Clinics, Volume: 67, Issue: 1, Published: 2012
  • Because scientists are unable to explain the unexplained, screening for cardiovascular abnormalities is a good method to protect against sudden unexpected death in patients with epilepsy

    Scorza, Fulvio A; Arida, Ricardo M; Cavalheiro, Esper A; Rocha e Silva, Maurício
  • The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil

    Scivoletto, Sandra; Silva, Thiago F; Cunha, Paulo Jannuzzi; Rosenheck, Robert A

    Abstract in English:

    OBJECTIVE: Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil. METHODS: A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively. RESULTS: Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence. CONCLUSIONS: Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth
  • Apolipoprotein E4 influences growth and cognitive responses to micronutrient supplementation in shantytown children from northeast Brazil Clinical Sciences

    Mitter, Sumeet S; Oriá, Reinaldo B; Kvalsund, Michelle P; Pamplona, Paula; Joventino, Emanuella Silva; Mota, Rosa M. S.; Gonçalves, Davi C; Patrick, Peter D; Guerrant, Richard L; Lima, Aldo A. M

    Abstract in English:

    OBJECTIVE: Apolipoprotein E4 may benefit children during early periods of life when the body is challenged by infection and nutritional decline. We examined whether apolipoprotein E4 affects intestinal barrier function, improving short-term growth and long-term cognitive outcomes in Brazilian shantytown children. METHODS: A total of 213 Brazilian shantytown children with below-median height-for-age z-scores (HAZ) received 200,000 IU of retinol (every four months), zinc (40 mg twice weekly), or both for one year, with half of each group receiving glutamine supplementation for 10 days. Height-for-age z-scores, weight-for-age z-scores, weight-forheight z-scores, and lactulose:mannitol ratios were assessed during the initial four months of treatment. An average of four years (range 1.4-6.6) later, the children underwent cognitive testing to evaluate non-verbal intelligence, coding, verbal fluency, verbal learning, and delayed verbal learning. Apolipoprotein E4 carriage was determined by PCR analysis for 144 children. RESULTS: Thirty-seven children were apolipoprotein E4(+), with an allele frequency of 13.9%. Significant associations were found for vitamin A and glutamine with intestinal barrier function. Apolipoprotein E4(+) children receiving glutamine presented significant positive Pearson correlations between the change in height-for-age z-scores over four months and delayed verbal learning, along with correlated changes over the same period in weight-for-age z-scores and weight-for-height z-scores associated with non-verbal intelligence quotients. There was a significant correlation between vitamin A supplementation of apolipoprotein E4(+) children and improved delta lactulose/mannitol. Apolipoprotein E4(-) children, regardless of intervention, exhibited negative Pearson correlations between the change in lactulose-to-mannitol ratio over four months and verbal learning and non-verbal intelligence. CONCLUSIONS: During development, apolipoprotein E4 may function concomitantly with gut-tropic nutrients to benefit immediate nutritional status, which can translate into better long-term cognitive outcomes.
  • Vulnerability to AIDS among the elderly in an urban center in central Brazil Clinical Sciences

    Driemeier, Marta; Andrade, Sônia Maria Oliveira de; Pontes, Elenir Rose Jardim Cury; Paniago, Anamaria Mello Miranda; Cunha, Rivaldo Venâncio da

    Abstract in English:

    OBJECTIVE: As the world population ages with an improved quality of life and sexual longevity, the prevalence of AIDS is rising among the elderly. The purpose of this study was to estimate the vulnerability to AIDS among individuals attending senior community centers in Campo Grande, Mato Grosso do Sul, Brazil. METHOD: This descriptive, exploratory investigation included 329 subjects selected in a probabilistic manner. Individuals with scores on the Mini-Mental State Examination indicating cognitive impairment were excluded from the analyses. Barthel's and Lawton's functional assessment scales were applied. Interviews were conducted to evaluate the presence of cognitive and behavioral factors associated with HIV transmission. RESULTS: Most subjects were non-dependent, fell within the 60- to 69-year age bracket and were female. A majority of individuals reported having knowledge about AIDS and were aware that the elderly are vulnerable to the disease. More than a quarter (26.9%) of the sample reported previous HIV testing. No participants reported drug use, homosexual orientation, or alcohol abuse. A minority of participants reported using medication for erectile dysfunction. Casual and multiple partners accounted for 12% and 34% of reported intercourse experiences, respectively. Condom use was reported by 14% of respondents. CONCLUSION: Unprotected sex was the primary factor accounting for vulnerability to AIDS among the elderly.
  • Periodontitis-associated risk factors in pregnant women Clinical Sciences

    Piscoya, Maria Dilma Bezerra de Vasconcellos; Ximenes, Ricardo Arraes de Alencar; Silva, Genivaldo Moura da; Jamelli, Sílvia Regina; Coutinho, Sonia Bechara

