Blood Pressure Variation Throughout Pregnancy According to Early Gestational BMI: A Brazilian Cohort

Background: The maternal cardiovascular system undergoes progressive adaptations throughout pregnancy, causing blood pressure fluctuations. However, no consensus has been established on its normal variation in uncomplicated pregnancies. Objective: To describe the variation in systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels during pregnancy according to early pregnancy body mass index (BMI). Methods: SBP and DBP were measured during the first, second and third trimesters and at 30-45 days postpartum in a prospective cohort of 189 women aged 20-40 years. BMI (kg/m2) was measured up to the 13th gestational week and classified as normal-weight (<25.0) or excessive weight (≥25.0). Longitudinal linear mixed-effects models were used for statistical analysis. Results: A decrease in SBP and DBP was observed from the first to the second trimester (βSBP=-0.394; 95%CI: -0.600- -0.188 and βDBP=-0.617; 95%CI: -0.780- -0.454), as was an increase in SBP and DBP up to 30-45 postpartum days (βSBP=0.010; 95%CI: 0.006-0.014 and βDBP=0.015; 95%CI: 0.012-0.018). Women with excessive weight at early pregnancy showed higher mean SBP in all gestational trimesters, and higher mean DBP in the first and third trimesters. Excessive early pregnancy BMI was positively associated with prospective changes in SBP (βSBP=7.055; 95%CI: 4.499-9.610) and in DBP (βDBP=3.201; 95%CI: 1.136-5.266). Conclusion: SBP and DBP decreased from the first to the second trimester and then increased up to the postpartum period. Women with excessive early pregnancy BMI had higher SBP and DBP than their normal-weight counterparts throughout pregnancy, but not in the postpartum period.

Assessment of Myocardial Ischemia in Obese Individuals Undergoing Physical Stress Echocardiography (PSE)

Background: Physical stress echocardiography is an established methodology for diagnosis and risk stratification of coronary artery disease in patients with physical capacity. In obese (body mass index ≥ 30 kg/m2) the usefulness of pharmacological stress echocardiography has been demonstrated; however, has not been reported the use of physical stress echocardiography in this growing population group. Objective: To assess the frequency of myocardial ischemia in obese and non-obese patients undergoing physical stress echocardiography and compare their clinical and echocardiographic differences. Methods: 4,050 patients who underwent treadmill physical stress echocardiography were studied according to the Bruce protocol, divided into two groups: obese (n = 945; 23.3%) and non-obese (n = 3,105; 76.6%). Results: There was no difference regarding gender. Obese patients were younger (55.4 ± 10.9 vs. 57.56 ± 11.67) and had a higher frequency of hypertension (75.2% vs. 57, 2%; p < 0.0001), diabetis mellitus (15.2% vs. 10.9%; p < 0.0001), dyslipidemia (59.5% vs 51.9%; p < 0.0001), family history of coronary artery disease (59.3% vs. 55.1%; p = 0.023) and physical inactivity (71.4% vs. 52.9%, p < 0.0001). The obese had greater aortic dimensions (3.27 vs. 3.14 cm; p < 0.0001), left atrium (3.97 vs. 3.72 cm; p < 0.0001) and the relative thickness of the ventricule (33.7 vs. 32.8 cm; p < 0.0001). Regarding the presence of myocardial ischemia, there was no difference between groups (19% vs. 17.9%; p = 0.41). In adjusted logistic regression, the presence of myocardial ischemia remained independently associated with age, female gender, diabetes and hypertension. Conclusion: Obesity did not behave as a predictor of the presence of ischemia and the physical stress echocardiography. The application of this assessment tool in large scale sample demonstrates the feasibility of the methodology, also in obese.

Left Atrial Volume Determinants in Patients with Non-Ischemic Dilated Cardiomyopathy

