A inadequação dos valores dos limites de tolerância biológica para a prevenção da intoxicação profissional pelo chumbo no Brasil

São revisados os trabalhos que, a partir de 1975,estudaram a ocorrência de manifestações neurológicas centrais e periféricas em trabalhadores ocupacionalmente expostos ao chumbo, que apresentavam níveis de exposição supostamente insuficientes para causarem Saturnismo. A partir da revisão realizada é sugerido que os limites de tolerância biológica utilizados em nosso meio para firmar o diagnóstico de intoxicação profissional pelo chumbo devam ser revistos. Tal sugestão baseia-se na existência de evidências bem estabelecidas que apontam disfunções da condução nervosa periférica e central, além de alterações de várias funções nervosas superiores, em trabalhadores profissionalmente expostos ao chumbo que apresentam indicadores de efeito biológico e indicadores de exposição inferiores aos limites estabelecidos pela legislação brasileira.

Resultados do tratamento cirúrgico da doença do refluxo gastroesofágico em crianças com e sem afecções neurológicas concomitantes

RACIONAL: Crianças portadoras de distúrbios neurológicos têm maior incidência de refluxo e, em geral, não apresentam melhora da sintomatologia com tratamento clínico, necessitando de intervenção cirúrgica. OBJETIVO: Comparar os resultados da operação antirefluxo em crianças normais e com comprometimento neurológico, identificando as principais complicações e causas de reoperação. MÉTODOS: Cento e vinte crianças portadores de refluxo foram distribuídas em dois grupos de estudo: Grupo I - 60 crianças normais; Grupo II - 60 crianças com comprometimento neurológico. Exame contrastado do esôfago, estômago e duodeno, endoscopia digestiva alta com biópsia, pHmetria esofágica de 24 horas e cintilografia foram os exames utilizados no diagnóstico e na avaliação da eficácia da operação antirefluxo. Todos os pacientes operados eram refratários ao tratamento clínico. O procedimento cirúrgico antirefluxo realizado foi predominantemente a fundoplicatura de Lind, sendo associada à gastrostomia em 55% dos pacientes do Grupo II. RESULTADOS: No Grupo II a indicação cirúrgica foi significantemente mais precoce que no Grupo I. A principal causa de indicação cirúrgica entre neuropatas foi o alto comprometimento do desenvolvimento neuropsíquico-motor e as pneumonias de repetição. O tempo de internação, as reoperações e a necessidade de dilatações esofágicas no pós-operatório foi maior no Grupo II (p<0,01). Ocorreram três óbitos no pós-operatório tardio no Grupo II (sepse e infecção respiratória grave). CONCLUSÃO: O tratamento cirúrgico adotado foi satisfatório para o tratamento cirúrgico do refluxo nos dois grupos de pacientes. Porém, torna-se necessário o aprofundamento dos estudos acerca da população de crianças neuropatas portadoras de refluxo, uma vez que estas respondem de forma menos favorável ao procedimento cirúrgico, principalmente no que se refere às taxas de mortalidade, recorrência dos sintomas respiratórios, índice de reoperações e gravidade das complicações pós-operatórias.

Achados endoscópicos em crianças com estridor

Doenças congênitas e adquiridas das vias aéreas podem causar dispnéia e estridor em crianças. Nas UTIs tem-se registrado maior sobrevida de prematuros, porém também elevada incidência de complicações relacionadas à intubação. OBJETIVO: Analisar retrospectivamente os achados endoscópicos em crianças com estridor. TIPO DE ESTUDO: Corte transversal. MATERIAL E MÉTODOS: Foram revisados 55 prontuários de crianças com estridor, submetidas aos exames endoscópicos de janeiro de 1997 a dezembro de 2003. Endoscopias foram: estridor pós-extubação (63,63%) e avaliação de estridor neonatal (21,82%). Observou-se alto índice de doenças associadas, como pulmonares (60%), neurológicas (45,4%) e DRGE (40%). Os principais achados endoscópicos e as indicações de traqueotomia foram: estenose subglótica (27,27%) e processos inflamatórios das vias aéreas (21,82%), principalmente em crianças com menos de cinco anos. Lesões congênitas foram mais freqüentes em crianças com menos de um ano. CONCLUSÕES: O estridor na infância possui múltiplas etiologias, sendo as relacionadas à intubação traqueal as mais freqüentes em hospitais com atendimento de doenças complexas. Pediatras e otorrinolaringologistas devem conhecer as causas de estridor, realizando avaliação clínica detalhada para determinar a gravidade do caso. O exame endoscópico deverá ser minucioso e detalhado.

