Case histories of infectious disease management in developing countries: Phnom Penh and Kabul

Healthcare in developing countries is affected by severe poverty, political instability and diseases that may be of lesser importance in industrialized countries. The aim of this paper was to present two cases and histories of physicians working in hospitals in developing countries and to discuss the opportunities for clinical investigation and collaboration. Cases of patients in Phnom Penh, Cambodia, with histoplasmosis, cryptococcal meningitis, crusted scabies, cerebral lesions and human immunodeficiency virus and of patients in Kabul, Afghanistan, with liver cirrhosis, nephrotic syndrome and facial ulcer are discussed. Greater developmental support is required from industrialized nations, and mutually beneficial cooperation is possible since similar clinical problems exist on both sides (e.g. opportunistic cardiovascular infections). Examples for possible support of hospital medicine include physician interchange visits with defined objectives (e.g. infection control or echocardiography training) and collaboration with clinical investigations and projects developed locally (e.g. epidemiology of cardiovascular diseases or nosocomial bloodborne infections).

O contributo da farm��cia comunit��ria no envelhecimento ativo

RESUMO: A popula����o mundial est�� a envelhecer de forma sustentada. O setor das farm��cias em Portugal est�� a passar por um conjunto de altera����es que conduzir�� a uma a����o mais interventiva ao n��vel da presta����o de cuidados de sa��de. Deste modo delineou-se um estudo descritivo, transversal e explorat��rio sem interven����o, de car��cter qualitativo e quantitativo que compara diferentes grupos et��rios com o objectivo de compreender melhor o papel do farmac��utico no ��mbito do envelhecimento das popula����es. Pretendemos assim optimizar pr��ticas e servi��os que podem ser realizados nas farm��cias e alertar os utentes, para gerir melhor a sua condi����o de sa��de, sensibilizando-os para o pr��prio processo de envelhecimento. Como principais resultados destacamos o papel de interven����o crucial da farm��cia, quer pela sua acessibilidade quer pela contribui����o que pode ter para a condi����o de sa��de das popula����es. Pela amostra estudada em 100% das farm��cias s��o feitos despistes e controlo da hipertens��o arterial e hipercolesterolemia, factores fundamentais no controlo da aterosclerose e das doen��as cardiovasculares. Podemos ainda concluir que a farm��cia pode ser o elemento de otimiza����o, revis��o e reconcilia����o das terap��uticas dos resistentes em lares e ao domic��lio, junto da popula����o 65+. Em termos das pessoas idosas, o nosso estudo indicia que, apesar da crise s��cio econ��mica dos ��ltimos anos, continuam a tomar os medicamentos mais essenciais, o que se relaciona com a pol��tica do medicamento implementada. Este trabalho pretende tamb��m, contribuir para o desenvolvimento de uma rede de compet��ncias da farm��cia ao n��vel do envelhecimento ativo, podendo ser uma oportunidade futura.--------------ABSTRACT: World population is getting older in a sustained way. Portuguese community pharmacies are going through a change process, leading to a higher intervention in healthcare delivery. The study designed is descriptive, transversal and exploratory, with no intervention, with a qualitative and quantitative component that compares different age groups. The purpose is to better understand pharmacists��� role in population aging. One of our main goals is to optimize practices and services with potential to be performed in pharmacies and aware patients to better manage their health, becoming more conscious of their aging process. As main results we highlight the intervention of pharmacies, not only by its accessibility but also sustained on the unique contribution pharmacies deliver in the best benefit of populations��� health condition. In the sample studied, 100% of pharmacies perform screening and vigilance of hypertension and hypercholesterolemia, essential for the control of atherosclerosis and cardiovascular diseases. We may also determine the importance of pharmacies intervention over therapeutics optimization, revision and reconciliation in nursing homes and in domicile, mostly focusing patients over 65. In what concerns to elderly population our study indicates that, despite social and economic crises of recent years, the elderly keeps taking its essential medicines, which is related with medicines politics implemented at the present moment. This project intends to pay a relevant contribution to the development of a group of core competencies in pharmacies, related to the promotion of an active and healthy aging process, which represents an important future opportunity for Portuguese Pharmacies.

Immunovirological parameters and cytokines in HIV infection

Although modern combined antiretroviral therapies (cART) result in lower morbidity and mortality and a visible improvement of clinical and laboratory parameters in HIV-infected, it is known that their long-term use contributes to appearance of the many events unrelated to AIDS such as cardiovascular diseases, cancer and osteoporosis, comorbidities which have been proposed as some of the most important that deprive the majority of infected to present an even better prognosis. This is because even with a decrease in inflammation and immune activation after drug intervention to the patient, these parameters remain higher than those shown by healthy individuals and the imbalance of cytokine profiles also persists. Therefore, evaluations of other biomarkers in clinical practice are needed to complement the exams already carried out routinely and allow more effective monitoring of HIV patients. This review aims to investigate the role of cytokines as potential markers showing studies on their behavior in various stages of HIV infection, with or without cART.

