Incidência de choques e qualidade de vida em jovens com cardioversor-desfibrilador implantável

OBJETIVOS: Avaliar a incidência e a causa de choques de CDI em crianças e adolescentes e sua repercussão na qualidade de vida (QV). MÉTODOS: De março/1997 a fevereiro/2006, 29 pacientes (15,7±5,4 anos) foram submetidos a implante de CDI. Parada cardiorrespiratória recuperada (41,5%), taquicardia ventricular sustentada (27,6%) e profilaxia primária de morte súbita cardíaca (30,9%) motivaram os implantes. O número de terapias foi avaliado por entrevista e pela telemetria dos CDI. A QV foi avaliada pela aplicação do questionário SF-36 e comparada à de indivíduos saudáveis. Empregou-se o método de Kaplan-Meier para análise da sobrevida livre de choques. RESULTADOS: Após 2,6±1,8 anos de seguimento, 8 (27,6%) pacientes receberam 141 choques apropriados em razão de TV polimórfica (6) ou FV (2), e 11 (37,9%) sofreram 152 choques inapropriados em razão de taquiarritmias supraventriculares (8) ou oversensing (3). A expectativa de sobrevida livre de choques apropriados foi de 74,2%±9,0 após um ano, e de 66,7%±10,7 após três anos. Observou-se diminuição da QV nos aspectos físicos (61,7±28,7), na vitalidade (64,7±19,1), na saúde mental (65,9±22,7) e nos aspectos emocionais (66,7±38,5). Medo e preocupações relacionados ao CDI foram referidos por todos os pacientes. CONCLUSÃO: A despeito da grande eficácia dessa terapêutica, a incidência elevada de choques interferiu na QV e na adaptação ao dispositivo.

Minimal invasive surgery for coronoid fracture: technical note.

Operative treatment of coronoid fracture often requires a large dissection of soft tissue, resulting in elbow stiffness and functional limitation. The authors present a minimal invasive, safe technique, useful in the case of isolated coronoid fracture associated with elbow dislocation. This technique does not require soft tissue dissection and allows an early unlimited resumption of sports activities.

Nosocomial nontyphoidal salmonellosis after antineoplastic chemotherapy: reactivation of asymptomatic colonization?

An increased frequency of nontyphoidal salmonellosis is well established in cancer patients, but it is unclear whether this represents increased susceptibility to exogenous infection or opportunistic, endogenous reactivation of asymptomatic carriage. In a retrospective study, a simple case definition was used to identify the probable presence of reactivation salmonellosis in five cancer patients between 1996 and 2002. Reactivation salmonellosis was defined as the development of nosocomial diarrhea >72 h after admission and following the administration of antineoplastic chemotherapy in an HIV-seronegative cancer patient who was asymptomatic on admission, in the absence of epidemiological evidence of a nosocomial outbreak. Primary salmonellosis associated with unrecognized nosocomial transmission or community acquisition and an unusually prolonged incubation period could not entirely be ruled out. During the same time period, another opportunistic infection, Pneumocystis pneumonia, was diagnosed in six cancer patients. Presumably, asymptomatic intestinal Salmonella colonization was converted to invasive infection by chemotherapy-associated intestinal mucosal damage and altered innate immune mechanisms. According to published guidelines, stool specimens from patients hospitalized for longer than 72 h should be rejected unless the patient is neutropenic or >or=65 years old with significant comorbidity. However, in this study neutropenia was present in only one patient, and four patients were <65 years old. Guidelines should thus be revised in order not to reject stool culture specimens from such patients. In cancer patients, nosocomial salmonellosis can occur as a chemotherapy-triggered opportunistic reactivation infection that may be similar in frequency to Pneumocystis pneumonia.

Le Constitutionnel : journal politique et littéraire

1816/09/10 (Numéro 738.5).