Background:Left atrial volume (LAV) is a predictor of prognosis in patients with heart failure.Objective:We aimed to evaluate the determinants of LAV in patients with dilated cardiomyopathy (DCM).Methods:Ninety patients with DCM and left ventricular (LV) ejection fraction ≤ 0.50 were included. LAV was measured with real-time three-dimensional echocardiography (eco3D). The variables evaluated were heart rate, systolic blood pressure, LV end-diastolic volume and end-systolic volume and ejection fraction (eco3D), mitral inflow E wave, tissue Doppler e´ wave, E/e´ ratio, intraventricular dyssynchrony, 3D dyssynchrony index and mitral regurgitation vena contracta. Pearson´s coefficient was used to identify the correlation of the LAV with the assessed variables. A multiple linear regression model was developed that included LAV as the dependent variable and the variables correlated with it as the predictive variables.Results:Mean age was 52 ± 11 years-old, LV ejection fraction: 31.5 ± 8.0% (16-50%) and LAV: 39.2±15.7 ml/m2. The variables that correlated with the LAV were LV end-diastolic volume (r = 0.38; p < 0.01), LV end-systolic volume (r = 0.43; p < 0.001), LV ejection fraction (r = -0.36; p < 0.01), E wave (r = 0.50; p < 0.01), E/e´ ratio (r = 0.51; p < 0.01) and mitral regurgitation (r = 0.53; p < 0.01). A multivariate analysis identified the E/e´ ratio (p = 0.02) and mitral regurgitation (p = 0.02) as the only independent variables associated with LAV increase.Conclusion:The LAV is independently determined by LV filling pressures (E/e´ ratio) and mitral regurgitation in DCM.

Screening for Fabry Disease in Left Ventricular Hypertrophy: Documentation of a Novel Mutation

AbstractBackground:Fabry disease is a lysosomal storage disease caused by enzyme α-galactosidase A deficiency as a result of mutations in the GLA gene. Cardiac involvement is characterized by progressive left ventricular hypertrophy.Objective:To estimate the prevalence of Fabry disease in a population with left ventricular hypertrophy.Methods:The patients were assessed for the presence of left ventricular hypertrophy defined as a left ventricular mass index ≥ 96 g/m2 for women or ≥ 116 g/m2 for men. Severe aortic stenosis and arterial hypertension with mild left ventricular hypertrophy were exclusion criteria. All patients included were assessed for enzyme α-galactosidase A activity using dry spot testing. Genetic study was performed whenever the enzyme activity was decreased.Results:A total of 47 patients with a mean left ventricular mass index of 141.1 g/m2 (± 28.5; 99.2 to 228.5 g/m2] were included. Most of the patients were females (51.1%). Nine (19.1%) showed decreased α-galactosidase A activity, but only one positive genetic test − [GLA] c.785G>T; p.W262L (exon 5), a mutation not previously described in the literature. This clinical investigation was able to establish the association between the mutation and the clinical presentation.Conclusion:In a population of patients with left ventricular hypertrophy, we documented a Fabry disease prevalence of 2.1%. This novel case was defined in the sequence of a mutation of unknown meaning in the GLA gene with further pathogenicity study. Thus, this study permitted the definition of a novel causal mutation for Fabry disease - [GLA] c.785G>T; p.W262L (exon 5).

Assessment of Intima-Media Thickness in Healthy Children Aged 1 to 15 Years

Abstract Background: Carotid intima-media thickness (CIMT) has been shown to be increased in children and adolescents with traditional cardiovascular risk factors such as obesity, hypertension, and chronic kidney disease, compared with those of healthy children. Objective: To assess the influence of sex, age and body mass index (BMI) on the CIMT in healthy children and adolescents aged 1 to 15 years. Methods: A total of 280 healthy children and adolescents (males, n=175; mean age, 7.49±3.57 years; mean BMI, 17.94±4.1 kg/m2) were screened for CIMT assessment. They were divided into 3 groups according to age: GI, 1 to 5 years [n=93 (33.2%); males, 57; mean BMI, 16±3 kg/m2]; GII, 6 to 10 years [n=127 (45.4%); males, 78; mean BMI, 17.9±3.7 kg/m2], and GIII, 11 to 15 years [n=60 (21.4%); males, 40; mean BMI, 20.9±4.5 kg/m2]. Results: There was no significant difference in CIMT values between male and female children and adolescents (0.43±0.06 mm vs. 0.42±0.05 mm, respectively; p=0.243). CIMT correlated with BMI neither in the total population nor in the 3 age groups according to Pearson correlation coefficient. Subjects aged 11 to 15 years had the highest CIMT values (GI vs. GII, p=0.615; GI vs. GIII, p=0.02; GII vs. GIII, p=0.004). Conclusions: CIMT is constant in healthy children younger than 10 years, regardless of sex or BMI. CIMT increases after the age of 10 years.