    Abstract in English:

    OBJECTIVE: The main objective of this study was to investigate the risk factors associated with periodontitis in pregnant women. METHODS: This study was conducted in two stages. In Stage 1, a cross-sectional study was conducted to determine the prevalence of periodontitis among 810 women treated at the maternity ward of a university hospital. In Stage 2, the factors associated with periodontitis were investigated in two groups of pregnant women: 90 with periodontitis and 720 without. A hierarchized approach to the evaluation of the risk factors was used in the analysis, and the independent variables related to periodontitis were grouped into two levels: 1) socio-demographic variables; 2a) variables related to nutritional status, smoking, and number of pregnancies; and 2b) variables related to oral hygiene. Periodontitis was defined as a probing depth > 4 mm and an attachment loss > 3 mm at the same site in four or more teeth. A logistic regression analysis was also performed. RESULTS: The prevalence of periodontitis in this sample was 11%. The variables that remained in the final multivariate model with the hierarchized approach were schooling, family income, smoking, body mass index, and bacterial plaque. CONCLUSION: The factors identified underscore the social nature of the disease, as periodontitis was associated with socioeconomic, demographic status, and poor oral hygiene.
  • Regulation of hypoxia-inducible factor-1α (HIF-1α) expression by interleukin-1β (IL-1 β), insulin-like growth factors I (IGF-I) and II (IGF-II) in human osteoarthritic chondrocytes Clinical Sciences

    Sartori-Cintra, Angelica Rossi; Mara, Cristiane Sampaio de; Argolo, Danielle L; Coimbra, Ibsen Bellini

    Abstract in English:

    OBJECTIVE: Hypoxia-inducible factor 1 alpha regulates genes related to cellular survival under hypoxia. This factor is present in osteroarthritic chondrocytes, and cytokines, such as interleukin-1 beta, participate in the pathogenesis of osteoarthritis, thereby increasing the activities of proteolytic enzymes, such as matrix metalloproteinases, and accelerating cartilage destruction. We hypothesize that Hypoxia Inducible Factor-1 alpha (HIF-1α) can regulate cytokines (catabolic action) and/or growth factors (anabolic action) in osteoarthritis. The purpose of this study was to investigate the modulation of HIF-1α in human osteoarthritic chondrocytes by interleukin-1 beta (IL-1β) and insulin-like growth factors I (IGF-I) and II (IGF-II) and to determine the involvement of the phosphatidylinositol-3kinase (PI-3K) pathway in this process. METHODS: Human osteroarthritic chondrocytes were stimulated with IL-1β, IGF-I and IGF-II and LY294002, a specific inhibitor of PI-3K. Nuclear protein levels and gene expression were analyzed by western blot and quantitative reverse transcription-polymerase chain reaction analyses, respectively. RESULTS: HIF-1α expression was upregulated by IL-1β at the protein level but not at the gene level. IGF-I treatment resulted in increases in both the protein and mRNA levels of HIF-1α , whereas IGF-II had no effect on its expression. However, all of these stimuli exploited the PI-3K pathway. CONCLUSION: IL-1β upregulated the levels of HIF-1α protein post-transcriptionally, whereas IGF-I increased HIF-1α at the transcript level. In contrast, IGF-II did not affect the protein or gene expression levels of HIF-1α . Furthermore, all of the tested stimuli exploited the PI-3K pathway to some degree. Based on these findings, we are able to suggest that Hypoxia inducible Factor-1 exhibits protective activity in chondrocytes during osteoarthritis.
  • An economic evaluation of antihypertensive therapies based on clinical trials Clinical Sciences

    Tsuji, Rosana Lima Garcia; Silva, Giovanio Vieira da; Ortega, Katia Coelho; Berwanger, Otavio; Mion Júnior, Decio

    Abstract in English:

    OBJECTIVE: Hypertension is a major issue in public health, and the financial costs associated with hypertension continue to increase. Cost-effectiveness studies focusing on antihypertensive drug combinations, however, have been scarce. The cost-effectiveness ratios of the traditional treatment (hydrochlorothiazide and atenolol) and the current treatment (losartan and amlodipine) were evaluated in patients with grade 1 or 2 hypertension (HT1-2). For patients with grade 3 hypertension (HT3), a third drug was added to the treatment combinations: enalapril was added to the traditional treatment, and hydrochlorothiazide was added to the current treatment. METHODS: Hypertension treatment costs were estimated on the basis of the purchase prices of the antihypertensive medications, and effectiveness was measured as the reduction in systolic blood pressure and diastolic blood pressure (in mm Hg) at the end of a 12-month study period. RESULTS: When the purchase price of the brand-name medication was used to calculate the cost, the traditional treatment presented a lower cost-effectiveness ratio [US$/mm Hg] than the current treatment in the HT1-2 group. In the HT3 group, however, there was no difference in cost-effectiveness ratio between the traditional treatment and the current treatment. The cost-effectiveness ratio differences between the treatment regimens maintained the same pattern when the purchase price of the lower-cost medication was used. CONCLUSIONS: We conclude that the traditional treatment is more cost-effective (US$/mm Hg) than the current treatment in the HT1-2 group. There was no difference in cost-effectiveness between the traditional treatment and the current treatment for the HT3 group.
  • Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: conventional laryngoscopy versus an intubating laryngeal mask airway Clinical Sciences

