Logomarca do periódico: Clinics

Open-access Clinics

Publication of: Faculdade de Medicina / USP
Area: Health Sciences ISSN printed version: 1807-5932
ISSN online version: 1980-5322
Previous title Revista do Hospital das Clínicas

Table of contents

Clinics, Volume: 67, Issue: 12, Published: 2012

Clinics, Volume: 67, Issue: 12, Published: 2012

Document list
Editorial
Molecular and genetic aspects of oncology and infectology in Clinics Rocha-e-Silva, Mauricio
Clinical Sciences
Supine sleep and positional sleep apnea after acute ischemic stroke and intracerebral hemorrhage Camilo, Millene R. Fernandes, Regina M. F. Sander, Heidi H. Nobre, Fernando Santos-Pontelli, Taiza Santos, Antonio C. dos Araujo, Draulio B. de Leite, João P. Pontes-Neto, Octavio M.

Abstract in English:

OBJECTIVE: Obstructive sleep apnea is frequent during the acute phase of stroke, and it is associated with poorer outcomes. A well-established relationship between supine sleep and obstructive sleep apnea severity exists in non-stroke patients. This study investigated the frequency of supine sleep and positional obstructive sleep apnea in patients with ischemic or hemorrhagic stroke. METHODS: Patients who suffered their first acute stroke, either ischemic or hemorrhagic, were subjected to a full polysomnography, including the continuous monitoring of sleep positions, during the first night after symptom onset. Obstructive sleep apnea severity was measured using the apnea-hypopnea index, and the NIHSS measured stroke severity. RESULTS: We prospectively studied 66 stroke patients. The mean age was 57.6±11.5 years, and the mean body mass index was 26.5±4.9. Obstructive sleep apnea (apnea-hypopnea index >5) was present in 78.8% of patients, and the mean apnea-hypopnea index was 29.7±26.6. The majority of subjects (66.7%) spent the entire sleep time in a supine position, and positional obstructive sleep apnea was clearly present in the other 23.1% of cases. A positive correlation was observed between the NIHSS and sleep time in the supine position (r s = 0.5; p<0.001). CONCLUSIONS: Prolonged supine positioning during sleep was highly frequent after stroke, and it was related to stroke severity. Positional sleep apnea was observed in one quarter of stroke patients, which was likely underestimated during the acute phase of stroke. The adequate positioning of patients during sleep during the acute phase of stroke may decrease obstructive respiratory events, regardless of the stroke subtype.
Clinical Sciences
The effects of one-half of a soccer match on the postural stability and functional capacity of the lower limbs in young soccer players Yamada, Ricardo Kim Fukushi Arliani, Gustavo Gonçalves Almeida, Gabriel Peixoto Leão Venturine, André Manrique Santos, Ciro Veronese dos Astur, Diego Costa Cohen, Moisés

Abstract in English:

OBJECTIVE: Most injuries occur during the final 15 minutes of each half of a soccer match, suggesting that physical exertion may influence changes in neuromuscular control and the body's ability to stabilize the joints of the lower extremities. The aim of this study was to analyze the effects of one-half of a soccer match on the functional capacity and stability of the lower limbs in young soccer players. METHODS: We analyzed 27 soccer players by evaluating the functional capacity of their lower limbs using the hop test protocol and their level of postural stability using the Biodex Stability System. The evaluations were performed before and after 45 minutes of game time. RESULTS: After the match, there was a decrease in the overall stability index (OSI) (F(1,23) = 5.64, p = 0.026) and the anterior-posterior stability index (APSI) (F(1,23) = 5.24,p = 0.032). In the single and triple hop tests, there was a higher functional capacity in the dominant limb compared to the non dominant limb in the pre- and post-game comparisons. CONCLUSION: The results of this study show that there is a decrease in the stability of the lower limbs in young soccer players after a 45 minutes soccer match, but the same result was not found for the functional capacity.
Clinical Sciences
The perception of sleep quality in kidney transplant patients during the first year of transplantation Silva, Dnyelle Souza Andrade, Elisangela dos Santos Prado Elias, Rosilene Motta David-Neto, Elias Nahas, William Carlos Castro, Manuel Carlos Martins de Castro, Maria Cristina Ribeiro de

