A Zona Incerta no sagüi (Callithrix jacchus): Análise Citoarquitetônica, Neuroquímica e Projeção Retiniana

The retinal projections in mammals usually reach, classically, three major functional systems: the primary visual system, the accessory optic system, and the circadian timing system. But the retinal projections also reach areas classically considered non-visual, one of which groups the neurons of the zona incerta (ZI), target this study. The primary visual system includes thalamic lateral geniculate complex is formed by the dorsal lateral geniculate nucleus, intergeniculate leaflet and the ventral lateral geniculate nucleus and other Components. The accessory optic system is composed of the small nuclei: nuclei terminal dorsal, lateral, medial and the interstitial nucleus of the superior posterior fasciculus. These nuclei are involved in visuo-motor activities. The circadian timing system is comprised of the suprachiasmatic nucleus of the hypothalamus, that act as master circadian pacemaker, entraining pathways and efferents pathways to the efectors, and the intergeniculate leaflet, that seems to act as a modulator of the pacemaker. The retinal projections too reach classically considered non-visual areas, including the zona incerta. This region is localized in the ventral thalamus and has been implicated in various functional properties including nociceptive and somatosensory processing, motor response, sociosexual behaviour, feeding and drinking, in symptoms of neurodegenerative diseases, arousal and attention. It also displays connection with several areas of central nervous system. The aim of this study was characterize the retinal projection in the zona incerta of Callithrix jacchus (sagüi), a primate of the New World through the anterograde axonal transport of the cholera toxin subunit b and analyze the citoarchicteture using Nissl and NeuN, and neurochemical substances such as serotonin, GABA, VIP, VP, GFAP and binding-calcium proteins. The zona incerta showed a different division of the literature in citoarquitetura, both by means of Nissl as neurochemical by NeuN, with a subdivision ventrolateral and dorsomedial. The neurochemical to the other substances corroborate with this subdivision. The GFAP was almost completely negative for the zona incerta, result non evidenced in previous studies yet. The 16 retinal projection in sagüi, unlike other primates and rodents, reached the caudal portion only. This work helps to make further studies are conducted based on this subdivision and the localization of the neurochemical substances associated with possible behaviors that the zona incerta is involved

Sofrimento solitário, mal-estar compartilhado :um estudo sobre a doença dos nervos

Nerves has been perceived as generalized suffering with multiple complaints, such as pain and other physical sensations, usually followed by symptoms of anxiety and/or depression. Even after medications have been prescribed, mainly psychotropic drugs to reduce these symptoms, exams aiming to discover the causes of the disorders, and a significant referral to health services, the problem tends to get progressively worse. The objective of this study is to characterize the diseases of clients who complain of nerves at the Unidade Mista de Felipe Camarão, Natal/RN, through in depth interviews, allowing for the clarification of ideas, beliefs and the meanings attributed to nerves by that person; to identify the symptoms and to know how they interfere in daily activities; to investigate the causes attributed to the problem and their relation to the biographical and psychosocial context of the patient. Thirteen women, health service clients, aged 30 to 59 years old, participated in the research. It was observed that they perceive, feel and act in unique ways with relation to symptoms, as well as to the attributed explanations and treatments given, showing the influence of life conditions, family context and their own subjectivity. Daily concerns and overwhelming responsibilities in the domestic environment, which usually stem from their precarious survival conditions, as well as marital conflicts motivated by the inequity of gender relations, contribute to trigger this type of suffering. The methodology of the research itself proved to be crucial to the comprehension and understanding of the meanings attributed to the complaints as well as to the argumenting process and the redefinition of the illness experience. Therefore, the importance of interdisciplinary intervention must be emphasize and specially the role of listening as relevant intervention resource

O paciente com infecção de vias aéreas superiores. Quando anestesiar?

JUSTIFICATIVA E OBJETIVOS: Anestesiar, com segurança, a criança com infecção de vias aéreas superiores (IVAS) constitui um dos grandes desafios do anestesiologista. A finalidade deste artigo é discutir a validade de anestesiar e quando anestesiar a criança com IVAS. CONTEÚDO: Estão ressaltados a importância da história clínica na investigação pré-operatória, os fatores que contribuem para o aparecimento de complicações no per e no pós-operatório, assim como o tipo de cirurgia e a técnica anestésica que favorecem estas complicações. CONCLUSÕES: O conhecimento das alterações no trato respiratório que acontecem após IVAS, da importância da avaliação correta da gravidade dos sintomas, dos fatores que podem contribuir para o aparecimento de complicações e da melhor técnica anestésica possibilita a seleção de pacientes com menor risco de desenvolver complicações no período per-operatório.