Clinical conditions associated withintestinal strongyloidiasis in Rio de Janeiro, Brazil

INTRODUCTION: Strongyloides stercoralis is a soil-transmitted helminth that produces an infection that can persist for decades. The relationships between certain clinical conditions and strongyloidiasis remains controversial. This study aims to identify the clinical conditions associated with intestinal strongyloidiasis at a reference center for infectious diseases in Rio de Janeiro, Brazil. METHODS: The clinical conditions that were assessed included HIV/AIDS, HTLV infection, cardiovascular diseases, diabetes, obstructive respiratory diseases, viral hepatitis, tuberculosis, cancer, chronic renal disease, nutritional/metabolic disorders, psychiatric conditions, rheumatic diseases and dermatologic diseases. We compared 167 S. stercoralis-positive and 133 S. stercoralis-negative patients. RESULTS: After controlling for sex (male/female OR = 2.29; 95% (CI): (1.42 - 3.70), rheumatic diseases remained significantly associated with intestinal strongyloidiasis (OR: 4.96; 95% CI: 1.34-18.37) in a multiple logistic regression model. With respect to leukocyte counts, patients with strongyloidiasis presented with significantly higher relative eosinophil (10.32% ± 7.2 vs. 4.23% ± 2.92) and monocyte (8.49% ± 7.25 vs. 5.39% ± 4.31) counts and lower segmented neutrophil (52.85% ± 15.31 vs. 61.32% ± 11.4) and lymphocyte counts (28.11% ± 9.72 vs. 30.90% ± 9.51) than S. stercoralis-negative patients. CONCLUSIONS: Strongyloidiasis should be routinely investigated in hospitalized patients with complex conditions facilitate the treatment of patients who will undergo immunosuppressive therapy. Diagnoses should be determined through the use of appropriate parasitological methods, such as the Baermann-Moraes technique.

Influence of physical exercise and sodium intake on arterial pressure and cardiac hypertrophy in rats

Evidence shows that cardiac hypertrophy (CH) is a risk factor for many cardiovascular diseases. Several stimuli may cause CH-like manifestations and promote volume or pressure overload. Exercise-induced cardiac hypertrophy is an expected adaptation to regular exercise training. Salt intake has been shown to be the most important determinant of blood pressure in different populations. The purpose of the present work was to verify the influence of physical exercise and sodium intake on the blood pressure and myocardium. The study was performed on 36 rats divided into six groups: Group I (diet without salt overload), Group II (diet without salt overload and swimming), Group III (diet with 2.5% NaCl solution and swimming), Group IV (diet with 5% NaCl solution and swimming), Group V (diet with 2.5% NaCl solution without exercise), Group VI (diet with 5% NaCl solution without exercise). The arterial pressure was significantly lower in Group I when compared with Group IV. The ratio of cardiac mass/body mass was increased in Groups III and IV. In conclusion, there was evidence that exercise training and NaCl intake promotes arterial hypertension and cardiac hypertrophy.

Molecular targeting of proteins by homocysteine: implications in familial and clinical hypercholesterolemia

Cardiovascular diseases (CVDs) are one of the leading causes of death and disability worldwide and one of its underlying causes is hypercholesterolemia. Hypercholesterolemia can have genetic (familial hypercholesterolemia, FH) and non-genetic causes (clinical hypercholesterolemia, CH), the first much more severe, with occurrence of premature atherosclerosis. While the pathophysiological role of homocysteine (Hcy) on CVD is still controversial, molecular targeting of protein by S and N-homocysteinylation offers a new paradigm to be considered in the vascular pathogenesis of hypercholesterolemia. On this regard, the present study aims to give new insights on protein targeting by Hcy in both CH and FH conditions. A total of 187 subjects were included: 65 normolipidemic and 122 hypercholesterolemic. Total (tHcy) and free (fHcy) fractions were quantified in serum samples after validation of an HPLCFD method, to assess S-homocysteinylation. Also, the lactonase (LACase) activity of paraoxonase-1 (PON1) was quantified by a colorimetric assay, as a surrogate of N-homocysteinylation. tHcy does not differ among groups. Nevertheless, fHcy declines in the hypercholesterolemic groups, with more evidence to the FH population. Consequently, there seems to be an increase of Shomocysteinylation, regardless of lipid lowering therapy (LLT). Also, despite of LLT use, LACase activity is lower in FH, thus the risk for protein N-homocysteinylation seems to be higher. Moreover, the decrease in LACase/ApoA1 and LACase/HDL ratios in FH, shows that HDL is dysfunctional in this population, despite its normal concentration values. Data supports that the pathophysiological role of Hcy on hypercholesterolemia may reside in its ability to post-translationally modify proteins. This role is particularly evident in FH condition. In the future, it will be interesting to identify which target proteins are modified and thus involved in vascular pathology progression.