Abstract in English:

OBJECTIVE: Poor sleep quality is one of the factors that adversely affects patient quality of life after kidney transplantation, and sleep disorders represent a significant cardiovascular risk factor. The objective of this study was to investigate the prevalence of changes in sleep quality and their outcomes in kidney transplant recipients and analyze the variables affecting sleep quality in the first years after renal transplantation. METHODS: Kidney transplant recipients were evaluated at two time points after a successful transplantation: between three and six months (Phase 1) and between 12 and 15 months (Phase 2). The following tools were used for assessment: the Pittsburgh Sleep Quality Index; the quality of life questionnaire Short-Form-36; the Hospital Anxiety and Depression scale; the Karnofsky scale; and assessments of social and demographic data. The prevalence of poor sleep was 36.7% in Phase 1 and 38.3% in Phase 2 of the study. RESULTS: There were no significant differences between patients with and without changes in sleep quality between the two phases. We found no changes in sleep patterns throughout the study. Both the physical and mental health scores worsened from Phase 1 to Phase 2. CONCLUSION: Sleep quality in kidney transplant recipients did not change during the first year after a successful renal transplantation.
Clinical Sciences
Differential expression of hypoxia-inducible factor 1α in non-small cell lung cancer and small cell lung cancer Karetsi, Eleni Ioannou, Maria G. Kerenidi, Theodora Minas, Markos Molyvdas, Paschalis A. Gourgoulianis, Konstantinos I. Paraskeva, Efrosyni

Abstract in English:

OBJECTIVES: The aim of this study was to compare the expression of hypoxia-inducible factor 1α and vascular endothelial growth factor in small cell lung cancer and subtypes of non-small cell lung cancer and examine their relationships with clinicopathologic factors, response to treatment and survival. METHODS: We examined samples obtained by bronchial endoscopic biopsy from 55 patients with inoperable lung cancer (16 with adenocarcinoma, 17 with squamous cell carcinoma, and 22 with small cell lung cancer). Hypoxiainducible factor 1α and vascular endothelial growth factor were detected using immunohistochemistry. The diagnosis, treatment, and follow-up of patients were conducted according to the standard practice. RESULTS: A significant difference (p=0.022) in hypoxia-inducible factor 1α expression was observed between nonsmall cell lung cancer (75.8% positive) and small cell lung cancer (45.5% positive). The frequency of hypoxiainducible factor 1α nuclear expression was 88.2% in squamous cell carcinoma, 62.5% in adenocarcinoma, and 45.5% in small cell lung cancer. A significant correlation was observed between hypoxia-inducible factor 1α and vascular endothelial growth factor expression (Fisher's exact test, p=0.001) when all types of lung cancer were examined, either collectively or separately. CONCLUSIONS: The expression of hypoxia-inducible factor-1α differs significantly between subtypes of lung cancer. These findings could help elucidate the biology of the different types of non-operable lung carcinomas and have implications for the design of new therapeutic approaches for lung cancer.
Clinical Sciences
Mechanical thrombectomy with solitaire stent retrieval for acute ischemic stroke in a Brazilian population Castro-Afonso, Luis Henrique de Abud, Thiago Giansante Pontes-Neto, Octávio Marques Monsignore, Lucas Moretti Nakiri, Guilherme Seizem Cougo-Pinto, Pedro Telles Oliveira, Lívia de Santos, Daniela dos Dias, Francisco A Fábio, Soraia Cabette Ramos Coletto, Francisco Antônio Abud, Daniel Giansante

Abstract in English:

OBJECTIVE: Large vessel occlusion in acute ischemic stroke is associated with low recanalization rates under intravenous thrombolysis. We evaluated the safety and efficacy of the Solitaire AB stent in treating acute ischemic stroke. METHODS: Patients presenting with acute ischemic stroke were prospectively evaluated. The neurological outcomes were assessed using the National Institutes of Health Stroke Scale and the modified Rankin Scale. Time was recorded from the symptom onset to the recanalization and procedure time. Recanalization was assessed using the thrombolysis in cerebral infarction score. RESULTS: Twenty-one patients were evaluated. The mean patient age was 65, and the National Institutes of Health Stroke Scale scores ranged from 7 to 28 (average 17±6.36) at presentation. The vessel occlusions occurred in the middle cerebral artery (61.9%), distal internal carotid artery (14.3%), tandem carotid occlusion (14.3%), and basilarartery (9.5%). Primary thrombectomy, rescue treatment and a bridging approach represented 66.6%, 28.6%, and 4.8% of the performed procedures, respectively. The mean time from symptom onset to recanalization was 356.5±107.8 minutes (range, 80-586 minutes). The mean procedure time was 60.4±58.8 minutes (range, 14-240 minutes). The overall recanalization rate (thrombolysis in cerebral infarction scores of 3 or 2b) was 90.4%, and the symptomatic intracranial hemorrhage rate was 14.2%. The National Institutes of Health Stroke Scale scores at discharge ranged from 0 to 25 (average 6.9±7). At three months, 61.9% of the patients had a modified Rankin Scale score of 0 to 2, with an overall mortality rate of 9.5%. CONCLUSIONS: Intra-arterial thrombectomy with the Solitaire AB device appears to be safe and effective. Large randomized trials are necessary to confirm the benefits of this approach in acute ischemic stroke.
Clinical Sciences
Nutritional risk and anthropometric evaluation in pediatric liver transplantation Zamberlan, Patrícia Leone, Cláudio Tannuri, Uenis Carvalho, Werther Brunow de Delgado, Artur Figueiredo

Abstract in English:

OBJECTIVE: To analyze the nutritional status of pediatric patients after orthotopic liver transplantation and the relationship with short-term clinical outcome. METHOD: Anthropometric evaluations of 60 children and adolescents after orthotopic liver transplantation, during the first 24 hours in a tertiary pediatric intensive care unit. Nutritional status was determined from the Z score for the following indices: weight/age height/age or length/age, weight/height or weight/length, body mass index/age, arm circumference/age and triceps skinfold/age. The severity of liver disease was evaluated using one of the two models which was adequated to the patients' age: 1. Pediatric End-stage Liver Disease, 2. Model for End-Stage Liver Disease. RESULTS: We found 50.0% undernutrition by height/age; 27.3% by weight/age; 11.1% by weight/height or weight/ length; 10.0% by body mass index/age; 61.6% by arm circumference/age and 51.0% by triceps skinfold/age. There was no correlation between nutritional status and Pediatric End-stage Liver Disease or mortality. We found a negative correlation between arm circumference/age and length of hospitalization. CONCLUSION: Children with chronic liver diseases experience a significant degree of undernutrition, which makes nutritional support an important aspect of therapy. Despite the difficulties in assessment, anthropometric evaluation of the upper limbs is useful to evaluate nutritional status of children before or after liver transplantation.
Clinical Sciences
Novel GATA5 loss-of-function mutations underlie familial atrial fibrillation Gu, Jian-Yun Xu, Jia-Hong Yu, Hong Yang, Yi-Qing

Abstract in English:

