Vitamina D em mulhers adultas fumantes e ex-fumantes: ingestão, concentração sérica e associação com variáveis ecocardiográficas

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Pre- and post-operative evaluations of eight dogs following right nephrectomy due to Dioctophyma renale

Background: Dioctophyma renale is a large nematode distributed worldwide that may cause progressive and severe destruction of renal parenchyma.Objectives: The present study aimed to evaluate pre- and post-operatively dogs submitted to right nephrectomy due to D. renale and to assess the histopathological damage of the removed kidney.Animals and methods: Eight crossbred dogs, aged from 12 to 48 months that were unilaterally nephrectomized due to the presence of D. renale were evaluated. Physical examination, urinalysis, complete blood count, serum biochemistry, and abdominal ultrasound were performed immediately before and one month after nephrectomy. The nephrectomized right kidneys were submitted to macroscopic and microscopic evaluations.Results: Urinalysis preoperatively detected occult blood in all dogs and D. renale eggs in five cases. Complete blood count showed all parameters within the reference range, except one dog post-operatively. Serum biochemistry performed before and after surgery verified that urea, creatinine and sodium were within the reference range values in all dogs. Other findings varied among the dogs. The length and arterial resistive index mean values of the left kidney were similar pre- and post-operatively.Conclusions: Thus, the inconsiderable change in laboratory findings pre- and post-operatively was attributable to compensation by left kidney function for the removed abnormal right kidney. Right kidney histology revealed chronic nephropathy due to D. renale.Clinical importance: Imaging diagnosis should be performed on dogs suspected as carrying the disease or on those from an enzootic area since the laboratory findings are not specific except eggs in the urine.

Avaliação do desempenho e características relacionadas ao grau de infecção por helmintos de bovinos da raça nelore

Pós-graduação em Ciência e Tecnologia Animal - FEIS

L'accertamento dei reati di guida in stato di ebbrezza e alterazione da droghe

La tesi affronta le questioni processuali connesse alla verifica dei reati di guida in stato di ebbrezza e di alterazione da droghe. La ricerca si sviluppa in tre direzioni. La prima parte studia la disciplina tedesca. L’analisi parte dalle norme sostanziali che definiscono le fattispecie incriminatrici contemplate dall’ordinamento osservato; s’interessa, poi, degli equilibri tra gli strumenti di captazione della prova utili ai reati in discorso ed il principio nemo tenetur se detegere (l’ estensione del diritto di difesa tedesco copre anche le prove reali e non prevede obblighi di collaborazione all’alcoltest). Prosegue, infine, con l’esame delle metodologie di acquisizione della prova, dall’etilometro agli screening per le droghe, sino al prelievo ematico coattivo, indispensabile per l’accertamento penale. La seconda sezione esamina gli artt. 186 e 187 del codice della strada italiano, alla luce del principio di libertà personale e del diritto a non autoincriminarsi. Particolarmente delicati gli equilibri rispetto a quest’ultimo: l’obbligatorietà di un atto potenzialmente autoaccusatorio è evitabile solo a pena di una severa sanzione. Occorre definire se il diritto di difesa copra anche il mero facere o garantisca il solo silenzio. Se si ammette, infatti, che il nemo tenetur sia applicabile anche alle prove reali, la collaborazione obbligatoria imposta al conducente è scelta incompatibile con il diritto di difesa: la disciplina italiana presenta, dunque, profili d’illegittimità costituzionale. La terza parte riguarda le problematiche processuali poste dai controlli stradali che emergono dall’analisi della giurisprudenza. Si affrontano, così, le diverse vicende della formazione della prova: ci si interroga sull’istituto processuale cui ricondurre gli accertamenti, sulle garanzie di cui goda il guidatore durante e dopo l’espletamento dell’atto, sulle eventuali sanzioni processuali derivanti da una violazione delle predette garanzie. Si esaminano, infine, le regole di apprezzamento della prova che guidano il giudice nella delicata fase valutativa.

