First report of Trypanosoma vivax outbreak in dairy cattle in São Paulo state, Brazil

Esta é a primeira descrição de um surto de Trypanosomavivax ocorrido no Estado de São Paulo, no município de Lins. Animais acometidos apresentaram febre, icterícia, diminuição da produção de leite, perda de peso, diarreia profusa, abortos, anemia, leucocitose e hiperfibrigenemia. Foram registrados 31 óbitos de vacas e bezerros em 1.080 bovinos no total. Três vacas apresentaram sintomatologia nervosa, como dismetria, ataxia e fraqueza muscular, além de ptialismo, aumento de linfonodos e edema submandibular. Hemoparasitas flagelados foram observados em esfregaços sanguíneos, e a espécie de tripanossomo foi diagnosticada como T.vivax por PCR. A cepa de T. vivax mostrou ser resistente ao tratamento com aceturato de diaminozeno e a infecção disseminou rapidamente no rebanho. Pelo ELISA, observou-se que 98,36% (599) das amostras de soro colhidas apresentaram títulos positivos para IgG anti-T.vivax. O surto ocorreu em condições de baixa precipitação pluviométrica, fato que indica que outros fatores estavam envolvidos na ocorrência desse surto, como a ausência de tabanídeos e a grande presença de Haematobia irritans e Stomoxys calcitrans, cujo aumento populacional pode ser devido ao uso de resíduos de usinas de açúcar e álcool nos canaviais que circundavam a granja leiteira.

Oncogenic osteomalacia: loss of hypophosphatemia might be the key to avoid misdiagnosis

A osteomalacia oncogênica é um diagnóstico clínico desafiador, caracterizado pela perda renal de fosfato e baixos níveis de 1,25-di-hidroxivitamina D3, ocorrendo na presença de um tumor produtor de altos níveis de fator de crescimento de fibroblasto 23. No entanto, é possível que se trate muito mais de uma falha de diagnóstico clínico do que propriamente uma doença rara. Os autores relatam o caso de um homem de 42 anos com histórico de fraqueza muscular progressiva por cinco anos e restrição à cadeira de rodas, sem diagnóstico. Seus exames laboratoriais evidenciavam baixos níveis de fósforo. A remoção cirúrgica de um hemangiopericitoma detectado previamente em cavidade nasal levou à resolução completa dos sintomas. Os autores enfatizam que, mesmo com a etiologia já evidenciada, o paciente consultou diversos clínicos no decorrer dos cinco anos até que fossem instituídos o diagnóstico e o tratamento adequados. Arq Bras Endocrinol Metab. 2012;56(8):570-3

Envenenamento fatal por baiacu (Tetrodontidae): relato de um caso em criança

É descrito um envenenamento pela ingestão de vísceras de um baiacu-pintado (Sphoeroides testudineus) por uma criança de dois anos, que apresentou sudorese fria, fraqueza muscular progressiva, parada cardiorrespiratória e morte. São discutidos os riscos do consumo da carne e vísceras de baiacus, fato comum em certas regiões do Brasil.

Comparison of clinical features and drug therapies among European and Latin American patients with juvenile dermatomyositis

ObjectiveTo compare the demographic features, presenting manifestations, diagnostic investigations, disease course, and drug therapies of children with juvenile dermatomyositis (JDM) followed in Europe and Latin America.MethodsPatients were inception cohorts seen between 1980 and 2004 in 27 paediatric rheumatology centres. The following information was collected through the review of patient charts: sex; age at disease onset; date of disease onset and diagnosis; onset type; presenting clinical features; diagnostic investigations; course type; and medications received during disease course.ResultsFour hundred and ninety patients (65.5% females, mean onset age 7.0 years, mean disease duration 7.7 years) were included. Disease presentation was acute or insidious in 57.1% and 42.9% of the patients, respectively. The course type was monophasic in 41.3% of patients and chronic polycyclic or continuous in 58.6% of patients. The more common presenting manifestations were muscle weakness (84.9%), Gottron's papules (72.9%), heliotrope rash (62%), and malar rash (56.7%). Overall, the demographic and clinical features of the 2 continental cohorts were comparable. European patients received more frequently high-dose intravenous methylprednisolone, cyclosporine, cyclophosphamide, and azathioprine, while methotrexate and antimalarials medications were used more commonly by Latin American physicians.ConclusionThe demographic and clinical characteristics of JDM are similar in European and Latin American patients. We found, however, several differences in the use of medications between European and Latin American paediatric rheumatologists.