Entre o fazer e o dever

A compreens��o da ocorr��ncia das doen��as em termos de risco e o estabelecimento de rela����es com os chamados estilos de vida, colocam na experi��ncia de doen��a um acr��scimo de conota����es morais, um dever de autodisciplina e responsabilidade. Estes princ��pios t��m sido in��meras vezes sublinhados nos discursos e pol��ticas da Sa��de P��blica, nomeadamente no que concerne ��s doen��as cardiovasculares pela import��ncia epidemiol��gica, econ��mica e social de que se revestem e consequente necessidade de redu����o da sua grande incid��ncia na popula����o, como �� o caso de Portugal. A hipertens��o, como doen��a cr��nica e fator de risco cardiovascular sujeita os doentes a controlo m��dico peri��dico, terap��utica farmacol��gica e impele a um comprometimento com comportamentos alimentares e exerc��cio f��sico adequado. Atrav��s das entrevistas realizadas a doentes hipertensos utentes da consulta espec��fica em Cuidados de Sa��de Prim��rios, verifica-se a presen��a de modos diversos de agir perante a circunst��ncia de se ter hipertens��o arterial, mostrando a presen��a de v��rias racionalidades, aprecia����es e valora����es pr��ticas dos comportamentos de sa��de e doen��a e do pr��prio corpo. Para os doentes hipertensos entrevistados, a hipertens��o arterial n��o �� encarada como uma ���verdadeira doen��a���, sendo vista sobretudo como resultado do envelhecimento e dos excessos que se acumularam no corpo, consequentes da pr��pria vida. Nas narrativas de experi��ncia de doen��a, os conceitos de modera����o e equil��brio, ���ter cuidado���, parecem servir de mecanismo de operacionaliza����o entre aquilo que s��o as recomenda����es m��dicas e as pr��ticas individuais. Constatam-se as capacidades dos doentes hipertensos constru��rem para si formas de gest��o da doen��a e do medo, sendo que os seus comportamentos podem passar por assumir o controlo dos fatores de risco ou ignor��-los. Em qualquer dos casos, as representa����es e a����es relativas �� hipertens��o e ��s recomenda����es m��dicas a ela associadas integram-se nas pr��ticas quotidianas dos doentes, ajustando-se a h��bitos e representa����es instaladas, constituindo-se em modos distintos de agir dos doentes hipertensos.

