In the October 2008 issue of Clinics

EDITORIAL

In the October 2008 issue of Clinics

Mauricio Rocha-e-Silva, Editor

Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil. [e-mail]

In this issue, we show images obtained by Miyakawa et al who develop an ex vivo flow system that allows for controlled hemodynamics in order to mimic arterial and venous conditions. Human saphenous veins were cultured either under venous or arterial hemodynamic conditions. Cell viability, cell density and apoptosis were compared before and after these intervals. Cell density was higher and apoptosis less pronounced under venous pressure conditions. The observed results resemble events taking place during early in vivo arterial-vein grafting and provide evidence that an ex vivo perfusion system may be useful for the identification of new therapeutic targets that ameliorate vein graft remodeling and increase graft patency over time.

Lopes et al evaluated the compliance with drug treatment in 75 patients with metabolic syndrome and the knowledge of cardiovascular risk factors through their medical records followed by patient interview. Patients involved in this study exhibited a high level of compliance with drug treatment, with no association between independent variables and compliance. Patient knowledge of diet and dyslipidemia was low

Kotovicz at al assessed the accuracy of clinical diagnoses by comparing pre- and postmortem findings, in a quest to identify potential risk factors for misdiagnoses in 288 patients who died at a tertiary hospital in São Paulo, Brazil and had a postmortem examination. The overall major and minor discrepancy rates were 16.3% and 28.1%, respectively, leading them to conclude that autopsy remains a crucial tool for improving medical care, and effort must be focused on increasing its practice worldwide

Crisostomo et al evaluated vasomotor function, lipids and C-reactive protein in 47 mildly hypertensive and hypercholesterolemic elderly (65-95 years old) patients, 23 treated with placebo, 24 with atorvastatin, and found that atorvastatin produced a significant change of lipids and C-reactive protein, with no changes in vasomotor function, suggesting the existence of intrinsic age-related vessel alterations

Ferreira et al conducted a cross-cultural adaptation of the Foot Health Status Questionnaire into Brazilian-Portuguese and to assess its measurement properties. The questionnaire was translated, back-translated and pre-tested in 40 rheumatoid arthritis subjects. A new corrected version was then tested in 65 patients. Authors conclude that the questionnaire was successfully translated and cross-culturally adapted generating a reliable, consistent, and valid instrument that is useful for evaluating foot health in patients with rheumatoid arthritis.

Macedo et al compared skin folds in the dominant and nondominant halves of the body in a group of 20 individuals with cerebral palsy and spastic hemiplegia vs. a group of 30 normal volunteers, and found differences between the dominant and nondominant halves of the body for biceps, triceps, thoracic, suprailiac, thigh and midcalf skin folds in the first group, in the biceps, subscapular, midaxillary, suprailiac, abdominal, thigh and midcalf skin folds in the normal volunteers.

Mendonça et al evaluated the effect the type of hip fracture (femoral neck or trochanteric) has on the Health-Related Quality of Life of 45 elderly subjects with hip fractures, 24 with a femoral neck fracture and 21 with a trochanteric fracture, and conclude that the mental and physical quality of life of elderly patients with a hip fracture is severely impaired one month after fracture, with partial recovery by the end of the fourth month, with no significantly difference according to fracture type.

Penna et al. measured capillary density in 28 therapeutically-controlled essential hypertensive patients and 19 normotensive subjects through nailfold videocapillaroscopy examination of the fourth finger of the left hand. Compared with normotensive subjects, hypertensive patients showed lower mean functional capillary density at baseline, during post-occlusive reactive hyperemia and during venous congestion responses. Authors conclude that patients treated for essential hypertension showed microvascular rarefaction, regardless of the type of therapy used.

Souza et al studied a case series of 14 HIV-positive elderly patients (62-71 years of age) who participated in a progressive resistance training program and evaluates their body composition, muscular strength, physical fitness and the evolution of CD4⁺ and CD8⁺ cell counts, and concluded that. resistance training increased strength, improved physical fitness, reduced upper and lower limb skinfolds, and were associated with an improvement in the CD4⁺ and CD4⁺/CD8⁺ counts without significant side effects.