A determinação dos números de indivíduos mínimos necessários na experimentação genética

The main object of the present paper consists in giving formulas and methods which enable us to determine the minimum number of repetitions or of individuals necessary to garantee some extent the success of an experiment. The theoretical basis of all processes consists essentially in the following. Knowing the frequency of the desired p and of the non desired ovents q we may calculate the frequency of all possi- ble combinations, to be expected in n repetitions, by expanding the binomium (p-+q)n. Determining which of these combinations we want to avoid we calculate their total frequency, selecting the value of the exponent n of the binomium in such a way that this total frequency is equal or smaller than the accepted limit of precision n/pª{ 1/n1 (q/p)n + 1/(n-1)| (q/p)n-1 + 1/ 2!(n-2)| (q/p)n-2 + 1/3(n-3) (q/p)n-3... < Plim - -(1b) There does not exist an absolute limit of precision since its value depends not only upon psychological factors in our judgement, but is at the same sime a function of the number of repetitions For this reasen y have proposed (1,56) two relative values, one equal to 1-5n as the lowest value of probability and the other equal to 1-10n as the highest value of improbability, leaving between them what may be called the "region of doubt However these formulas cannot be applied in our case since this number n is just the unknown quantity. Thus we have to use, instead of the more exact values of these two formulas, the conventional limits of P.lim equal to 0,05 (Precision 5%), equal to 0,01 (Precision 1%, and to 0,001 (Precision P, 1%). The binominal formula as explained above (cf. formula 1, pg. 85), however is of rather limited applicability owing to the excessive calculus necessary, and we have thus to procure approximations as substitutes. We may use, without loss of precision, the following approximations: a) The normal or Gaussean distribution when the expected frequency p has any value between 0,1 and 0,9, and when n is at least superior to ten. b) The Poisson distribution when the expected frequecy p is smaller than 0,1. Tables V to VII show for some special cases that these approximations are very satisfactory. The praticai solution of the following problems, stated in the introduction can now be given: A) What is the minimum number of repititions necessary in order to avoid that any one of a treatments, varieties etc. may be accidentally always the best, on the best and second best, or the first, second, and third best or finally one of the n beat treatments, varieties etc. Using the first term of the binomium, we have the following equation for n: n = log Riim / log (m:) = log Riim / log.m - log a --------------(5) B) What is the minimun number of individuals necessary in 01der that a ceratin type, expected with the frequency p, may appaer at least in one, two, three or a=m+1 individuals. 1) For p between 0,1 and 0,9 and using the Gaussean approximation we have: on - ó. p (1-p) n - a -1.m b= δ. 1-p /p e c = m/p } -------------------(7) n = b + b² + 4 c/ 2 n´ = 1/p n cor = n + n' ---------- (8) We have to use the correction n' when p has a value between 0,25 and 0,75. The greek letters delta represents in the present esse the unilateral limits of the Gaussean distribution for the three conventional limits of precision : 1,64; 2,33; and 3,09 respectively. h we are only interested in having at least one individual, and m becomes equal to zero, the formula reduces to : c= m/p o para a = 1 a = { b + b²}² = b² = δ2 1- p /p }-----------------(9) n = 1/p n (cor) = n + n´ 2) If p is smaller than 0,1 we may use table 1 in order to find the mean m of a Poisson distribution and determine. n = m: p C) Which is the minimun number of individuals necessary for distinguishing two frequencies p1 and p2? 1) When pl and p2 are values between 0,1 and 0,9 we have: n = { δ p1 ( 1-pi) + p2) / p2 (1 - p2) n= 1/p1-p2 }------------ (13) n (cor) We have again to use the unilateral limits of the Gaussean distribution. The correction n' should be used if at least one of the valors pl or p2 has a value between 0,25 and 0,75. A more complicated formula may be used in cases where whe want to increase the precision : n (p1 - p2) δ { p1 (1- p2 ) / n= m δ = δ p1 ( 1 - p1) + p2 ( 1 - p2) c= m / p1 - p2 n = { b2 + 4 4 c }2 }--------- (14) n = 1/ p1 - p2 2) When both pl and p2 are smaller than 0,1 we determine the quocient (pl-r-p2) and procure the corresponding number m2 of a Poisson distribution in table 2. The value n is found by the equation : n = mg /p2 ------------- (15) D) What is the minimun number necessary for distinguishing three or more frequencies, p2 p1 p3. If the frequecies pl p2 p3 are values between 0,1 e 0,9 we have to solve the individual equations and sue the higest value of n thus determined : n 1.2 = {δ p1 (1 - p1) / p1 - p2 }² = Fiim n 1.2 = { δ p1 ( 1 - p1) + p1 ( 1 - p1) }² } -- (16) Delta represents now the bilateral limits of the : Gaussean distrioution : 1,96-2,58-3,29. 2) No table was prepared for the relatively rare cases of a comparison of threes or more frequencies below 0,1 and in such cases extremely high numbers would be required. E) A process is given which serves to solve two problemr of informatory nature : a) if a special type appears in n individuals with a frequency p(obs), what may be the corresponding ideal value of p(esp), or; b) if we study samples of n in diviuals and expect a certain type with a frequency p(esp) what may be the extreme limits of p(obs) in individual farmlies ? I.) If we are dealing with values between 0,1 and 0,9 we may use table 3. To solve the first question we select the respective horizontal line for p(obs) and determine which column corresponds to our value of n and find the respective value of p(esp) by interpolating between columns. In order to solve the second problem we start with the respective column for p(esp) and find the horizontal line for the given value of n either diretly or by approximation and by interpolation. 2) For frequencies smaller than 0,1 we have to use table 4 and transform the fractions p(esp) and p(obs) in numbers of Poisson series by multiplication with n. Tn order to solve the first broblem, we verify in which line the lower Poisson limit is equal to m(obs) and transform the corresponding value of m into frequecy p(esp) by dividing through n. The observed frequency may thus be a chance deviate of any value between 0,0... and the values given by dividing the value of m in the table by n. In the second case we transform first the expectation p(esp) into a value of m and procure in the horizontal line, corresponding to m(esp) the extreme values om m which than must be transformed, by dividing through n into values of p(obs). F) Partial and progressive tests may be recomended in all cases where there is lack of material or where the loss of time is less importent than the cost of large scale experiments since in many cases the minimun number necessary to garantee the results within the limits of precision is rather large. One should not forget that the minimun number really represents at the same time a maximun number, necessary only if one takes into consideration essentially the disfavorable variations, but smaller numbers may frequently already satisfactory results. For instance, by definition, we know that a frequecy of p means that we expect one individual in every total o(f1-p). If there were no chance variations, this number (1- p) will be suficient. and if there were favorable variations a smaller number still may yield one individual of the desired type. r.nus trusting to luck, one may start the experiment with numbers, smaller than the minimun calculated according to the formulas given above, and increase the total untill the desired result is obtained and this may well b ebefore the "minimum number" is reached. Some concrete examples of this partial or progressive procedure are given from our genetical experiments with maize.