Observações clínicas e laboratoriais em cães com cinomose nervosa

Em 81 cães com sinais clínicos, lesões histológicas e corpúsculos de inclusão no sistema nervoso central característicos de cinomose nervosa foi constatada ocorrência freqüente de: alteração das reações posturais (87,65%), diminuição da secreção lacrimal (83,95%), presença de mioclonias (75,30%), paresias (69,12%), conjuntivite (56,79%), corioretinite/ hiperqueratose naso-digital (51,85%), linfopenia (51,85%), anemia (48,05%), principalmente microcítica hipocrômica, e discretas alterações liquóricas caracterizadas por aumento de proteínas totais (77,33%) e pleocitose linfocítica (50,72%). A presença de corpúsculos de Lenz em tecidos extraneurais oscilou entre 30 e 45 %, com maior freqüência em linfonodos. Enquanto outras anormalidades clínicas, neurológicas e laboratoriais não tiveram freqüência expressiva para dar apoio ao diagnóstico, o incorreto programa de vacinação foi uma constante.

Application of synthetic peptides to the diagnosis of neurocysticercosis

We tested the possible diagnostic utility of five Taenia saginata oncosphere-derived synthetic peptides in T. solium neurocysticercosis (NC). The five peptides correspond to protein sequences with high antigenic indexes that were cloned from a T. saginata oncosphere cDNA library. The test samples consisted of cerebrospinal fluid (CSF) samples randomly collected from patients referred from Mexican and Brazilian neurological institutes. Indirect enzyme-linked immunosorbent assays (ELISA) were carried out with the peptides either unconjugated or coupled to carrier proteins, and were compared with results obtained using T. solium cyst fluid as a positive control. For active inflammatory NC, the higher sensibility (93%) and specificity (85%) was obtained with peptides HP6-2 and Ts45W-1, respectively, coupled to ovalbumin, in both Mexican and Brazilian patients. Examining the results of the individual peptide assays in combination, in some instances, improved the sensitivity to 100%.

Detecção de herpesvírus bovino 5 (BoHV-5) em bovinos do Sudeste Brasileiro

This paper reports the detection of bovine herpesvirus type 5 (BoHV-5) by a specific nested PCR assay. Samples were collected from the central nervous system (CNS) of cattle from Minas Gerais and São Paulo States, Brazil. All animals died presenting neurological symptoms. Nineteen frozen CNS samples analyzed had been previously tested by fluorescence antibody test for rabies virus and showed negative results. Three paraffin-embedded brain tissue samples were examined by histopatology and the observed alterations suggested nonsuppurative meningoencephalitis. BoHV-5 was detected in five (22.7%) among 22 tested samples. The occurrence of BoHV-5 infection is reported in the Southeast region of Brazil, indicating that epidemiological studies should be carried out.

Lead poisoning in cattle grazing pasture contaminated by industrial waste

Lead poisoning is described in a herd of 120 Nelore cows of which 35 were affected. All affected cows died after a clinical course of 2-7 d with clinical signs related to cortical neurological disturbances. The source of Pb was fumes from a car battery recycling plant which has had a failure in its filtering system. Lead concentrations in liver and kidneys of 2 cows, in soil;and in grass where the cows were held were respective 39 to 431 ppm, 147 to 431 ppm,and 245ppm. No significant gross changes were observed. Histopathology revealed of neuronal necrosis, vacuolation of the neuropil and hypertrophy of the vascular endothelium inthecerebral cortices, degeneration of the epithelial cellsofrenal proximal tubules, and hemosiderosis of kidney, spleen and liver.

Brain and lung cryptococcoma and concurrent corynebacterium pseudotuberculosis infection in a goat: a case report

A four-year-old male goat with a history of neurological disorder was euthanized. It presented uncommon nodules in the brain and lungs associated with multiple abscesses, predominantly in the spleen and liver. Histological examination of brain and lung sections revealed yeast forms confirmed to be Cryptococcus gattii after a combination of isolation and polymerase chain reaction (PCR) procedures. Moreover, Corynebacterium pseudotuberculosis infection was diagnosed by PCR of samples from the lung, spleen and liver. The present report highlights the rare concurrent infection of C. gatti and C. pseudotuberculosis in an adult goat from São Paulo state, Brazil, and indicates the necessity of surveillance in the treatment of goats with atypical pulmonary infections associated with neurological disorders.

Auditory processing disorder in perisylvian syndrome

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

DIAGNOSIS of REGIONAL CEREBRAL BLOOD FLOW ABNORMALITIES USING SPECT: AGREEMENT BETWEEN INDIVIDUALIZED STATISTICAL PARAMETRIC MAPS and VISUAL INSPECTION BY NUCLEAR MEDICINE PHYSICIANS WITH DIFFERENT LEVELS of EXPERTISE IN NUCLEAR NEUROLOGY

