insufficient to draw conclusions on the role c-KIT mutations in these tumors.

Low Apgar scores at 5 minutes in a low risk population: maternal and obstetrical factors and postnatal outcome

OBJETIVO: Avaliar a associação entre índice de Apgar menor que sete no 5º minuto, os fatores pré-natais e resultados pós-natais. MÉTODOS: Trata-se de estudo retrospectivo com 27.252 recém-nascidos em maternidade escola com população de baixo risco obstétrico, de janeiro de 2003 a dezembro de 2010. Prontuários de todos os casos com índice de Apgar < 7 no 5º minuto (n = 121; - 0,4%) e de 363 casos com Apgar > 7 no 5º minuto, escolhidos ao acaso, foram revisados. Os principais desfechos estudados foram: óbito neonatal, insuficiência respiratória neonatal, necessidade de intubação orotraqueal e de unidade terapia intensiva (UTI) neonatal e encefalopatia hipóxico-isquêmica. RESULTADOS: Após análise de regressão múltipla, desacelerações tardias (DIP II) (OR: 2,4; IC95%: 1,4-4,1) e período expulsivo prolongado (OR: 3,3; IC 95%: 1,3-8,3) se associaram com Apgar < 7 no 5º minuto; assim como com insuficiência respiratória ao nascimento (OR: 3,0; IC 95%: 1,3-6,9), intubação traqueal (OR: 2,5; IC 95%: 1,2-4,8), necessidade de UTI neonatal (OR: 9,5; IC 95%: 6,7-16,8) e encefalopatia hipóxico-isquêmica (OR: 14,1; IC 95%: 3,6-54,7). Nenhuma outra variável prénatal se associou com Apgar < 7 no 5º minuto (p < 0,05). CONCLUSÃO: DIP II e período expulsivo prolongado estão associados com Apgar < 7 no 5º minuto em população obstétrica de baixo risco; situação essa relacionada com maior risco de insuficiência respiratória no parto, necessidade de suporte ventilatório e encefalopatia hipóxico-isquêmica.

Metabolismo de glicose em gêmeos monozigóticos discordantes para aptidão cardiorrespiratória

OBJETIVO: Verificar se as concentrações de glicose e insulina em jejum são reguladas pela aptidão cardiorrespiratória (VO2máx), independentemente dos efeitos genéticos. MÉTODOS: Dados de 38 pares de gêmeos monozigóticos (11 a 18 anos) foram analisados transversalmente. Os participantes foram submetidos a um teste de esforço máximo com ergoespirometria aberta (MedGraphics VO2000® - Medical Graphics Corp., St. Paul, MN) e à coleta de sangue para estimar a concentração de glicose e insulina em jejum. A zigosidade foi determinada por intermédio da investigação de concordância dos gêmeos em relação a 15 marcadores genéticos polimórficos. Nove pares demonstraram diferença média intrapar para o consumo máximo de oxigênio ≥10mL.kg-1.min-1 e foram divididos em dois grupos, de alta e baixa aptidão. Os grupos foram comparados a partir do teste pareado de Wilcoxon, tendo em vista a assimetria dos dados. RESULTADOS: em média, os gêmeos do grupo de alta aptidão apresentaram consumo máximo de oxigênio 17% superior (13,5±3,7mL.kg-1.min-1) a seus irmãos menos aptos. Não houve diferença entre os grupos para as concentrações de insulina (36,5±34,6 versus 25,3±13,7mg/dL; p<0,813), porém, os gêmeos mais aptos demonstraram menor concentração de glicose do que seus contrapares menos aptos (82,9±7,3 versus 86,7±7,6mg/dL; p<0,010). CONCLUSÕES: Neste estudo, caracterizado como caso-controle (gêmeos monozigóticos discordantes), o irmão com menor aptidão cardiorrespiratória apresentou maior concentração de glicose em jejum, sugerindo que a baixa aptidão cardiorrespiratória está associada a distúrbios no metabolismo de glicose.