mRNA metabolism: nonsense mediated mRNA decay as a tool for gene therapy and the role of human DIS3L2 in transcript degradation

Tese de mestrado em Biologia Humana e Ambiente, apresentada à Universidade de Lisboa, através da Faculdade de Ciências, 2015

Los insectos galícolas en Schinus fasciculata (Anacardiaceae) en el Espinal del centro de Argentina

La más compleja de las interacciones que plantas e insectos han desarrollado durante el transcurso de su evolución, son las agallas. Las especies de insectos galícolas se encuentran en la mayoría de las regiones biogeográficas, principalmente en ambientes xéricos, de los cuales un ejemplo lo constituye la ecorregión del Espinal, ubicada en la Provincia Biogeográfica de la Pampa, Subregión Chaqueña. Schinus fasciculata (Griseb.) I.M. Johnst. (Anacardiaceae) es una especie arbórea o arbustiva representativa de la ecorregión del Espinal que presenta diversas agallas entomógenas. Los objetivos del presente trabajo son identificar las especies de insectos que producen agallas en hojas y tallos de Schinus fasciculata en un relicto de Espinal de la provincia de Córdoba y caracterizar exomorfológicamente las agallas. Se seleccionaron 18 ejemplares de S. fasciculata distribuidos en cuatro transectas de 100 m2. Se caracterizaron cinco morfotipos de agallas, tres en hojas, inducidas por insectos del orden Hemiptera y dos en tallos, originadas por insectos del orden Lepidoptera. Los insectos productores de las mismas fueron identificados a nivel de especie y los distintos morfotipos de agallas fueron únicos para cada especie de insecto inductor.

Estudo do ciclo evolutivo do "Schizotrypanum Cruzi" em cultura de tecidos de embrião de galinha

Culturas de tecido de embrião de galinha foram contaminadas com Schizotrypanum de diversas procedências. Serviram como material de contaminação, culturas em tubos de agar-sangue e em um caso sangue parasitado de cobaia. Os transplantes de tecidos foram mantidos em cultura de acordo com a técnica de Carrel, ligeiramente modificada. Os tecidos usados foram baço, miocárdio, fígado, epitélio da iris, gânglio espinhal e monócitos do sangue de galinha adulta. Em todos estes tecidos o Schizotrypanum foi facilmente cultivado, parasitando os diferentes tipos de células existentes: fibroblastos, histiocitos, macrófagos, células epiteliais, células nervosas, etc. Os autores puderam seguir o ciclo completo do parasito, confirmando os conhecimentos clássicos da sua evolução no tecido: transformação em leishmânia, multiplicação por divisão binária, transformação em critídia e finalmente em tripanosoma adulto. Também observaram formas parasitárias que aparentemente evoluiram diretamente da forma de leishmânia à de tripanosoma, sem passar por critídia. Conseguiu-se a infecção de um camondongo inoculado com S. cruzi de origem humana passado por cultura de tecidos. Os autores também estudam diferentes fenômenos observados nas relações entre as células e os parasitos.