Tosun et al investigated the prevalence of obstructive sleep apnea in patients with ischemic stroke and evaluated the effectiveness of nasal continuous positive airway pressure treatment. And found it to be 73.7%, with significantly lower levels of minimum SaO₂ while the percent of total sleep time in the wake stage and stage 1 sleep was significantly longer. They suggest that the clinical assessment of obstructive sleep apnea be part of the evaluation of stroke patients in rehabilitation units, and early treatment should be started

Mitre et al evaluated the results of a sequence of 47 laparoscopic Anderson-Hynes pyeloplasties for the treatment of patients with ureteropelvic junction obstruction, independently of the etiology and conclude that the outcome of this procedure for different causes of pyeloureteral obstruction presented a success rate similar to a previously-published open procedure, with the advantage of being less invasive. This procedure may be considered the first option for the treatment of ureteropelvic junction obstruction.

De Aguiar et al. studied the immunophenotype of leukocytes of 30 patients with tuberculosis or malignancy vs. a control group of 20 healthy blood donors, and found that tuberculous and malignant peripheral blood is enriched in lymphocytes with a helper/inducer T cell phenotype, which is characteristic of memory cells. They also showed that CD14-positive cells were more frequently found in malignant effusions, while CD3-positive cells expressing Fas ligand were more frequently found in tuberculous effusions.

Dinçel et al discuss the risk assessments for patients with hip fractures due to fall-related, low energy traumas and non-fractured control patients in the Turkish population by examining bone mineral density and genetic data, two features associated with femoral strength and hip fracture risk. They found the bone mineral density (trochanteric and total bone mineral density values) of the fracture group was significantly decreased relative to the control group. No statistical tests for the polymorphisms of the COL1A1, ESR, and VDR genes were conducted because results were expressed in terms of frequency. Differences in the IL-6 and OPG genes polymorphisms between the two groups were examined and authors conclude that increasing the number of cases will allow an evaluation of racial differences in femoral hip fracture risk by genotypes.

Ozenoglu et al. investigated serum leptin, adiponectin and paraoxonase1 levels in 32 obese adult females receiving pharmacotherapy for various psychiatric disorders vs. a control group of 22 obese females who were free of psychiatric disorders. They found that body weight was positively correlated with leptin levels in both groups, but negatively correlated with adiponectin levels in the control group and positively correlated with adiponectin levels in the study group indicating a higher risk for obesity-related disorders, particularly metabolic syndrome, diabetes and cardiovascular disease, in patients treated with psychiatric drugs

Felix VN et al. investigated resources to provide better conditions for oropharyngeal swallowing for improvement in the quality of life of Parkinson's disease patients. Three men and one woman (average age: 70 years) afflicted with Parkinson's disease for 9 years were submitted to a rehabilitation program for oropharyngeal dysphagia after a clinical evaluation of swallowing consisting of 2 weeks of daily sessions in which a biofeedback resource adapted especially for this study was used. The patients were then reevaluated for swallowing ability at follow-up. Authors claim that an effortful swallow maneuver reinforced by biofeedback appears to be a therapeutic resource in the rehabilitation of oropharyngeal dysphagia in Parkinson's disease patients.

Mendes et al prospectively evaluated the dynamics of CD28 and CD57 expression in CD8+ T lymphocytes during cytomegalovirus viremia in 33 bone marrow transplant recipients vs. 33 healthy volunteers and observed continuous relative changes in the CD28+ and CD57+ subsets during the first 120 days post- bone marrow transplant, as part of immune system reconstitution and maturation. A clear correlation was observed between the expansion of the CD57+CD28-CD8+ T lymphocyte subpopulation and the occurrence of graft versus host disease and cytomegalovirus viremia.

Rabelo et al compared the endothelium-dependent venous vasodilator response mediated by either acetylcholine or bradykinin in 23 healthy volunteers, and found that the maximum endothelium-dependent venodilation was similar for both drugs, as well as the mean responses for each dose of both drugs. The maximum responses to acetylcholine and bradykinin also had good agreement.

Gibelli et al performed an immunohistochemical study of stellate cells in experimental cholestasis in newborn and adult rats, and found an increase in the number of collagen-producing myofibroblast cells in young animals, suggesting that there is more intense fibrosis in this population. This finding may explain why young animals with bile duct obstruction experience more intense portal fibrosis that is similar to the pathology observed in the livers of newborns with biliary atresia.

We publish 2 reviews: Pereira et al review controversies in the management of asymptomatic patients sustaining penetrating thoracoabdominal wounds, and Cabar et al review serum markers in the diagnosis of tubal pregnancy. We also publish 3 case reports.

Publication Dates

• Publication in this collection
  13 Oct 2008
• Date of issue
  2008