Acute, subchronic and chronic 2,4-dichlorophenoxyacetic acid (2,4-D) intoxication in rats

The acute, subchronic and chronic toxicities of 2,4- dichlorophenoxyacetic acid (2,4-D) were studied in rats. Animals were exposed acutely (600 mg/kg), subchronically (200 ppm for 30 d) and chronically (200 ppm for 180 d) to 2,4-D by the oral route. Clinical, laboratory and histopathological methods were used as indicators of toxicity. After acute exposure, the herbicide decreased locomotor activity and induced ataxia, sedation, muscular weakness (mainly of the hind quarters) and gasping for breath; increased aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), alkaline phosphatase (AP), amylase activities and creatinine levels; decreased total protein (TP) and glucose levels; and increased hematocrit values. Subchronic and chronic 2,4-D exposures did not induce overt clinical signs or symptoms of intoxication. However, subchronic herbicide exposure increased AST activity and albumin and hematocrit values, and chronic exposure increased AST, AP and LDH activities, decreased amylase and glucose levels, but did not change hematocrit values. Chromatographic analysis of the serum of chronically exposed rats showed the presence of the herbicide; the amount found (3.76 ± 1.16 mg/ml) suggested the absence of 2,4-D accumulation within the body. Although macroscopic or histopathological lesions were not observed in acutely, subchronically or chronically 2,4-D exposed rats, the laboratory data obtained suggest tissue injuries after dosing, since the results are considered early indicators of primarily hepatic and muscle tissue damage.

Dynamic and isometric protocols of knee extension: Effect of fatigue on the EMG signal

The objective of this study was to analyze the electromyographic (EMG) signal behavior of rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL) and biceps femoris (caput longum) (BFCL) from nine women during fatiguing dynamic and isometric knee extensions tests and to determine their EMGFT (Electromyographic Fatigue Threshold). Surface electrodes, biological signal acquisition module, analogical-digital converter board and specific software were used. The RMS (Root Mean Square) values obtained from concentric phase (80 to 30 degrees) of the dynamic knee extension andfrom isometric contraction were correlated with time on each load by linear regression analysis. The respective slopes were correlated with the correspondent load to determine the EMGFT. Force (Kgf) and median frequency - MF (Hz) obtained during MIVC (Maximal Isometric Voluntary Contraction) performed before and after the fatiguing tests were calculated in Matlab environment. The results demonstrated that the endurance time decreases with higher loads the EMG amplitude increase with time and was greater at higher loads, between muscles in dynamic exercise the RF and VL showed higher slopes, and in isometric exercise the VL showed the same behavior The EMGFT values were similar in both exercises; the force values predominantly decreased after fatiguing tests; however the MF only decreased after some loads. The protocols proposed allowed standardizing protocols at least to induce the fatigue process and to determine the EMGFT as an endurance indicative, which may be used to evaluate the effectiveness of rehabilitative or training interventions indicated to reduce muscle weakness and fatigue.

Manifestações sistêmicas na doença pulmonar obstrutiva crônica

Chronic obstructive pulmonary disease is progressive and is characterized by abnormal inflammation of the lungs in response to inhalation of noxious particles or toxic gases, especially cigarette smoke. Although this infirmity primarily affects the lungs, diverse extrapulmonary manifestations have been described. The likely mechanisms involved in the local and systemic inflammation seen in this disease include an increase in the number of inflammatory cells (resulting in abnormal production of inflammatory cytokines) and an imbalance between the formation of reactive oxygen species and antioxidant capacity (leading to oxidative stress). Weakened physical condition secondary to airflow limitation can also lead to the development of altered muscle function. Chronic obstructive pulmonary disease presents diverse systemic effects including nutritional depletion and musculoskeletal dysfunction (causing a reduction in exercise tolerance), as well as other effects related to the comorbidities generally observed in these patients. These manifestations have been correlated with survival and overall health status in chronic obstructive pulmonary disease patients. In view of these facts, the aim of this review was to discuss findings in the literature related to the systemic manifestations of chronic obstructive pulmonary disease, emphasizing the role played by systemic inflammation and evaluating various therapeutic strategies.

Adverse drug reaction as cause of hospital admission of elderly people: a pilot study

The objective of this study was to estimate the prevalence of adverse drug reactions (ADR) related to hospital admission of elderly people, identifying the use of potentially inappropriate medication (PIM), the ADR and the risk factors associated with the hospitalization. A cross-sectional study was conducted in a private hospital of São Paulo State, Brazil. All patients aged ≥ 60 years, admitted in the general practice ward in May 2006 were interviewed about the drugs used and the symptoms/complaints that resulted in hospitalization. More than a half (54.5 %) of elderly hospitalizations were related with ADR. The therapeutic classes involved with ADR were: cardiovascular (37.7 %), central nervous (34.6 %) and respiratory (5.7 %). The ADR observed were disorders in circulatory (28.4 %), digestive (20.0 %) and respiratory (18.9 %) tracts. 27 elderly had made PIM and in 20 of them this was the cause of hospitalization. Polypharmacy was an ADR risk factor (p = 0.021).These data allows the healthcare professionals upgrade, qualifying them in pharmcovigilance.