O puru-puru da Amazônia (Pinta, Carate, Mal del Pinto etc)

1) "Purú-purú" é uma palavra indígena que quer dizer "pintado" ou "manchado", peculiar à Amazonia Brasileira. Com êsse nome é designada uma dermatose referida entre os selvicolas desde 1774, por Ribeiro Sampaio. Certas tribus, com alta incidência da moléstia passaram a ser cahamadas também "Purú-purús", o mesmo acontecendo com o rio onde habitavam - Rio Purús. 2) A doença existe na bacia do Rio Solimões e seus principais afluentes: Javari, Juruá, Purús, Içá, Japurá, e Negro. Por esses rios, o fóco da dermatose se continua nos países limitrofes com o Brasil: Guianas, Venezuela, Colombia, Perú (Equador) e Bolivia. 3) Desde 1890 essa dermatose foi relacionada à pinta (carate ou mal del pinto) por P. S. de Magalhães, idéa essa depois defendida por Juliano Moreira, Carlos Chagas, Roquete Pinto, Wappeus, O. da Fonseca Filho, Da Matta, Brumpt e outros, baseados na semelhança clínica e na terapêutica. Recentemente (1945), essa provavel identidade das duas dermatoses, recebeu fundamento sorológico de Biocca (que verificou a positividade das reações de Kline e Kahn em doentes de purú-purú), e, pelo presente trabalho, recebe base clínico-epidemio-anatomo-patológica. 4) Sob o ponto de vista clínico, as lesões cutaneas discromicas da moléstia, são de 3 órdens: a) lesões papulo-eritemato-escamosas, isoladas ou não, arredondadas, pruriginosas e de bordos nitidos; b) lesões maculo-escamosas, maiores mais pálidas, ás vezes já mostrando alterações pigmentares na parte central; c) máculas discromod´rmicas, lisas ou ligeiramente escamosas, com maior ou menor alteração pigmentar, as quais assumem diferentes aspéctos, consequentes à hipo - ou hiperpigmentação, variaveis também com a côr do paciente. As colorações predominantes nas manchas, são o branco, o preto e o vermelho, com tonalidades eminentemente variaveis. Embora raramente, nessas extensas dermodiscromias, observa-se superposição de lesões papulo-eritemato-escamosas. O aparecimento dos 3 tipos de leões acima citados, obedece seguramente a um processo evolutivo da dermatose, dando-se na órdem exposta e de acordo com o tempo de doença. Além das lesões discromicas, características da enfermidade, foi observado purido, e infartamento ganglionar. O estado geral dos doentes era bom. A avaliação de anemia e eosinofilia, foi prejudicada pela ocurrência de outros processos mórbidos (malaria e helmintiases). Em 2 pacientes pretos e adultos, havia avançada hiperqueratose palmo-plantar. 5) Sob o ponto de vista epidemiológico, foram feitas as seguintes observações: a) Idade. A dermtose ocorre em tôdas as idades, mais incide principalmente dos 15 aos 29 anos. Tomando um grupo relativamente homogêneo de doéntes de um mesmo local, 53% têm 15 e mais anos de idade. De 36 doentes que deram informações seguras ou aproximadas quanto à idade em que lhes apareceu a doença, verifica-se que 77% já estavam infectados antes dos 15 anos. Em 5 casos, a infecção se deu antes dos 2 anos de idade. b) Sexo. Nos doentes em conjunto, existiam 34 homens e 35 mulheres. Mas, no grupo homogeneo acima citado, havia ligeira predominância do sexo feminino (60.7%). c) Côr ou raça. Foram encontradas as seguintes percentagens: Pretos - 34.8%, brancos - 27.5% índios - 23.2% e mulatos - 14.5%. Essas diferenças não indicam predileção racial. d) Família. A A dermatose é eminentemente familial. Em grupo de 41 doentes, 34 pertenciam a 8 familias. e) Lesão inicial. Contágio. Em 6 casos ainda existia a lesão inicial, chamada "empigem", isolada ou acompanhada de outras lesões semelhantes. De 33 doentes, 26 (78.8%) referiam a lesão inicial nas partes descobertas do corpo (rosto, braços e mãos, pernas e pés), isto é regiões mais sujeitas a pequenos traumas, que servem como "porta de entrada" do treponema. Os AA não acreditam na existência de um vetor. Pensam que o contágio é direto, as condições eficientes e predisponentes do mesmo, coexistindo no domícilio, onde vivem em promiscuidade e falta de higiene, doentes e sadios. Os autores não encontraram treponemas em córtes impregnados de “purú-purú”, tanto de “lesão recente” como de “lesão tardia”. Atribuem o fracasso ao provável uso de antitreponemicos pelos doentes, uma vez que a terapeutica empírica pelo arsênico e mercúrio é muito espalhada na Amazônia. Histopatológicamente, encontraram na “lesão recente”: hiperqueratose, hiperacantose, exocitose, exoserose e espongiose na epiderme; e infiltração de células redondas, edema e diltação dos capilares no derma papilar e subpapilar; pela impregnação, acharam irregularidade na distribuição do pigmento melanico, assim como melanóforos entre as células inflamatórias do derma. Na “lesão tardia” observaram: notável atrofia do epiderme, reduzida às vezes , a 3 a 5 camadas celulares, havendo desaparecimento das papilas dérmicas; no derma, havia discreta infiltração de células redondas, relacionadas aos vasos sanguineos, ao lado de macrófagos melaniferos mais ou menos abundantes; pela impregnação, quanto às alterações pigmentares, foram observadas todas as graduações, desde a completa ausência de pigmento na basal, até um acúmulo notável de melanina, atingindo as próprias células de Malpighi. 7) Com o tratamento pelo “neo-salvarsan” os AA observaram grandes melhoras e mesmo cura aparente, com 6 a 8 injeções. Certas manifestações acromicas vitiligoides, antigas, não mostraram modificações apreciáveis com a terapêutica. 8) No Brasil, fora da Amazônia, tem sido descrito casos isolados de purú-purú, porém, na opinião dos autores, todos ou quase todos, são provavelmente, manifestações discromicas tardias de sífilis ou bouba, semelhantes aos publicados por um deles (F. N. G). Pensam do mesmo modo, quanto aos casos de pinta descritos fora da América: África, Egito, Argeria, Sahara, Trípoli, Turquestão, Filipinas, Iraque, Índia, Ceilão, etc. Ainda nesta mesma ordem de idéas, os autores negam validade ao conceito epidemiológico da existência de “casos isolados”, a não ser procedentes das “zonas pintogenas”. 9) Um dos autores (F. N. G.) emite a seguinte hipótese, que considera sugestiva, embora dificilmente demonstrável: Os treis treponemas (T. pallidum, T. pertenue e T. carateum), oriundos de um ancestral comum. tornaram-se peculiares respectivamente ao branco, ao preto e ao índio, mantendo-se assim isolados. Secundariamente, com as correntes migratórias, misturaram-se as doenças...