INTRODUCTION: Visual analysis is widely used to interpret regional cerebral blood flow (rCBF) SPECT images in clinical practice despite its limitations. Automated methods are employed to investigate between-group rCBF differences in research Studies but have rarely been explored in individual analyses.OBJECTIVES: To compare visual inspection by nuclear physicians with the automated statistical parametric mapping program using a SPECT dataset of patients with neurological disorders and normal control images.METHODS: Using statistical parametric mapping, 14 SPECT images from patients with various neurological disorders were compared individually with a databank of 32 normal images using a statistical threshold of p<0.05 (corrected for multiple comparisons at the level of individual voxels or clusters). Statistical parametric mapping results were compared with Visual analyses by a nuclear physician highly experienced in neurology (A) as well as a nuclear physician with a general background of experience (B) who independently classified images as normal or altered, and determined the location of changes and the severity.RESULTS: of the 32 images of the normal databank, 4 generated maps showing rCBF abnormalities (p<0.05, corrected). Among the 14 images from patients with neurological disorders, 13 showed rCBF alterations. Statistical parametric mapping and physician A completely agreed on 84.37% and 64.28% of cases from the normal databank and neurological disorders, respectively. The agreement between statistical parametric mapping and ratings of physician B were lower (71.18% and 35.71%, respectively).CONCLUSION: Statistical parametric mapping replicated the findings described by the more experienced nuclear physician. This finding suggests that automated methods for individually analyzing rCBF SPECT images may be a valuable resource to complement visual inspection in clinical practice.

Herpes Virus Bovino tipo 1 (BoHV-1) como posible causa de encefalitis en bovinos de la región del Magdalena Medio Colombiano. Estudio serológico y análisis epidemiológico

The bovine Herpesvirus type 1 and type 5 (BoHV-1 and BoHV-5), causing diseases and significant economic losses in farms of worldwide. Both affect the nervous system of cattle, although BoHV-5 has been the most associated with this type of pathogenesis. Given the death of animals with nervous symptoms and negative diagnoses for rabies virus in the area of study, this research focused on the detection of positive reactors to bovine herpes virus serum neutralization. We collected 518 blood samples from animals without Herpesvirus vaccine, in the municipalities of Caparrapi, Cimitarra, Honda and Victoria, in the Middle Magdalena River Region. In addition, epidemiological information useful to discuss neurological disease was collected through primary and secondary sources. For the analysis of data was used chi-square test by identification of relationship between evidence of viral infection and the variables recorded. The results revealed that 286 cases were positive for Herpesvirus infection, corresponding to a prevalence of 55.5%, however, there was no statistical relationship (p < 0.05) between the presence of antibodies and the variables analyzed. In conclusion, some cases of neurological disease in cattle in this region could be due to infection with herpes viruses. We discussed about the presence of BoHV-1 and BoHV-5 in the ambient, diagnosis and monitoring plans, as well as economic losses, which may cause in herds in this area.

Hypoactivity of the central dopaminergic system and autistic-like behavior induced by a single early prenatal exposure to lipopolysaccharide

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

Labeling index in pituitary adenomas evaluated by means of MIB-1: is there a prognostic role? A critical review

Objective: The present article presents an overview of the literature, and analyses the methods and the primary questions related to assessment of proliferation index using the Ki-67/MIB-1 labeling index in pituitary adenomas. Although atypical adenomas are characterized by their atypical morphological features by an elevated mitotic index, a Ki-67 (MIB-1) labeling index greater than 3% and extensive nuclear staining for p53, use of the proliferation index (LI) of pituitary adenomas in assessing the degree of tumor aggressiveness is a controversial topic in the literature, and there are disparate results involving many studies.Methods: A review of literature was carried out to correlate the role of Ki-67 LI and its correlation with clinical findings, tumor size, invasiveness, recurrence, adenoma subtype, adenoma doubling time, and pituitary carcinomas is addressed. Results: The prognosis cannot be predicted on the basis of the Ki-67 LI alone. Although there is no direct relation between Ki-67 LI and some of these variables and controversial data were found regarding some topics, our review justify the use of Ki-67 in the analysis of pituitary adenomas as an additional information for clinical decision.Conclusion: Although assessment of proliferative may be helpful in predicting subsequent tumor recurrence or invasiveness, there are many other important and as yet unidentified factors pituitary tumors. It is clear that further research is needed to clarify these molecular mechanisms to predict those with a potentially poor clinical outcome.

Susceptibility of neuron-like cells derived from bovine Wharton's jelly to bovine herpesvirus type 5 infections

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

Evolução neurológica e eletrencefalográfica em crianças após meningencefalites purulentas

Twenty children with diagnosed meningitis were available for prospective study; each was submitted to neurological and electroencephalographic examination, Distractability Quotient (Gesell) and Intelligence Quotient (Raven) tests. Patients were followed from 6 months to 3 years after the acute phase of the disease. There is a statistically significant difference between the D.Q of post-meningitic children and the D.Q. of non meningitic controls of the same social class and ages, when the onset of illness was before 30 months of age. No statistically significant correlation was found between the D.Q. and the patient's length of hospitalization or the first cerebrospinal fluid protein level. There is a possibility that significant correlation between the D.Q. and age at onset of illness may be observed by studying a larger number of patients. No statistically significant difference was found between the I.Q. of post-meningitic children and controls when the onset of illness was after age 4.