Atividade inseticida do extrato das folhas de Piper hispidum (Piperaceae) sobre a broca-do-café (Hypothenemus hampei)

Este trabalho teve como objetivo avaliar o potencial inseticida do extrato acetônico das folhas de Piper hispidum Kunth sobre Hypothenemus hampei (Ferrari, 1867) em aplicação tópica, superfície contaminada e efeito de repelência. Adotou-se as diluições de 25,0; 5,0; 0,1; 0,02; 0,004 e 0,0008 mg mL-1 para exposição em superfície contaminada e aplicação tópica. No teste de repelência, utilizou-se a diluição 0,5 mg mL-1 do extrato. As avaliações foram realizadas nas 48 horas após a exposição ao extrato. Na exposição em superfície contaminada, obteve-se 100% de mortalidade, na diluição 25,0 mg mL-1, e de 50 a 80% nas diluições 0,004 a 5,0 mg mL-1, enquanto 0,0008 mg mL-1 e o controle resultaram em apenas 5% de mortalidade. Na aplicação tópica, atingiu-se 60 a 65% de mortalidade, com as diluições de 0,1 a 25,0 mg mL-1. As diluições de 0,2 a 0,0008 mg mL-1 não diferiram do controle. Os índices de repelência foram inferiores ao valor mínimo preconizado na literatura para se considerar uma substância como repelente. Este estudo evidencia a atividade inseticida do extrato de folhas de P. hispidum sobre H. hampei, o que sugere seu potencial no controle deste inseto.

L’utilisation des corticostéroïdes et le retard de croissance linéaire chez les enfants atteints de la maladie de Crohn

La maladie de Crohn (MC) est une maladie chronique et récidivante du tractus gastro-intestinal. Dans la population pédiatrique, elle est très souvent accompagnée d'un retard de croissance (jusqu'à 88%). La MC se manifeste souvent autour de la puberté d’où l’importance du retard de croissance linéaire à ce stade crucial du développement de l’enfant. Une des questions essentielles est de savoir si le retard de croissance peut persister à l'âge adulte. La littérature est inconsistante sur ce point. En ce qui concerne les facteurs de risque potentiels, les corticostéroïdes (CS) qui sont la première ligne de traitement pour la majorité des patients, ont été largement impliqués. Bien qu'il existe des explications démontrant le mécanisme d’action des corticostéroïdes sur la croissance linéaire, les études cliniques impliquant l'utilisation CS soit à un retard de croissance temporaire ou permanent restent controverser et limiter. Nous avons examiné cette relation importante dans notre étude présente. Les principaux objectifs de l'étude sont les suivants: 1. D’évaluer la fréquence du retard de croissance chez le jeune atteint de la maladie de Crohn et qui a reçu des corticostéroïdes (CS) au cours de son traitement et 2. D’évaluer les facteurs de risque associés au retard de croissance temporaire ou permanent dans cette population. Méthodes : Afin d’atteindre nos objectifs, on a mené une étude de cohorte rétrospective. Cette cohorte comprend des patients qui ont été diagnostiqués de la MC (avant l’âge de 18 ans) à la clinique de gastroentérologie du Centre Hospitalier-Universitaire Sainte-Justine (CHUSJ) à Montréal. Ces patients ont tous reçus des CS en traitement initial(en excluant les rechutes). Les dossiers médicaux des patients ont été examinés de façon prospective afin de d’acquérir des informations sur : 1. La taille à chaque visite médicale; 2. La durée du traitement des CS; 3. L’administration de médication concomitante; 4. D’autres variables cliniques telles que l’âge au diagnostic, le sexe, la localisation et le comportement de la maladie. Pour ceux qui avaient atteints l’âge de 18 ans et qui ne fréquentaient plus la clinique, leur taille finale a été obtenue en les contactant par téléphone. Leurs parents ont aussi été contactés afin d’obtenir leur taille. On a converti nos résultats en scores de Z ou scores-Z ajustée pour l’âge et le sexe en utilisant la classification 2007 de l’Organisation Mondiale de la Santé(OMS). On a aussi calculé les tailles adultes cibles avec les données que nous avons récoltées. La raison de tout cela était de rendre nos résultats comparables aux études antérieures et renforcer ainsi la validité de nos trouvailles. Les enfants avec un score de Z<-1.64 (qui correspond au 5ème percentile) ont été considérés comme ayant un retard de croissance temporaire. Les scores-Z pour les tailles adultes finales ont été calculés en utilisant les mêmes normes de référence selon le sexe pour les personnes âgées de 17,9 ans. Un z-score <-1,64 a aussi été utilisé pour classer les individus avec un retard permanent. Ajouter à cela, ceux ayant une taille adulte finale <8,5cm de leur taille adulte cible (estimée à partir des hauteurs parentales) étaient considérés comme ayant un retard de croissance permanent. Des analyses de régression logistiques ont été faites pour examiner les facteurs associés à un retard de croissance temporaire et/ou permanent. Résultats : 221 patients ont été retenus. L’âge moyen de diagnostic était de 12.4 années et l’âge moyen de prise de CS était de 12.7 années. La répartition par sexe avait une légère prédominance masculine 54.3% contre 45.7% pour le sexe féminin. La majorité des patients étaient d’âge pubère (62.9%). On a surtout des patients avec une prédominance de maladie de type inflammatoire (89.1%) et localisé au niveau de l’iléo-colon (60.2%). Presque tous avaient pris une médication concomitante (88.7%) et n’avaient subi aucune chirurgie (95.9%). 19% des patients avaient un retard de croissance temporaire. L'analyse univariée a suggéré que le plus jeune âge au moment du diagnostic de la maladie et l'âge précoce à l'administration de stéroïdes étaient associés à un risque accru de retard de croissance temporaire. L’administration de CS à un jeune âge a été la seule variable (dans l’analyse multivariée) associée à un risque élevé de retard de croissance temporaire. En comparant à ceux ayant reçu des CS après l’âge de 14 ans (tertile 3), l’administration de CS à un âge précoce est fortement associé à un risque de retard de croissance (<11.6ans, OR: 6.9, 95% CI: 2.2-21.6, p-value: 0.001; 11.8ans-14ans, OR: 5.4, 95% CI: 1.7-17.1, p-value: 0.004). 8 (5.8%) sur 137 des sujets avaient une taille adulte finale <8,5cm de leur taille adulte cible. Dans l’analyse de régression linéaire multivariée, seul la variable de la taille adulte cible était associé à un changement de la taille adulte finale. Conclusion : Nos résultats suggèrent que la fréquence du retard de croissance permanent chez les enfants atteint de la MC est très faible. Un retard temporaire ou permanent de la croissance n’ont pas été associés à une augmentation de la quantité de CS administrée bien que l'administration de CS à un âge précoce soit associée à un retard de croissance temporaire.