Extrinsic compression of popliteal artery in asymptomatic athlete and non-athlete individuals - A comparative study using duplex scan (color duplex sonography)

Aim. Extrinsic compression of the popliteal artery and absence of surrounding anatomical abnormalities characterize the functional popliteal artery entrapment syndrome (PAES). The diagnosis is confirmed to individuals who have typical symptoms of popliteal entrapment and occlusion or important stenosis of the popliteal artery with color duplex sonography (CDS), magnetic resonance imaging (MRI) or arteriography during active plantar flexion-extension maneuvers. However, variable result findings in normal asymptomatic subjects have raised doubts as to the validity of these tests. The purpose of this study was to compare the frequency of popliteal artery compression in 2 groups of asymptomatic subjects, athletes and non-athletes.Methods. Forty-two individuals were studied. Twenty-one subjects were indoor soccer players, and 21 were sedentary individuals. Physical activity was evaluated through questionnaires, anthropometric measurements, and cardiopulmonary exercise test. Evaluation of popliteal artery compression was performed in lower limbs with CDS, ankle-brachial index (ABI) measurements and continuous wave Doppler of the posterior tibial artery.Results. The athletes studied fulfilled the criteria of high level of physical activity whereas sedentary subjects met the criteria of low level of activity. Popliteal artery compression was observed with CDS in 6 (14.2%) studied subjects; 2 of whom (4.7%) were athletes and 4 (9.5%) were non-athletes. This difference was not statistically significant (p=0.21). Doppler of the tibial arteries and ABI measurements gave good specificity and sensibility in the identification of popliteal artery compression.Conclusion. The frequency of popliteal artery compression during maneuvers in normal subjects was 14.2% irrespective of whether or not they performed regular physical activities. Both Doppler and ABI showed good agreement with CDS and should be considered in screening popliteal arteries in individuals suspected of PAES.

Evaluation of nutritional status in patients with endemic pemphigus foliaceus

A avaliação nutricional foi realizada em dezesseis doentes portadores de pênfigo foliáceo endêmico, sendo dez portadores da forma localizada da doença (Grupo G1) e seis portadores da forma disseminada da mesma (Grupo G2). Foram realizadas avaliações antropométricas (peso, altura, índice de Quetelét, prega cutânea tricipital, prega cutânea subescapular, circunferência braquial, circunferência muscular do braço, área do braço, área muscular do braço, área adiposa do braço) e laboratorial (eletroforese de proteínas séricas). Quanto aos parâmetros antropométricos, observaram-se as seguintes alterações: a circunferência do braço, área do braço, e área muscular do braço mostraram valores mais baixos nos doentes do grupo G2 que nos do grupo G1. O peso e a circunferência muscular do braço, por sua vez, mostraram tendência a valores mais baixos nos doentes do grupo G2 que nos do grupo G1. A eletroforese de proteínas revelou valores de albumina diminuídos em ambos os grupos, e menores nos doentes do grupo G2. Quanto às demais frações, com exceção das beta globulinas, não foram evidenciadas alterações. A análise global dos resultados permite concluir que os doentes com pênfigo foliáceo endêmico apresentam um quadro de desnutrição proteica, mas não calórica. Esta desnutrição mostrou-se mais acentuada no pênfigo foliáceo disseminado.

Injuries caused by scorpionfishes and (Scorpaena plumieri Bloch, 1789 Scorpaena brasiliensis Cuvier 1829) in the Southwestern Atlantic Ocean (Brazilian coast): epidemiologic, clinic and therapeutic aspects of 23 stings in humans

Fishes of the family Scorpaenidae are responsible for severe injuries and occasionally deaths in humans around the world. The more venomous fishes on the Brazilian coast and in the Southwestern Atlantic region are classified in the genus Scorpaena (family Scorpaenidae). However, there are few studies on the venomous apparatus, the effects of the venom, or clinical aspects of human envenoming provoked by Atlantic scorpionfishes.In this communication, the authors present 23 accidents caused by scorpionfishes of the genus Scorpaena among fishermen, and report the species that provoked the injuries, the circumstances of contacts, the clinical aspects observed and the therapeutic measures utilized for control of the symptoms of the victims. The intense pain and the systemic findings observed in the patients were very frequent and we think that the injuries provoked by scorpionfishes should be considered the most important manifestations caused by venomous fishes of the East Atlantic Ocean. (C) 2003 Elsevier B.V. Ltd. All rights reserved.