Entwicklung eines immunologischen Testsystems zur Detektion des marinen Biotoxins Domoinsäure

Domoinsäure ist ein von mehreren Arten mariner Kieselalgen der Gattung Pseudonitzschia produziertes Toxin, welches während einer Algenblüte in Molluscen wie z.B. der Miesmuschel Mytilus sp. akkumuliert werden kann. Beim Verzehr solch kontaminierter Muscheln können sowohl beim Menschen als auch bei Tieren erhebliche Vergiftungserscheinungen auftreten, die von Übelkeit, Kopfschmerzen und Orientierungsstörungen bis hin zum Verlust des Kurzzeitgedächtnisses (daher auch als amnesic shellfish poisoning bekannt) reichen und in einigen Fällen tödlich enden. rnDie heute gängigen Methoden zur Detektion von Domoinsäure in Muschelgewebe wie Flüssigkeitschromatographie und Maus-Bioassay sind zeit- und kostenintensiv bzw. in Anbetracht einer Verbesserung des Tierschutzes aus ethischer Sicht nicht zu vertreten. Immunologische Testsysteme stellen eine erstrebenswerte Alternative dar, da sie sich durch eine vergleichsweise einfache Handhabung, hohe Selektivität und Reproduzierbarkeit auszeichnen.rnDas Ziel der vorliegenden Arbeit war es, ein solches immunologisches Testsystem zur Detektion von Domoinsäure zu entwickeln. Hierfür wurden zunächst Antikörper gegen Domoinsäure gewonnen, wofür das Toxin wiederum als erstes über die Carbodiimid-Methode an das Trägerprotein keyhole limpet hemocyanin (KLH) gekoppelt wurde, um eine Immunantwort auslösen zu können. Kaninchen und Mäuse wurden mit KLH-DO-Konjugaten nach vorgegebenen Immunisierungsschemata immunisiert. Nach vier Blutabnahmen zeigte das polyklonale Kaninchenantiserum eine ausreichend hohe Sensitivität zum Antigen; das nachfolgende Detektionssystem wurde mit Hilfe dieses polyklonalen Antikörpers aufgebaut. Zwar ist es gegen Ende der Arbeit auch gelungen, einen spezifischen monoklonalen Antikörper aus der Maus zu gewinnen, jedoch konnte dieser aus zeitlichen Gründen nicht mehr im Detektionssystem etabliert werden, was durchaus wünschenswert gewesen wäre. rnWeiterhin wurde Domoinsäure im Zuge der Entwicklung eines neuartigen Testsystems an die Trägerproteine Ovalbumin, Trypsininhibitor und Casein sowie an Biotin konjugiert. Die Kopplungserfolge wurden im ELISA, Western Blot bzw. Dot Blot nachgewiesen. Die Ovalbumin-gekoppelte sowie die biotinylierte Domoinsäure dienten im Folgenden als die zu messenden Größen in den Detektionsassays- die in einer zu untersuchenden Probe vorhandende, kompetitierende Domoinsäure wurde somit indirekt nachgewiesen. rnDer zulässige Höchstwert für Domoinsäure liegt bei 20 µg/g Muschelgewebe. Sowohl mit Biotin-DO als auch mit OVA-DO als den zu messenden Größen waren Domoinsäurekonzentrationen unterhalb dieses Grenzwertes nachweisbar; allerdings erwies sich der Aufbau mit Biotin-DO um das ca. 20-fache empfindlicher als jener mit OVA-DO. rnDie in dieser Arbeit präsentierten Ergebnisse könnten als Grundlage zur Etablierung eines kommerzialisierbaren immunologischen Testsystems zur Detektion von Domoinsäure und anderen Biotoxinen dienen. Nach erfolgreicher Validierung wäre ein solches Testsystem in seiner Handhabung einfacher als die gängige Flüssigkeitschromatographie und besser reproduzierbar als der Maus-Bioassay.rn

Obesity and overweight associated with lower rates of colorectal cancer screening in Switzerland

Screening for colorectal cancer (CRC) is associated with reduced CRC mortality, but low screening rates have been reported in several settings. The aim of the study was to assess predictors of low CRC screening in Switzerland. A retrospective cohort of a random sample of 940 patients aged 50-80 years followed for 2 years from four Swiss University primary care settings was used. Patients with illegal residency status and a history of CRC or colorectal polyps were excluded. We abstracted sociodemographic data of patients and physicians, patient health status, and indicators derived from RAND's Quality Assessment Tools from medical charts. We defined CRC screening as colonoscopy in the last 10 years, flexible sigmoidoscopy in the last 5 years, or fecal occult blood testing in the last 2 years. We used bivariate and multivariate logistic regression analyses. Of 940 patients (mean age 63.9 years, 42.7% women), 316 (33.6%) had undergone CRC screening. In multivariate analysis, birthplace in a country outside of Western Europe and North America [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.45-0.97], male sex of the physician in charge (OR 0.67, 95% CI 0.50-0.91), BMI 25.0-29.9 kg/m2 (OR 0.66, CI 0.46-0.96) and at least 30.0 kg/m2 (OR 0.61, CI 0.40-0.90) were associated with lower CRC screening rates. Obesity, overweight, birthplace outside of Western Europe and North America, and male sex of the physician in charge were associated with lower CRC screening rates in Swiss University primary care settings. Physician perception of obesity and its impact on their recommendation for CRC screening might be a target for further research.