Involvement of organic systems in golden retriever X-linked muscular dystrophy

Duchenne muscular dystrophy is a lethal genetic disease characterized by progressive muscle degeneration that usually had been used the Golden Retriever as a model for studying the disease (GRMD - Golden Retriever Muscular Dystrophy). A total of 16 male dystrophic Golden Retrievers dogs between 5 to 51 months of age were examined in the present study. The animals were classified as dystrophic according to two simultaneous complementary criteria: genotypic analysis and serum creatine kinase levels. The macroscopic abnormalities of the different organs and tissues and histopathological features were described using hematoxylin-eosin. The lesions in the skeletal muscles associated with the digestive problems resulted in cachexia with different intensities in all the dystrophic dogs. Cardiac muscle involvement was found in 87,5% of the GRMD dogs resulting, however, in cardiac failure in only 18,8% of the animals. The musculature of the diaphragm was hypertrophic in all affected animals resulting in progressive respiratory muscle weakness and at later stages in respiratory failure (81,25%). The liver abnormalities found in dystrophic dogs were originated mainly from heart disease and developed progressively. Hyperemia of mucosa and granular material indicated changes in the functioning and emptying of bladder. The germinative lineage cells presented moderate to severe degeneration probably due to degeneration of the scrotum and cremaster muscle which prevented the proper thermo-regulation of the testicle. Our results highlight the fact that there is significant impairment of the cardiac, respiratory and skeletal muscle systems in GRMD dogs since the age of five months. In addition, significant alterations of the gastrointestinal tract, urinary and reproductive systems are indicating the presence of degenerative lesions in the smooth musculature.

Descrição clínico - epidemiológica de uma série de casos de miosite aguda viral

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação da qualidade de vida, força muscular respiratória e distância percorrida no teste de caminhada de seis minutos em pacientes com hipertensão arterial pulmonar sob tratamento farmacológico específico

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeito do treinamento físico na qualidade de vida, capacidade funcional e fatores de risco cardiovascular nos portadores de doença renal crônica em tratamento conservador

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Colapso induzido pelo exercício em um Labrador Retriever

The exercise-induced collapse (EIC) is a hereditary disease characterized by muscle weakness, impaired locomotion and collapse after intense exercise. This autossomic recessive disorder affects mainly Labrador Retriever presenting the mutation c.767G>T in the dynamin 1 (DNM1) gene. The objective of this study is to report the first case of exercise-induced collapse in Labrador Retriever in Brazil. The molecular test detected the specific genetic mutation and confirmed the clinical diagnosis in a Labrador Retriever with clinical history of weakness and collapse after exercise. It is important to include this disease as part of the differential diagnosis of neuromuscular diseases in Labrador Retriever and use the molecular test to guide matings.

Paralisia periódica hipocalêmica tireotóxica em paciente de ascendência africana

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

Avaiação da Dor e da Postura em Pacientes com Lombalgia Submetidos a Dois Protocolos de Fortalecimento Abdominal

Introduction: the lumbar spine is the main part of the body responsible for the support of the loads, where approximately half of body weight is in stable balance. This support relates to the action of abdominal muscles, of great importance in the balance of that region. The existence of abdominal muscle weakness, such won’t perform its function, may induce pathological postural attitude, that predispose the pain. Objective: to compare the effects of two abdominal strengthening protocols on pain and postural alignment in individuals with low back pain. Method: participated of the study 21 individuals of both genders, with ages between 19 and 25 years old (average 21,8±1,5) and average Body Mass Index (BMI) 21,9 (±2,48), divided randomly in isometric abdominal stimulation group (n=8), abdominal strengthening group (n=7) and control group (n=6). They realized eight sessions of strengthening, when responded Visual Analogue Scale (VAS) before and after each intervention. The control group (n=6) had no intervention. The postural data had been analyzed by photogrammetry. Results: Pain and posture data were analyzed using paired t test, with signifi cance index of 5%. Postural angles had no signifi cant differences (p>0,05) from all angles analyzed after the intervention to none of the groups. For pain values, a signifi cant decrease (p<0,05) was observed since the fi fth session in patients who were treated by the abdominal exercises protocol, and the fi rst session in patients who were treated by the isometric abdominal stimulation protocol. However, this decrease in pain was immediate, not lasting along the treatment sessions, in both protocols. Conclusion: the proposed protocols did not interfere in postural alignment. They were effective to decrease pain in a same session, once the isometric was the most effective, but they weren’t effective in preserving the improves over time.