Primary cutaneous cryptococcosis in Brazil: report of 11 cases in immunocompetent and immunosuppressed patients

Background Primary cutaneous cryptococcosis is an uncommon infectious disease caused by Cryptococcus neoformans or Cryptococcus gattii affecting immunosuppressed as well as immunocompetent patients. It is often misdiagnosed as it may mimic other cutaneous diseases. Materials and methods We report a series of cases diagnosed from 2005 to 2010 in two general hospitals. The diagnosis in all patients was made on the basis of histopathology and culture. Phenoloxidase and canavanine-glycine-bromothymol blue tests were used in order to identify the Cryptococcus species. Systematic investigation ruled out the systemic involvement in every case. Results Eleven patients, 81.8% male, were diagnosed during this study. The immunosuppression status was identified in 54.5% of patients, and all of them were under corticosteroid therapy due to a variable set of diseases. All patients presented with circumscribed lesions on their upper limbs. Most lesions showed an infiltrative or tumoral aspect with up to 40 cm diameter. Fluconazole, up to 400 mg/daily, was the main therapeutic regimen and proved to be efficient. Conclusions Primary cutaneous cryptococcosis has been diagnosed in both immunosuppressed and immunocompetent patients. Its peculiar clinical aspect could facilitate early diagnosis. Culture and biochemical tests should be performed in order to define the species involved.

Low-level laser therapy for the treatment of epidermolysis bullosa: A case report

Epidermolysis bullosa (EB) is a rare group of diseases characterized by skin fragility. There is no specific treatment, short of protection from trauma, currently available for these patients. Low-level laser therapy (LLLT) was effective as an analgesic and in accelerating cutaneous wound healing after six sessions of therapy in a child with dystrophic EB with cutaneous scarring and blisters on the limbs and trunk.

Assessment of Quality of Life and Psychologic Aspects in Patients with Gestational Trophoblastic Disease

OBJECTIVE: To assess quality of life (QoL) and psychological aspects in patients with gestational trophoblastic disease (GTD).METHODS: This cross-sectional self-report study was conducted among 54 women. Validated questionnaires assessed QoL (WHO-QOL-bref), symptoms of depression (Beck Depression Inventory [BDI]) and anxiety (State-Trait Anxiety Inventory [STAI]).RESULTS: Most patients rated overall QoL as good (44.44%) anti were satisfied with their health status (42.59%). Mean QoL domain score was lowest for psychologic health (53.86 +/- 21.46) and highest for social relationships (65.74 +/- 22.41). BDI mean was 15.81 +/- 11.15, indicating dysphoria. STAI means were 46 +/- 6.46 for trait-anxiety and 43.72 +/- 4.23 for state-anxiety, both evidencing medium-high anxiety. Among employed patients, environment domain mean was the highest (p = 0.024). Presence of children resulted in lowest means for physical health (p = 0.041) and environment (p = 0.045). Patients desiring children showed significantly higher means for physical health (p = 0.004), psychological health (p = 0.021) and environment (p = 0.003). Chemotherapy had no significant influence on QoL (p > 0.05).CONCLUSION: This study evidenced psychological impact on GTD patients, suggesting specialized care centers should provide psychological interventions during treatment and follow-up of GTD patients, highlighting the importance of a multidisciplinary approach. (J Reprod Med 2009;54:239-244)