    Sener, Elif Bengi; Ustun, Emre; Ustun, Burcu; Sarihasan, Binnur

    Abstract in English:

    OBJECTIVES: We compared hemodynamic responses and upper airway morbidity following tracheal intubation via conventional laryngoscopy or intubating laryngeal mask airway in hypertensive patients. METHODS: Forty-two hypertensive patients received a conventional laryngoscopy or were intubated with a intubating laryngeal mask airway. Anesthesia was induced with propofol, fentanyl, and cis-atracurium. Measurements of systolic and diastolic blood pressures, heart rate, rate pressure product, and ST segment changes were made at baseline, preintubation, and every minute for the first 5 min following intubation. The number of intubation attempts, the duration of intubation, and airway complications were recorded. RESULTS: The intubation time was shorter in the conventional laryngoscopy group than in the intubating laryngeal mask airway group (16.33 ± 10.8 vs. 43.04±19.8 s, respectively) (p<0.001). The systolic and diastolic blood pressures in the intubating laryngeal mask airway group were higher than those in the conventional laryngoscopy group at 1 and 2 min following intubation (p<0.05). The rate pressure product values (heart rate x systolic blood pressure) at 1 and 2 min following intubation in the intubating laryngeal mask airway group (15970.90 ± 3750 and 13936.76 ± 2729, respectively) were higher than those in the conventional laryngoscopy group (13237.61 ± 3413 and 11937.52 ± 3160, respectively) (p<0.05). There were no differences in ST depression or elevation between the groups. The maximum ST changes compared with baseline values were not significant between the groups (conventional laryngoscopy group: 0.328 mm versus intubating laryngeal mask airway group: 0.357 mm; p = 0.754). The number and type of airway complications were similar between the groups. CONCLUSION: The intense and repeated oropharyngeal and tracheal stimulation resulting from intubating laryngeal mask airway induces greater pressor responses than does stimulation resulting from conventional laryngoscopy in hypertensive patients. As ST changes and upper airway morbidity are similar between the two techniques, conventional laryngoscopy, which is rapid and safe to perform, may be preferred in hypertensive patients with normal airways.
  • Clinical predictors of prosthesis-patient mismatch after aortic valve replacement for aortic stenosis Clinical Sciences

    Astudillo, Luis M; Santana, Orlando; Urbandt, Pablo A; Benjo, Alexandre M; Elkayam, Lior U; Nascimento, Francisco O; Lamas, Gervasio A; Lamelas, Joseph

    Abstract in English:

    OBJECTIVE: We sought to ascertain predictors of Patient Prosthesis Mismatch, an independent predictor of mortality, in patients with aortic stenosis using bioprosthetic valves. METHOD: We analyzed 2,107 sequential surgeries. Patient Prosthesis Mismatch was calculated using the effective orifice area of the prosthesis divided by the patient's body surface area. We defined nonsignificant, moderate, and severe Patient Prosthesis Mismatch as effective orifice area indexes of .0.85 cm²/m, 0.85-0.66 cm²/m², and <0.65 cm²/m², respectively. RESULTS: A total of 311 bioprosthetic patients were identified. The incidence of nonsignificant, moderate, and severe Patient Prosthesis Mismatch was 41%, 42, and 16%, respectively. Severe Patient Prosthesis Mismatch was significantly more prevalent in females (82%). In severe Patient Prosthesis Mismatch, the perfusion and the crossclamp times were considerably lower when compared with nonsignificant Patient Prosthesis Mismatch and moderate Patient Prosthesis Mismatch. Patients with severe Patient Prosthesis Mismatch had a significantly higher likelihood of spending time in the intensive care unit and a significantly longer length of stay in the hospital. Body surface area was not different in severe Patient Prosthesis Mismatch when compared with nonsignificant Patient Prosthesis Mismatch. In-hospital mortality in patients with nonsignificant, moderate, and severe Patient Prosthesis Mismatch was 2.3%, 6.1%, and 8%, respectively. Minimally invasive surgery was significantly associated with moderate Patient Prosthesis Mismatch in 49% of the patients, but not with severe Patient Prosthesis Mismatch. CONCLUSION: Severe Patient Prosthesis Mismatch is more common in females, but not in those with minimal available body surface area. Though operative times were shorter in these patients, intensive care unit and hospital lengths of stay were longer. Surgeons and cardiologists should be cognizant of these clinical predictors and complications prior to valve surgery.
  • Reduced occurrence of programmed cell death and gliosis in the retinas of juvenile rabbits after shortterm treatment with intravitreous bevacizumab Basic Researches