Alterações microscópicas na erupção do Sarampo

A lesão inicial na erupção do sarampo parece ser a necrose hialina de células epidérmicas, quer isoladas, quer em pequenos grupos. A associação das lesões epidérmicas a alterações do derma é, contudo, precoce, ocorrendo já na erupção com 12 horas de duração. No período compreendido entre a 12ª e a 36ª horas de duração da erupção, são geralmente encontradas, no mesmo fragmento de pele, lesões em fases diversas de evolução, ìntimamente associadas, constando de minúsculas vesículas evoluindo para vésico-pústulas que sofrem, posteriormente, dessecamento e descamação. É considerada como alteração patognomônica da erupção do sarampo, embora incostante, a presença de células paraqueratósicas com as inclusões intranucleares descritas por TORRES & TEIXEIRA (1932 b). As lesões do derma, bem conhecidas, constam de edema das papilas e infiltração da pars papillaris e da reticullaris por grandes mononucleares, alguns encerrando numerosos grânulos irregulares, intensamente corados (células de MALLORY-MEDLAR-LIPSCHÜTZ). São apresentados argumentos segundo os quais tais células seriam macrófagos que fagocitaram grânulos de queratoialina, em consequência de desordens no processo de cornificação determinadas pelo vírus. A formação de vesículas e pústulas, cuja devida apreciação exige o exame microscópico, caracterizada a erupção do sarampo. Tal característica aproxima esta doença, geralmente incluída no grupo das doenças exantemáticas, do grupo das doenças pustulosas (varicela, zoster, varíola e alastrim). As lesões epidérmicas não foram mais achadas, 72 horas após o início da erupção, ao passo que as dérmicas persistiam sob a forma de manguitos perivasculares bem definidos, associados à moderada proliferação de fibrócitos.