Serum calcification propensity predicts all-cause mortality in predialysis CKD

Medial arterial calcification is accelerated in patients with CKD and strongly associated with increased arterial rigidity and cardiovascular mortality. Recently, a novel in vitro blood test that provides an overall measure of calcification propensity by monitoring the maturation time (T50) of calciprotein particles in serum was described. We used this test to measure serum T50 in a prospective cohort of 184 patients with stages 3 and 4 CKD, with a median of 5.3 years of follow-up. At baseline, the major determinants of serum calcification propensity included higher serum phosphate, ionized calcium, increased bone osteoclastic activity, and lower free fetuin-A, plasma pyrophosphate, and albumin concentrations, which accounted for 49% of the variation in this parameter. Increased serum calcification propensity at baseline independently associated with aortic pulse wave velocity in the complete cohort and progressive aortic stiffening over 30 months in a subgroup of 93 patients. After adjustment for demographic, renal, cardiovascular, and biochemical covariates, including serum phosphate, risk of death among patients in the lowest T50 tertile was more than two times the risk among patients in the highest T50 tertile (adjusted hazard ratio, 2.2; 95% confidence interval, 1.1 to 5.4; P=0.04). This effect was lost, however, after additional adjustment for aortic stiffness, suggesting a shared causal pathway. Longitudinally, serum calcification propensity measurements remained temporally stable (intraclass correlation=0.81). These results suggest that serum T50 may be helpful as a biomarker in designing methods to improve defenses against vascular calcification.

Lazy lips: hyperkalemia and acute tetraparesis-a case report from an urban emergency department.

A 58-year-old male patient was admitted to our emergency department at a large university hospital due to acute onset of general weakness. It was reported that the patient was bradycardic at 30/min and felt an increasing weakness of the limbs. At admission to the emergency department, the patient was not feeling any discomfort and denied dyspnoea or pain. The primary examination of the nervous system showed the cerebral nerves II-XII intact, muscle strength of the lower extremities was 4/5, and a minimal sensory loss of the left hemisphere was found. In addition, the patient complained about lazy lips. During ongoing examinations, the patient developed again symptomatic bradycardia, accompanied by complete tetraplegia. The following blood test showed severe hyperkalemia probably induced by use of aldosterone antagonists as the cause of the patient's neurologic symptoms. Hyperkalemia is a rare but treatable cause of acute paralysis that requires immediate treatment. Late diagnosis can delay appropriate treatment leading to cardiac arrhythmias and arrest.

AMERICAN TRYPANOSOMIASIS (CHAGAS') DISEASE - A STUDY OF FETO-MATERNAL MORBIDITY AND MORTALITY

The possibility of a relationship between American Trypanosomiasis (Chagas') disease and pregnancy outcome was analyzed measuring feto-maternal morbidity and mortality in a sample of 604 pregnant women and their offspring seen at the Hospital Universitario de Maternidad y Neonatologia in Cordoba, Argentina during 1979.^ A cross-sectional, "case-comparison" investigation was employed to determine the degree of risk between having a reactive chagasic serologic test and a negative pregnancy outcome as determined by abortion, stillbirth, and infant death prior to one week of age. Patients were selected using a dichotomous, 0-1 scale with either the presence or the absence of a reactive Machado-Guerreiro complement fixation serologic blood test result.^ The data obtained were analyzed using appropriate statistical techniques for measuring the comparisons between the case and control groups under various demographic and socioeconomic variables such as, age, marital status, educational attainment, and residence. Similarly, additional biological variables of birth order, maternal and fetal complications, and prematurity were examined.^ From the analysis of the data obtained in this investigation, no definite conclusions can be reached regarding the risk of having an unsuccessful pregnancy outcome in the presence of a reactive serologic finding because the study design was a cross-sectional one and the number of events were too few for an adequate analysis. Notwithstanding these limitations, the results obtained, after statistical adjustments were employed, demonstrated that women with a reactive test result were older, were of a higher parity, and were less educated. Marital status and residence were not significant variables. The risk of pregnancy wastage, however, was almost twice as frequent in the reactive group as in the non-reactive group of women. Statistically significant differences in maternal morbidity involved two complications, polyhydramnios and varicosities of the lower extremities and vulva; while in the newborn, infection was higher in infants whose mothers exhibited a reactive serologic test result.^ In summary, what this research study has shown is the need for engaging in a larger, longitudinal study for an in-depth exploration of feto-maternal morbidity and mortality--an investigation that would corraborate or refute the findings of this study.^