Antibacterial properties of fibrous stents coated with silver oxide nanocoatings

Stents are rigid and perforated tubular structures, which are inserted into blood vessels in order to prevent or inhibit the constriction of blood flow, restoring the normal blood flow, when blood vessels are clogged, being used in 70% of angioplasties. These medical devices assume great importance in the treatment of cardiovascular diseases (CVD) which are the leading cause of death worldwide. In the European Union CVD account for 40% of deaths and assume an estimated annual cost of 196 billion euros[1]. Stents must possess certain requirements, in order to, adequately, perform its function, such as biocompatibility (so that its use does not c ause damage on the health of its user), mechanical strength, radiopacity (so that it is easy to view), longitudinal flexibility, ease of handling, corrosion resistance and having high strength and high radial expansion ability to recover. Stents can be made of different materials, but metals, particularly stainless steel, are the most common. However, metallic stents present several dRawbacks such as corrosion and restenosis, leading to health complications for the patient, or even death. In order to minimize these disadvantages, new materials, like fibrous materials, have been used [2]. Monofilaments present high potential for stents development because, in addition to its biocompatibility, these materials allow the application of various surface treatments, such as antibacterial coatings. Furthermore, monofilament exhibit excellent mechanical properties, like greater stiffness and good results when subjected to compression, tensile and bending forces, since these forces will be directly supported by the monofilament [3]. To minimize the reaction of the human body and Limit the adhesion of microorganisms to the stent surface, some coatings have been developed, including the use of novel metals with antimicrobial properties, like silver. The main objective of this study was the development of fibrous stents, incorporation of silver oxide nanocoating. For the development of the stent, polyester monofilaments with 0.27mm of diameter were used in braiding technology, with a mandrel diameter of 6mm and a braiding angle of 35���. The mechanical behaviour of the stent were evaluated by mechanical testing under longitudinal and radial compression, bending. The results of compressive strength tests are according with value from literature: 1.13 to 2.9 N for radial compression and 0. 16-5.28N to longitudinal compression. From literature is also possible to verify that stents must present 75% of unchanged diameter during the bending test and must possess a porosity between 70% and 80% [4]. The produced polyester stent presents values of 1.29N for radial compression, 0.23N for longitudinal compression, 80% of porosity and 85.5% of unchanged diameter, during bending tests. For the antibacterial functionalization, silver oxide nanocoatings were prepared, through reactive magnetron g, with an Ag target in an Ar +O2 atmosphere. In order to evaluate the nanostructure and morphology of the coatings, d ifferent technique s like X-ray diffraction (XRD), scanning electron microscopy (SEM) and and X- ray photoelectron spectroscopy (XPS were used. From the analyses of XRD it is possible to verify that the peaks corresponds to planes of Ag2 O and MATERIAIS 2015 Porto, 21-23 June, 2015 characterize a cubic phase. The presence of Ag2 O is corroborated by XPS spectrum, where it is possible to observe silver, not only, in oxide state, but a lso in mettalic state, and it is possible to verify the presence of silver clusters, confirmed by SEM analysis. Films��� roughness and topography, parameters influencing the wettability of the surface and microorganism adhesion, were measured by Atomic Force Microscopy (AFM), and it was observed that the roughness is very low (under 10 nm). Coatings��� hydrophobicity and surface tension parameters were determined by contact angle measurement, and it was verified the hydrophobic behavior of the coatings. For antibacterial tests were used Staphylococcus epidermidis strain (IE186) and Staphylococcus aureus(ATCC 6538), and halo inhibition zone tests were realized. Ag+release rates were studied by means of inductively coupled plasma mass spectrometry (ICP -MS). The obtained results suggest that silver oxide coatings do not modify significantly surface properties of the substrate, like hydrophobicity and roughness, and present antimicrobial properties for both bacteria used.

Synthesis and anticancer activity of N3-substituted-6,8-diaminopurines

[Excerpt] Cancer is the second most common cause of death in developed countries appearing just after cardiovascular diseases. The treatment of cancer remains a major medical challenge and the development of new anticancer drugs is an emerging topic for the scientific community. During the past three decades several chemical classes of anticancer drugs have been identified. In particular, 2,6-diamino purines proved to be important candidates as new anti-cancer agents.

Dynamic modelling and analysis of hydraulic forces in radial blood pumps

Disserta����o de mestrado integrado em Biomedical Engineering Biomaterials, Biomechanics and Rehabilitation

Hormonal, metabolic and nutritional alterations in smokers: emergency for smoking abstinence

OBJECTIVE: To evaluate the biochemical and nutritional status of smokers in treatment for smoking cessation and its association with anthropometric parameters. METHODS: This is a cross-sectional study with convenience sample. Adult smokers were assessed at the start of treatment in the Interdisciplinary Center for Tobacco Research and Intervention of the University Hospital of the Federal University of Juiz de Fora (CIPIT/HU-UFJF). We evaluated the body mass index (BMI), conicity index (CI); waist circumference (WC), percentage of body fat (%BF), fasting glycemia, cortisol, insulin, total cholesterol (TC), LDL-c, HDL-c, triglycerides (TG) and metabolic syndrome (MS). RESULTS: Most participants (52.2%) had MS and high cardiovascular risk. The fasting glycemia was abnormal in 30.4%. There was a significant positive correlation between BMI and WC (r = 0.90; p = 0.0001), %BF (r = 0.79; p = 0.0001), CI (r = 0.65; p = 0.0001), glycemia (r = 0.42; p = 0.04) and TG (r = 0.47; p = 0.002). The CI presented positive correction with insulin (r = 0.60; p = 0.001), glycemia (r = 0.55; p = 0.007), TG (r = 0.54; p = 0.008) and %BF (r = 0.43; p = 0.004). Patients with longer duration of smoking had a higher risk of developing MS (OR = 9.6, p = 0.016). CONCLUSION: The smokers evaluated had increased risk for developing MS, especially those with longer duration of smoking, requiring urgent smoking cessation.