Vaginal Flora Alterations and Clinical Symptoms in Low-Risk Pregnant Women

Background: To evaluate associations between alterations in vaginal flora and clinical symptoms in low-risk pregnant women. Methods: Vaginal specimens from 245 pregnant women were analyzed by microscopy for vaginal flora. Signs and symptoms of vaginal infection were determined by patient interviews and gynecologic examinations. Results: Abnormal vaginal flora was identified in 45.7% of the subjects. The final clinical diagnoses were bacterial vaginosis (21.6%), vaginal candidosis (10.2%), intermediate vaginal flora (5.2%), aerobic vaginitis (2.9%), mixed flora (2.9%) and other abnormal findings (2.9%). The percentage of women with or without clinical signs or symptoms was not significantly different between these categories. The presence of vaginal odor or vaginal discharge characteristics was not diagnostic of any specific flora alteration; pruritus was highly associated with candidosis (p < 0.0001). Compared to women with normal flora, pruritus was more prevalent in women with candidosis (p < 0.0001), while vaginal odor was associated with bacterial vaginosis (p = 0.0026). Conclusion: The prevalence of atypical vaginal flora is common in our low-risk pregnant population and is not always associated with pathology. The occurrence of specific signs or symptoms does not always discriminate between women with different types of atypical vaginal flora or between those with abnormal and normal vaginal flora. Copyright (C) 2010 S. Karger AG, Basel

Síndromes hipertensivas da gestação: identificação de casos graves

A hipertensão arterial está entre as causas mais freqüentes de morte materna. Entre os tipos presentes na gravidez destacam-se as manifestações específicas, isto é, a pré-eclâmpsia e a hipertensão gestacional, definidas clinicamente por aumento dos níveis da pressão arterial após a 20ª semana de gestação, associado (pré-eclâmpsia) ou não (hipertensão gestacional) à proteinúria. Na fase inicial a doença é assintomática, porém, quando não tratada ou não se interrompe a gestação, sua evolução natural é desenvolver as formas graves, como a eclâmpsia e a síndrome HELLP. Eclâmpsia é definida pela manifestação de uma ou mais crises convulsivas tônico-clônicas generalizadas e/ou coma, em gestante com hipertensão gestacional ou pré-eclâmpsia, na ausência de doenças neurológicas. Pode ocorrer durante a gestação, durante o trabalho de parto e no puerpério imediato. É comumente precedida pelos sinais e sintomas de eclâmpsia iminente (distúrbios do sistema nervoso central, visuais e gástricos). A associação de hemólise, plaquetopenia e disfunção hepática já era relatada na literatura na década de cinqüenta. em 1982, Weinstein reuniu estas alterações sob o acrônimo de HELLP, significando hemólise (H), aumento de enzimas hepáticas (EL) e plaquetopenia (LP), e denominou-as de síndrome HELLP. A literatura diverge em relação aos valores dos parâmetros que definem a síndrome. Sibai et al. (1986) propuseram sistematização dos padrões laboratoriais e bioquímicos para o diagnóstico da mesma, que foi adotada pelo Ministério da Saúde do Brasil. As manifestações clínicas podem ser imprecisas, sendo comuns queixas como dor epigástrica, mal-estar geral, inapetência, náuseas e vômitos. O diagnóstico precoce é, eminentemente, laboratorial e deve ser pesquisado de maneira sistemática nas mulheres com pré-eclâmpsia grave/eclâmpsia e/ou dor no quadrante superior direito do abdome. Diferenciar a síndrome HELLP de outras ocorrências, com manifestações clínicas e/ou laboratoriais semelhantes, não é tarefa fácil. O diagnóstico diferencial é particularmente difícil para doenças como púrpura trombocitopênica trombótica, síndrome hemolítico-urêmica e fígado gorduroso agudo da gravidez, devido à insuficiente história clínica e à semelhança dos aspectos fisiopatológicos. O conhecimento da fisiopatologia da pré-eclâmpsia, o diagnóstico precoce e a atuação precisa no momento adequado nas situações complicadas pela eclâmpsia e/ou síndrome HELLP permitem melhorar o prognóstico materno e perinatal.

Consequences of Chronic Nasal Obstruction on the Laryngeal Mucosa and Voice Quality of 4- to 12-Year-Old Children