Cetoacidosis inducida por corticoides y gatifloxacina en una mujer joven no diabética

Objetivo: Comunicar un caso de cetoacidosis inducida por corticoides y gatifloxacina y discutir los mecanismos de esta inusual y seria complicación. Caso clínico: Mujer de 32 años, ingresa por neumonía adquirida en la comunidad de 5 días de evolución. Antecedentes: AR probable diagnosticada 4 meses antes tratada con metotrexate y corticoides intermitente. Examen físico: regular estado general, IMC 21, Tº 38ºC, FR 32/min, derrame pleural derecho, FC 96/min, PA 110/70, artralgias sin artritis. Exámenes complementarios: Hto 23%, GB 16300/mm3, VSG 96mm/1ºh, glucemia 0.90mg/dl, función hepática y amilasa normales, uremia 1.19g/l, creatinina 19mg/l. Hemocultivos (2) y esputo positivos para Neumococo penicilina-sensible. La neumonía responde a gatifloxacina. Deteriora la función renal hasta la anuria con acidosis metabólica. Se interpreta como glomerulonefritis lúpica rápidamente progresiva por proteinuria de 2g/24hs, FR (+) 1/1280, FAN (+) 1/320 homogéneo, Anti ADN (+) , complemento bajo: C3 29.4mg/dl y C4 10mg/dl, Ac anti Ro, La, Scl70, RNP y anticardiolipinas positivos. Se indica metilprednisolona EV (3 bolos 1g), complicándose con hiperglucemias de >6 g/l y cetoacidosis con cetonuria (+); Ac anti ICA y antiGAD negativos con HbA1C 5.2%. Es tratada en UTI (insulina y hemodiálisis). La paciente mejora, se desciende la dosis de corticoides, con normalización de la glucemia sin tratamiento hipoglucemiante. Comentarios 1) La presencia de HbA1C nomal, Ac anti ICA y GAD negativos permite descartar con razonable grado de certeza una diabetes tipo1 asociada al lupus. 2) El desarrollo de la cetoacidosis durante el tratamiento con corticoides y gatifloxacina y su resolución posterior avalan el rol etiológico de los mismos. 3) La cetoacidosis puede explicarse por estimulación de la gluconeogénesis y la insulinoresistencia a nivel de receptor y post-receptor generada por los fármacos potenciado por el estado inflamatorio relacionado con el lupus y la sepsis.

Colored soldiers /

Preface -- Black recruits -- Scrap Jennings' whiskey -- Corporal Shoe-Blacken -- Presidential interference -- The grave digger -- The "K.P.'s" or a dark knight in June -- The razor raffle -- Skeeter and the dentist -- Cuffy Green -- Capt. Pig-Iron-Pete -- The blood test -- Private Snowball Sneed --Speedy aikin -- A wife's revenge -- Shorty Sim's funeral -- Straffus Ashtraft -- Satisfying a soldier.