Perspetivas de casais e de diretores de biobancos face �� criopreserva����o do sangue do cord��o umbilical em Portugal

Disserta����o de mestrado em Crime, Diferen��a e Desigualdade

Reduction of QTc interval dispersion. Potential mechanism of cardiac protection of pyridostigmine bromide

OBJECTIVE: Parasympathetic dysfunction is an independent risk factor in individuals with coronary artery disease, and cholinergic stimulation is a potential therapeutical option. We determined the effects of pyridostigmine bromide, a reversible anticholinesterase agent, on electrocardiographic variables of healthy individuals. METHODS: We carried out a cross-sectional, double blind, randomized, placebo-controlled study. We obtained electrocardiographic tracings in 12 simultaneous leads of 10 healthy young individuals at rest before and after oral administration of 45 mg of pyridostigmine or placebo. RESULTS: Pyridostigmine increased RR intervals (before: 886��27 ms vs after: 1054��37 ms) and decreased QTc dispersion (before: 72��9ms vs after: 45��3ms), without changing other electrocardiographic variables (PR segment, QT interval, QTc, and QT dispersion). CONCLUSION: Bradycardia and the reduction in QTc dispersion induced by pyridostigmine may effectively represent a protective mechanism if these results can be reproduced in individuals with cardiovascular diseases.

Prevalencia das Doencas Cardiacas Ilustrada em 60 Anos dos Arquivos Brasileiros de Cardiologia

Considerando a relevância histórica e acadêmica dos Arquivos Brasileiros de Cardiologia, posto que sua indexação no MEDLINE iniciou-se em 1950, assumiu-se como hipótese que a análise das publicações de 60 anos poderia refletir as tendências evolutivas das doenças cardíacas no Brasil. Os dados do trabalho foram coletados com um programa desenvolvido para a finalidade, tornando possível a extração automática das informações do banco de dados MEDLINE. As informações do trabalho foram coletadas pesquisando-se "Arquivos Brasileiros de Cardiologia AND parâmetro selecionado em inglês". Foram arbitrados quatro grupos observacionais: (1) principais grupos de doenças do coração (doença arterial coronariana, valvulopatia cardíaca, cardiopatias congênitas e cardiomiopatias); (2) doenças relevantes na prática clínica (arritmias cardíacas, Cor Pulmonale, infarto do miocárdio e insuficiência cardíaca congestiva); (3) fatores de risco cardiovascular (hipertensão arterial, diabete, dislipidemia e aterosclerose), e; (4) grupo arbitrado em função da evolução crescente das publicações sobre insuficiência cardíaca congestiva constadas nos grupos anteriores (insuficiência cardíaca congestiva, infarto do miocárdio, cardiopatia reumática e cardiopatia chagásica). Foram descritas todas as publicações dentro dos grupos estabelecidos, ressaltando-se o crescente aumento da insuficiência cardíaca e do diabete como fatores de risco. Foi possível um levantamento relativamente fácil, com auxílio do programa de computação desenvolvido para a pesquisa bibliográfica de seis décadas. Ressaltando-se as limitações do estudo, sugere-se a existência de um elo epidemiológico entre as doenças cardiológicas prevalentes no Brasil e as publicações dos Arquivos Brasileiros de Cardiologia.

Lipoprotein (a): Structure, Pathophysiology and Clinical Implications

The chemical structure of lipoprotein (a) is similar to that of LDL, from which it differs due to the presence of apolipoprotein (a) bound to apo B100 via one disulfide bridge. Lipoprotein (a) is synthesized in the liver and its plasma concentration, which can be determined by use of monoclonal antibody-based methods, ranges from < 1 mg to > 1,000 mg/dL. Lipoprotein (a) levels over 20-30 mg/dL are associated with a two-fold risk of developing coronary artery disease. Usually, black subjects have higher lipoprotein (a) levels that, differently from Caucasians and Orientals, are not related to coronary artery disease. However, the risk of black subjects must be considered. Sex and age have little influence on lipoprotein (a) levels. Lipoprotein (a) homology with plasminogen might lead to interference with the fibrinolytic cascade, accounting for an atherogenic mechanism of that lipoprotein. Nevertheless, direct deposition of lipoprotein (a) on arterial wall is also a possible mechanism, lipoprotein (a) being more prone to oxidation than LDL. Most prospective studies have confirmed lipoprotein (a) as a predisposing factor to atherosclerosis. Statin treatment does not lower lipoprotein (a) levels, differently from niacin and ezetimibe, which tend to reduce lipoprotein (a), although confirmation of ezetimibe effects is pending. The reduction in lipoprotein (a) concentrations has not been demonstrated to reduce the risk for coronary artery disease. Whenever higher lipoprotein (a) concentrations are found, and in the absence of more effective and well-tolerated drugs, a more strict and vigorous control of the other coronary artery disease risk factors should be sought.