    Fusco, Maria Alice; Portes, André Luís Freire; Allodi, Silvana; Moraes Junior, Haroldo Vieira de; Monteiro, Mário Luiz Ribeiro; Miguel, Nádia Campos de Oliveira

    Abstract in English:

    OBJECTIVE: Bevacizumab has been widely used as a vascular endothelial growth factor antagonist in the treatment of retinal vasoproliferative disorders in adults and, more recently, in infants with retinopathy of prematurity. Recently, it has been proposed that vascular endothelial growth factor acts as a protective factor for neurons and glial cells, particularly in developing nervous tissue. The purpose of this study was to investigate the effects of bevacizumab on the developing retinas of juvenile rabbits. METHODS: Juvenile rabbits received bevacizumab intravitreously in one eye; the other eye acted as an untreated control. Slit-lamp and fundoscopic examinations were performed both prior to and seven days after treatment. At the same time, retina samples were analyzed using immunohistochemistry to detect autophagy and apoptosis as well as proliferation and glial reactivity. Morphometric analyses were performed, and the data were analyzed using the Mann-Whitney U test. RESULTS: No clinical abnormalities were observed in either treated or untreated eyes. However, immunohistochemical analyses revealed a reduction in the occurrence of programmed cell death and increases in both proliferation and reactivity in the bevacizumab-treated group compared with the untreated group. CONCLUSIONS: Bevacizumab appears to alter programmed cell death patterns and promote gliosis in the developing retinas of rabbits; therefore, it should be used with caution in developing eyes
  • Paradoxical effects of brain death and associated trauma on rat mesenteric microcirculation: an intravital microscopic study Basic Researches

    Simas, Rafael; Sannomiya, Paulina; Cruz, José Walber M. C; Correia, Cristiano de Jesus; Zanoni, Fernando Luiz; Kase, Maurício; Menegat, Laura; Silva, Isaac Azevedo; Moreira, Luiz Felipe P

    Abstract in English:

    OBJECTIVE: Experimental findings support clinical evidence that brain death impairs the viability of organs for transplantation, triggering hemodynamic, hormonal, and inflammatory responses. However, several of these events could be consequences of brain death-associated trauma. This study investigated microcirculatory alterations and systemic inflammatory markers in brain-dead rats and the influence of the associated trauma. METHOD: Brain death was induced using intracranial balloon inflation; sham-operated rats were trepanned only. After 30 or 180 min, the mesenteric microcirculation was observed using intravital microscopy. The expression of Pselectin and ICAM-1 on the endothelium was evaluated using immunohistochemistry. The serum cytokine, chemokine, and corticosterone levels were quantified using enzyme-linked immunosorbent assays. White blood cell counts were also determined. RESULTS: Brain death resulted in a decrease in the mesenteric perfusion to 30%, a 2.6-fold increase in the expression of ICAM-1 and leukocyte migration at the mesentery, a 70% reduction in the serum corticosterone level and pronounced leukopenia. Similar increases in the cytokine and chemokine levels were seen in the both the experimental and control animals. CONCLUSION: The data presented in this study suggest that brain death itself induces hypoperfusion in the mesenteric microcirculation that is associated with a pronounced reduction in the endogenous corticosterone level, thereby leading to increased local inflammation and organ dysfunction. These events are paradoxically associated with induced leukopenia after brain damage
  • Narcolepsy after A/H1N1 vaccination Case Reports

    Mendes, Mirian Fabiola Studart Gurgel; Valladares Neto, Dirceu de Campos; Azevedo, Rosângela Aparecida de; Caramelli, Paulo
  • Novel compound aquaporin 2 mutations in nephrogenic diabetes insipidus Case Reports

    Liberatore Junior, Raphael D; Carneiro, Juliana G; Leidenz, Franciele B; Melilo-Carolino, Rachel; Sarubi, Helena C; De Marco, Luiz
  • Intravascular leiomyoma with heart extension Case Reports

    Morales, Marcia Maria; Anacleto, Alexandre; Leal, João Carlos; Carvalho, Sergio; Del'Arco, Jerônimo
  • Laparoendoscopic single-site (LESS) repair of lumbar hernia: initial case report Case Reports

    Tobias-Machado, Marcos; Araújo, Felipe Brandao Corrêa de; Castro-Neves, Oseas; Correa, Walter Fernandes; Mitre, Anuar Ibrahim; Pompeo, Antonio Carlos Lima
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