Detecting non-multiplicative genotype relative risks from transmissions of parental alleles to affected children

The differential transmission of alleles from parents to affected children indicates that the locus under investigation is either directly involved in the occurrence of the disease or that there are allelic associations with other loci that are directly involved. Conditional logistic regression applied to a diallelic locus leads to a test with two degrees of freedom. The power of a single degree of freedom test to detect non-multiplicative allelic effects is discussed here.

Chemistry and biology of maculalactone A from the marine cyanobacterium Kyrtuthrix maculans

Maculalactone A is the most abundant secondary metabolite in Kyrtuthrix maculans, a marine cyanobacterium found in the mid-high shore of moderately exposed to sheltered rocky shores in Hong Kong and South East Asia. This species appears to survive as pure colonies forming distinct black zones on the rock. Maculalactone A may provide K. maculans with a chemical defense against several marine organisms, including the common grazer, Chlorostoma argyrostoma and settlement by larvae of the barnacles, Tetraclita japonica, Balanus amphitrite and Ibla cumingii. The natural concentration of maculalactone A varied with season and also with tidal height on the shore and although a strong positive linear correlation was observed between maculalactone A concentration and herbivore grazing pressure, manipulative experiments demonstrated that grazing pressure was not directly responsible for inducing the biosynthesis of this metabolite. The potential of maculalactone A as a natural marine anti-fouling agent (i.e. as an alternative to environmentally-damaging copper- and tin-based anti-fouling paints) was investigated after achieving a gram-scale synthesis of this compound. Preliminary field trials with anti-fouling paints which contained synthetic maculalactone A as the active principle have confirmed that this compound seems to have a specific activity against molluscan settlers.