Sôbre alguns Phlebotomus e Brumptomyia da Colômbia (Diptera, Psychodidae)

The first case of Kala-azar in Colombia was discovered in Soledad, S. Vicente do Chucuri, Dept. Santander, by Gast-Galvis who viscerotomized a three year old girl deceased in December, 1943. In 1944, fifty-three Phlebotominae were collected in the chicken pen of the girl's house, two new species included. Mangabeira helped by A. Gast Galvis, Juan Antonio Montoya and E. Osorno Mesa, collected some Phlebotomus in that country. The geographical distribution of the species of Phlebotomus collected in Colombia (P. abonnenci, P. camposi, P. columbianus, P. dubitans, P. gasti, P. montoyai, P. saulensis, P. serranus, P. triramulus) and two species of Brumptomyia (B. beaupertuyi and b mesari), are included. our description of the male P. columbianus is based on some specimens found in association with females. However, doubts exist about such association of sexes. There is no correspondence between the length of the spicules and the ducts of spermathecae. Besides, the specimens were not obtained by raising. The following new species are described and compared with previously known ones: a) Phlebotomus gasti sp. n. differs from the other species by a protruding tubercle in the gubernaculum. It has also fewer setae in the tuft of the basistyle, a different length of the inferior gonapophyses, and a differently shaped clasper. b) Phlebotomus dubitans sp. n. differs from P. walkeri and P. deanei (according to personal information from O. Theodor, who examined the types, they are identical to P. williamsi and P. sericeus respectively), mainly because these species have the inferior gonapophyses larger than the basistyle and fewer setae in the basistyle. P. evandroi is separated by the shape of the claspers and by the tuft of setae of the basistyle. P. marajoensis is the closest relative to P. dubitans. There is a possibility of their being synonymous. On the other hand, they can be differentiated by the existence of three extra distal spines in P. marajoensis. There is also a difference in their palpal indexes: for marajoensis I - II - IV - III - V, and for dubitans I - IV (III - II) - V. We notice, too, that the inferior gonapophyses in P. marajoensis is a little shorter. P. marajoensis has a long seta in the basistyle (clearly shown in the original drawing), not found in the new species. c) Phlebotomus montoyai sp. n.: The closest relatives are P. noguchii, P. peruensis, P. pescei, P. quinquifer and P. rickardi. They differ from the new species by the number and length of the setae of the basistyle tuft which are more numerous and longer in the new species. The shapes of their claspers are also different. Other differences are: the basal portion of the basistyle in P. noguchii is very wide (in montoyai it is narrower); the intermediate spine of the dististyle is located on a protruding tubercle ( in the new species there is hardly a tubercle); the spicules are long, and the inferior gonapophyses is longer than the basistyle. P. quinquifer and P. rickardi have a shorter dististyle and narrower wings, with different venation. The main difference, however lies, in the M4, which ends almost at the level of the junction of M1 with M2 (in P. montoyai the M4 ends far behind). In P. peruensis and P. pescei the intermediary spine of the dististyle is closer to the distal spine than to the basal one, whereas in the new species it is situated between the two pairs. Their inferior gonapophyses is longer than the basistyle. d) Brumptomyia mesai sp. n. - Closest relatives are: B. hamatus, B. pentacanthus, B. beaupertuyi which are easily separated from the new species because the tufts of their basistyle have thin and differently shaped hairs. Also their claspers are shaped differently. B. avellari is also easily recognized on account of the twisted aspect of its clasper and because the basal tuft of the basistyle has few setae, B. brumpti tuft of setae arise directly from the basistyle; these setae are stronger than those of the new species. It has 8 blade-like setae located on the inner surface of the distal half, whereas the new species has only six setae. In B. brumpti, there are three median and two terminal spines in the dististyle; in the new species, there are two median and two terminal spines and one between them, which is closer to the two median spines. The comparison with B. galindoi is based in a specimen determined by Fairchild and deposited in the entomological collection of the "Faculdade de Higiene e Saúde Pública da Universidade de S. Paulo". The genitalia of the new species is much shorter, in galindoi the inferior gonapophyses is 0,8 mm long whereas in B. mesai it hardly reaches 0,6 mm. The shape of the clasper and the distribution of its setae are different. The sub-median lamellae, besides being longer in B. galindoi are also longer in comparison with the other parts of the genitalia. The gubernaculum of the new species is longer, thinner, and more pointed; in B. galindoi it is shorter and triangular. In the drawing published by Fairchild and Hertig 91947), the basistyle shows 8 blade-like setae on the distal half, whereas in the new species only six are found.