A case of extraovarian primary peritoneal carcinoma in an oophorectomized-hysterectomized patient: a diagnostic dilemma

Extra Ovarian Primary Peritoneal Carcinoma (EOPPC) is a rare type of adenocarcinoma of the pelvic and abdominal peritoneum. The objective examination and the histological aspect of the neoplasia virtually overlaps with that of ovarian carcinoma. The reported case is that of a 72 year-old patient who had undergone a total hysterectomy with bilateral annessiectomy surgery 20 years earlier subsequently to a diagnosis for uterine leiomyomatosis. The patient came to our attention presenting recurring abdominal pain, constipation, weight loss, severe asthenia and fever. Her blood test results showed hypochromic microcytic anemia and a remarkable increase CA125 marker levels. Instrumental diagnostics with Ultrasound (US) and CT scans indicated the presence of a single peritoneal mass (10-12 cm diameter) close to the great epiploon. The patient was operated through a midline abdominal incision and the mass was removed with the great omentum. No primary tumor was found anywhere else in the abdomen and in the pelvis. The operation lasted approximately 50 minutes. The post-operative course was normal and the patient was discharged four days later. The histological exam of the neoplasia, supported by immunohistochemical analysis, showed a significant positivity for CA 125, vimentin and cytocheratin, presence of psammoma bodies, and cytoarchitectural pattern resembling that of a serous ovarian carcinoma even in absence of primitiveness, leading to a final diagnosis of EOPPC. The patient later underwent six cycles of chemotherapy with paclitaxel (135 mg/m2/24 hr) in association with cisplatin (75mg/m2). At the fourth year follow-up no sign of relapse was observed. .

HBV vaccination of HCV-infected patients with occult HBV infection and anti-HBc-positive blood donors

Anti-HBc positivity is a frequent cause of donation rejection at blood banks. Hepatitis B virus (HBV) infection may also occur in HBsAg-negative patients, a situation denoted occult infection. Similarly, very low levels of HBV-DNA have also been found in the sera of patients with chronic hepatitis C virus (HCV) infection, even in the absence of serum HBsAg. Initially we searched for HBV-DNA in serum of 100 blood donors and 50 HCV-infected patients who were HBsAg negative/anti-HBc positive by nested-PCR and by an HBV monitor commercial test for HBV-DNA. Anti-HBs seroconversion rates were measured in 100 blood donors and in 22 patients with chronic HCV infection after HBV vaccination to determine if the HBV vaccination could eliminate an occult HBV infection in these individuals. Occult HBV infection was detected in proportionally fewer blood donors (6/100 = 6%) than chronic hepatitis C patients (12/50 = 24%) (P < 0.05). We noted seroconversion in 6/6 (100%) HBV-DNA(+) and in 84/94 (89.4%) HBV-DNA(-) blood donors (P > 0.05). All subjects who were HBV-DNA(+) before the first dose of HBV vaccine (D1), became HBV-DNA(-) after D1, D2, and D3. Among 22 HCV-positive patients, 10 HBV-DNA(+) and 12 HBV-DNA(-), seroconversion was observed in 9/10 (90%) HBV-DNA(+) and in 9/12 (75%) HBV-DNA(-) subjects (P > 0.05). The disappearance of HBV-DNA in the majority of vaccinated patients suggests that residual HBV can be eliminated in patients with occult infection.

Human immunodeficiency virus test-seeking blood donors in a large blood bank in Sao Paulo, Brazil

BACKGROUND: Persons with human immunodeficiency virus (HIV) risk behaviors are excluded from donation to reduce the risk of transfusion-transmitted infection. Persons donating to be tested for HIV may therefore deny risk behaviors. STUDY DESIGN AND METHODS: A random sample of donors completed a survey on motivations, knowledge, and attitudes on the screening process. Donors were considered test seekers if they agreed with two statements ""I think that blood donation is a good, fast, and anonymous way to get my blood tested"" and ""I donate to get my test results."" This study was conducted from June to November 2006 at the largest blood bank in Sao Paulo, Brazil. RESULTS: Of 3061 participants, 208 (7%) were test seekers. They tended to be male and had a lower educational level. They were more likely to have incorrect knowledge about blood safety (e.g., not knowing that a unit can test antibody negative and still transmit infection, 60% vs. 42%, p = 0.02), express dissatisfaction with screening questions (e.g., feeling that important questions were not asked, 14% vs. 5%, p < 0.01), and concur that donors do not answer questions truthfully (e.g., donors have more sexual partners than they admit, 29% vs. 18%, p < 0.01). Test seekers were more likely to believe that it is acceptable to donate blood to get tested for HIV (41% vs. 10%, p < 0.01). CONCLUSIONS: Test-seeking motivation, coupled with low knowledge of window period risk, is counter to improving blood safety and to donor prevention needs. Donor education needs to be improved along with availability of appropriate HIV counseling and testing.