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

Hiperoxalúria primária com insuficiência renal crônica terminal em lactente

Objetivo: descrever caso clínico de um lactente com insuficiência renal crônica terminal, causada por hiperoxalúria primária.Método: após revisão da literatura, verifica-se a raridade da doença; na França, a prevalência é de 1,05/milhão, com taxa de incidência de 0,12/milhão/ano. Pesquisa abordando centros especializados mundiais detectou, em 1999, 78 casos em lactentes; destes, em 14% o quadro inicial foi de uremia. A gravidade e a raridade da doença sugerem o relato deste caso.Resultados: criança de sexo feminino, com quadro de vômitos e baixo ganho de peso desde os primeiros meses de vida, desenvolveu insuficiência renal terminal aos 6 meses de idade, sendo mantida em tratamento dialítico desde então. Aos 8 meses, foi encaminhada para esclarecimento diagnóstico, apresentando déficit pôndero-estatural grave e os seguintes exames laboratoriais: uréia= 69 mg/dl, creatinina=2,2 mg/dl e clearance de creatinina= 12,5 ml/min/1.73m²SC. O exame de urina foi normal, a ultra-sonografia renal revelou tamanho normal e hiperecogenicidade de ambos os rins. A dosagem de oxalato urinário foi de 9,2mg/kg/dia ou 0,55 mmol/1.73m²SC, e a relação oxalato:creatinina, de 0,42. A biópsia renal diagnosticou presença de grande quantidade de depósitos de cristais de oxalato de cálcio no parênquima renal. A radiografia de ossos longos evidenciou sinais sugestivos de osteopatia oxalótica, e a fundoscopia indireta, sinais de retinopatia por oxalato. A criança foi mantida em diálise peritoneal ambulatorial contínua, tendo sido iniciado tratamento com piridoxina.Conclusões: a hiperoxalúria primária deve ser considerada como um dos diagnósticos diferenciais de insuficiência renal crônica em lactentes, especialmente na ausência de história sugestiva de outras patologias.

Evaluation of cytokines concentration and percentage of survival of rabies virus-infected mice submitted to anti-rabies Vero-cell propagated vaccine and P-acnes

Previously, survival of rabies infection was shown to correlate with low IL-6 serum concentration in mice subjected to post-exposure treatment with the Fuenzalida Palacios rabies vaccine in conjunction with the immunomodulator Propionibacterium acnes, previously Corynebacterium parvum. Considering the substitution of the Fuenzalida Palacios rabies vaccine by the Vero cell raised anti-rabies vaccine in almost all countries, the objective of this work was to evaluate the survival and cytokine serum concentration of rabies virus-infected mice treated with P. acnes in conjunction with or the anti-rabies-VERO vaccine. For this, Swiss mice were experimentally infected with street rabies virus and subjected to vaccine and/or P. acnes following infection. Animals were killed at different times and serum was collected to evaluate cytokines. The greatest survival was observed in animals given one or two does of P. acnes in the absence of vaccination. Animals given anti-rabies VERO vaccine alone or with three doses of P. acnes had the second highest survival rate. The group that had the highest percentage of mortality also had the highest IL-6 concentration on the 10th day, a time correlating with clinical symptoms of the animals. The results reinforce the inefficacy of anti-rabies vaccine in only one dose as a post-exposure treatment irrespective of the type of vaccine used, the immunomodulation activity of P. acnes in rabies post-exposure treatment and suggest a role for IL-6 in rabies virus pathogenesis. (c) 2006 Elsevier B.V. All rights reserved.

Análise das condições de saúde e de vida da população urbana de Botucatu, SP (Brasil): III - Conhecimentos e opiniões dos profissionais de saúde a respeito de sintomas de doenças, 1984

Foram estudados os conhecimentos e opiniões dos profissionais de saúde do Município de Botucatu, SP (Brasil), acerca da freqüência e gravidade de treze sintomas e sinais de doenças, visando à comparação com as opiniões emitidas pela população urbana do Município. Foram entrevistados 435 profissionais de saúde ativos (médicos, enfermeiros, auxiliares e atendentes de enfermagem e outros), a maioria do sexo feminino, com idade de 25 a 44 anos. A categoria de atendentes foi a mais numerosa. de modo geral, os cinco últimos sintomas da relação constante do formulário - sangue no escarro, sangramento vaginal, caroço no seio, acessos e sangue na urina, foram considerados menos freqüentes e mais graves, comparativamente aos oito primeiros: falta de ar, febre, fraqueza, dor nas costas, dor no peito, dor de cabeça, tosse e diarréia. Dentre as categorias, os médicos diferenciaram-se atribuindo, com menor freqüência, escores altos para a freqüência e gravidade. Os clínicos valorizaram mais do que os cirurgiões, esses dois fatores, para quase todos os sintomas. O cotejo com a opinião dos leigos entrevistados revelou semelhanças nas tendências, embora tenha havido, por parte destes, maior valorização da freqüência e gravidade.