Biological and structural characterization of a new PLA(2) from the Crotalus durissus collilineatus venom

In the present article we report on the biological characterization and amino acid sequence of a new basic Phospholipases A(2) (PLA(2)) isolated from the Crotalus durissus collilineatus venom (Cdcolli F6), which showed the presence of 122 amino acid residues with a pI value of 8.3, molecular mass of 14 kDa and revealed an amino acid sequence identity of 80% with crotalic PLA(2)s such as Mojave B, Cdt F15, and CROATOX. This homology, however, dropped to 50% if compared to other sources of PLA(2)s such as from the Bothrops snake venom. Also, this PLA(2) induced myonecrosis, although this effect was lower than that of BthTx-I or whole crotoxin and it was able to induce a strong blockage effect on the chick biventer neuromuscular preparation, independently of the presence of the acid subunid (crotapotin). The neurotoxic effect was strongly reduced by pre-incubation with heparin or with anhydrous acetic acid and rho-BPB showed a similar reduction. The rho-BPB did not reduce significantly the myotoxic activity induced by the PLA(2), but the anhydrous acetic acid treatment and the pre-incu-bation of PLA(2) with heparin reduced significantly its effects. This protein showed a strong antimicrobial activity against Xanthomonas axonopodis passiflorae (Gram-negative), which was drastically reduced by incubation of this PLA(2) with rho-BPB, but this effect was marginally reduced after treatment with anhydrous acetic acid. Our findings here allow to speculate that basic amino acid residues on the C-terminal and molecular regions near catalytic site regions such as Calcium binding loop or rho-wing region may be involved in the binding of this PLA(2) to the molecular receptor to induce the neurotoxic effect. The bactericidal effect, however, was completely dependent on the enzymatic activity of this protein.

Genomic organization of the Neurospora crassa gsn gene: possible involvement of the STRE and HSE elements in the modulation of transcription during heat shock

Glycogen synthase, an enzyme involved in glycogen biosynthesis, is regulated by phosphorylation and by the allosteric ligand glucose-6-phosphate (G6P). In addition, enzyme levels can be regulated by changes in gene expression. We recently cloned a cDNA for glycogen synthase (gsn) from Neurospora crassa, and showed that gsn transcription decreased when cells were exposed to heat shock (shifted from 30degreesC to 45degreesC). In order to understand the mechanisms that control gsn expression, we isolated the gene, including its 5' and 3' flanking regions, from the genome of N. crassa. An ORF of approximately 2.4 kb was identified, which is interrupted by four small introns (II-V). Intron I (482 bp) is located in the 5'UTR region. Three putative Transcription Initiation Sites (TISs) were mapped, one of which lies downstream of a canonical TATA-box sequence (5'-TGTATAAA-3'). Analysis of the 5'-flanking region revealed the presence of putative transcription factor-binding sites, including Heat Shock Elements (HSEs) and STress Responsive Elements (STREs). The possible involvement of these motifs in the negative regulation of gsn transcription was investigated using Electrophoretic Mobility Shift Assays (EMSA) with nuclear extracts of N. crassa mycelium obtained before and after heat shock, and DNA fragments encompassing HSE and STRE elements from the 5'-flanking region. While elements within the promoter region are involved in transcription under heat shock, elements in the 5'UTR intron may participate in transcription during vegetative growth. The results thus suggest that N. crassa possesses trans-acting elements that interact with the 5'-flanking region to regulate gsn transcription during heat shock and vegetative growth.

Bright vortex solitons in bose condensates

We suggest the possibility of observing and studying bright vortex solitons in attractive Bose-Einstein condensates in three dimensions with a radial trap. Such systems lie on the verge of critical stability and we discuss the conditions of their stability. We study the interaction between two such solitons. Unlike the text-book solitons in one dimension, the interaction between two radially trapped and axially free three-dimensional solitons is inelastic in nature and involves exchange of particles and deformation in shape. The interaction remains repulsive for all phase δ between them except for δ ≈ 0.

Flutuação populacional e distribuição espacial de Diaphorina citri Kuwayama (Hemiptera: Liviidae) em propriedades citrícolas com manejo intensivo do Huanglongbing

Pós-graduação em Agronomia (Entomologia Agrícola) - FCAV