Segunda contribuição sobre as alterações ultra-estruturais dos hepatócitos na forma aguda (toxêmica) da esquistossomose mansoni

Estudamos as alterações ultra-estruturais dos hepatócitos na forma aguda, toxêmica, da esquistossomose, em cinco pacientes, membros de uma mesma família infectados em idênticas condições em um córrego existente próximo da lagoa de Pampulha, em Belo Horizonte (MG), e não tratados especificamente para a esquistossomose. Este estudo confirma os dados obtidos em trabalho anterior, em sete pacientes infectados no Município de Sabara (MG). Nos cinco casos, as alterações ultra-estruturais foram inespecíficas, pouco acentuadas, embora mais intensas do que as observadas anteriormente, e se caracterizaram sobretudo pelas modificações das organelas citoplasmáticas, explicando o freqüente encontro de células claras a microscopia óptica. A identificação de alguns granulomas a microscopia eletrônica permitiu verificar que estes mostram, no exstudato, granulócitos eosinófilos, macrófagos, plasmócitos, células epitelióides e mastócitos. Entre as células havia material amorfo e finos feixes de colágeno.

Leishmanioses tegumentares: aspectos clínicos e imunopatológicos

Foi visto nesta revisão que os parasitas do gênero Leishmania induzem uma variedade de respostas complexas nos hospedeiros vertebrados, efetuadas e/ou moduladas pelo seu sistema imunológico. Foi também salientado que o destino da Leishmania no interior de macrófagos depende de relações particulares parasito-hospedeiro, envolvendo não apenas as propriedades intrísecas do parasita, mas também as características, geneticamente determinadas, da cédula hospedeira ou das suas interações com outras células imunocompetentes. Atráves de uma revisão das evidências consubstanciando essesconceitos, os mesmos foram aplicados na descrição do espectro clínico e imunopatológico da doença humana, particularmente das leishmanioses cutâneas e mucocutâneas do Novo e do Velho Mundo. Finalmente, baseando-se nos resultados obtidos em modelos experimentais de leishmaniose cutânea, os quais reproduzem os achados das formas resolutiva e persistentes da doença humana, o autor apresenta uma análise esquemática da evolução das características histopatológicas das lesões leishmanióticas.

Changes of overweight and obesity in the adult Swiss population according to educational level, from 1992 to 2007.

In many high income developed countries, obesity is inversely associated with educational level. In some countries, a widening gap of obesity between educational groups has been reported. The aim of this study was to assess trends in body mass index (BMI) and in prevalence of overweight and obesity and their association with educational level in the adult Swiss population. Four cross-sectional National health interview surveys conducted in 1992/93 (n = 14,521), 1997 (n = 12,474), 2002 (n = 18,908) and 2007 (n = 17,879) using representative samples of the Swiss population (age range 18-102 years). BMI was derived from self-reported data. Overweight was defined as BMI > or = 25 and <30 kg/m(2), and obesity as BMI > or = 30 kg/m(2). Mean (+/- standard deviation) BMI increased from 24.7 +/- 3.6 in 1992/3 to 25.4 +/- 3.6 kg/m2 in 2007 in men and 22.8 +/- 3.8 to 23.7 +/- 4.3 kg/m(2) in women. Between 1992/3 and 2007, the prevalence of overweight + obesity increased from 40.4% to 49.5% in men and from 22.3% to 31.3% in women, while the prevalence of obesity increased from 6.3% to 9.4% in men and from 4.9% to 8.5% in women. The rate of increase in the prevalence of obesity was greater between 1992/3 and 2002 (men: +0.26%/year; women: +0.31%/year) than between 2002 and 2007 (men: +0.10%/year; women: +0.10%/year). A sizable fraction (approximately 25%) of the increasing mean BMI was due to increasing age of the participants over time. The increase was larger in low than high education strata of the population. BMI was strongly associated with low educational level among women and this gradient remained fairly constant over time. A weaker similar gradient by educational level was apparent in men, but it tended to increase over time. In Switzerland, overweight and obesity increased between 1992 and 2007 and was associated with low education status in both men and women. A trend towards a stabilization of mean BMI levels was noted in most age categories since 2002. The increase in the prevalence of obesity was larger in low education strata of the population. These findings suggest that obesity preventive measures should be targeted according to educational level in Switzerland.