OBJECTIVE: This study aimed to identify novel GATA5 mutations that underlie familial atrial fibrillation. METHODS: A total of 110 unrelated patients with familial atrial fibrillation and 200 unrelated, ethnically matched healthy controls were recruited. The entire coding region of the GATA5 gene was sequenced in 110 atrial fibrillation probands. The available relatives of the mutation carriers and 200 controls were subsequently genotyped for the identified mutations. The functional effect of the mutated GATA5 was characterized using a luciferase reporter assay system. RESULTS: Two novel heterozygous GATA5 mutations (p.Y138F and p.C210G) were identified in two of the 110 unrelated atrial fibrillation families. These missense mutations cosegregated with AF in the families and were absent in the 400 control chromosomes. A cross-species alignment of GATA5 protein sequence showed that the altered amino acids were completely conserved evolutionarily. A functional analysis revealed that the mutant GATA5 proteins were associated with significantly decreased transcriptional activation when compared with their wild-type counterpart. CONCLUSION: The findings expand the spectrum of GATA5 mutations linked to AF and provide novel insights into the molecular mechanism involved in the pathogenesis of atrial fibrillation, suggesting potential implications for the early prophylaxis and personalized treatment of this common arrhythmia.
Clinical Sciences
The impact of asymptomatic vertebral fractures on quality of life in older community-dwelling women: the São Paulo Ageing & Health Study Lopes, Jaqueline B. Fung, Leandro K. Cha, Caroline C. Gabriel, Gustavo M. Takayama, Liliam Figueiredo, Camille P. Pereira, Rosa Maria R.

Abstract in English:

OBJECTIVES: The aim of this study was to investigate the impact of asymptomatic vertebral fractures on the quality of life in older women as part of the Sao Paulo Ageing & Health Study. METHODS: This study was a cross-sectional study with a random sample of 180 women 65 years of age or older with or without vertebral fractures. The Quality of Life Questionnaire of the European Foundation for Osteoporosis was administered to all subjects. Anthropometric data were obtained by physical examination, and the body mass index was calculated. Lateral thoracic and lumbar spine X-ray scans were obtained to identify asymptomatic vertebral fractures using a semi-quantitative method. RESULTS: Women with asymptomatic vertebral fractures had lower total scores [61.4(15.3) vs. 67.1(14.2), p = 0.03] and worse physical function domain scores [69.5(20.1) vs. 77.3(17.1), p = 0.02] for the Quality of Life Questionnaire of the European Foundation for Osteoporosis compared with women without fractures. The total score of this questionnaire was also worse in women classified as obese than in women classified as overweight or normal. High physical activity was related to a better total score for this questionnaire (p = 0.01). Likewise, lower physical function scores were observed in women with higher body mass index values (p<0.05) and lower physical activity levels (p,0.05). Generalized linear models with gamma distributions and logarithmic link functions, adjusted for age, showed that lower total scores and physical function domain scores for the Quality of Life Questionnaire of the European Foundation for Osteoporosis were related to a high body mass index, lower physical activity, and the presence of vertebral fractures (p<0.05). CONCLUSION: Vertebral fractures are associated with decreased quality of life mainly physical functioning in older community-dwelling women regardless of age, body mass index, and physical activity. Therefore, the results highlight the importance of preventing and controlling asymptomatic vertebral fractures to reduce their impact on quality of life among older women.
Clinical Sciences
Effects of Brazilian Cardioprotective Diet Program on risk factors in patients with coronary heart disease: a Brazilian Cardioprotective Diet randomized pilot trial Weber, Bernardete Galante, Andrea Polo Bersch-Ferreira, Angela Cristine Torreglosa, Camila Ragne Carvalho, Vitor Oliveira Victor, Elivane da Silva Espírito-Santo, Jose Amalth do Ross-Fernandes, Maria Beatriz Soares, Rafael Marques Costa, Rosana Perim Lara, Enilda de Sousa Buehler, Anna Maria Berwanger, Otávio

Abstract in English:

OBJECTIVE: To evaluate the effectiveness of the Brazilian Cardioprotective Diet Program in reducing blood pressures, fasting glucose levels and body mass indices in patients with established atherothrombotic disease. METHOD: This randomized controlled pilot trial included outpatients who were over 45 years of age with atherothrombotic cardiovascular disease. Group A, who received the Brazilian Cardioprotective Diet Program, had weekly sessions with dietitians. Groups B and C received the usual dietary therapy that is given to patients with cardiovascular diseases as proposed by the Brazilian guidelines. This diet had the same nutrient profile as that given to Group A, but it was customized by the integration of typical Mediterranean foods. The difference between Groups B and C was the number of sessions with the dietitian. Group B received weekly sessions, while group C only had monthly sessions. ClinicalTrials.gov: NCT 01453166. RESULTS: There was a greater reduction in systolic (7.8%) and diastolic (10.8%) blood pressures in Group A compared with Group B (2.3% and 7.3%), and Group C (3.9% and 4.9%, respectively). Fasting glucose decreased by 5.3% and 2% in Groups A and B, respectively. Fasting glucose increased by 3.7% in Group C. The BMIs decreased by 3.5% and 3.3% in Groups A and B, respectively. Group C did not present with any changes in BMI. However, none of these data showed statistical differences between the groups, which is methodologically acceptable in pilot trials. CONCLUSIONS: The Brazilian Cardioprotective Diet Program seems to be more effective in reducing blood pressures, fasting glucose levels, weights and BMIs in patients with previous cardiovascular disease compared with the diet that has been proposed by the Brazilian guidelines.
Clinical Sciences
Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: analysis of 100 cases from a high-volume urologic center Marmiroli, Rafael Antunes, Alberto A. Reis, Sabrina T. Nakano, Elcio Srougi, Miguel

Abstract in English:

OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostatespecific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications.
Clinical Sciences
Plantar thermography is useful in the early diagnosis of diabetic neuropathy Balbinot, Luciane Fachin Canani, Luis Henrique Robinson, Caroline Cabral Achaval, Matilde Zaro, Milton Antônio

Abstract in English:

OBJECTIVES: This study evaluated plantar thermography sensitivity and specificity in diagnosing diabetic polyneuropathy using cardiac tests (heart rate variability) as a reference standard because autonomic small fibers are affected first by this disease. METHODS: Seventy-nine individuals between the ages of 19 and 79 years old (28 males) were evaluated and divided into three groups: control (n = 37), pre-diabetics (n = 13) and type 2 diabetics (n = 29). The plantar images were recorded at baseline and then minutes after a provocative maneuver (Cold Stress Test) using an infrared camera that is appropriate for clinical use. Two thermographic variables were studied: the thermal recovery index and the interdigital anisothermal technique. Heart rate variability was measured in a seven-test battery that included three spectral indexes (in the frequency domain) and four Ewing tests (the Valsalva maneuver, the orthostatic test, a deep breathing test, and the orthostatic hypotension test). Other classically recommended tests were applied, including electromyography (EMG), Michigan inventory, and a clinical interview that included a neurological physical examination. RESULTS: Among the diabetic patients, the interdigital anisothermal technique alone performed better than the thermal recovery index alone, with a better sensitivity (81.3%) and specificity (46.2%). For the pre-diabetic patients, the three tests performed equally well. None of the control subjects displayed abnormal interdigital anisothermal readouts or thermal recovery indices, which precluded the sensitivity estimation in this sample of subjects. However, the specificity (70.6%) was higher in this group. CONCLUSION: In this study, plantar thermography, which predominately considers the small and autonomic fibers that are commonly associated with a sub-clinical condition, proved useful in diagnosing diabetic neuropathy early. The interdigital anisothermal test, when used alone, performed best.
Clinical Sciences
The modified Hodge test is a useful tool for ruling out Klebsiella pneumoniae carbapenemase Cury, Ana Paula Andreazzi, Denise Maffucci, Márcia Caiaffa-Junior, Hélio Hehl Rossi, Flávia

Abstract in English:

OBJECTIVE: Enterobacteriaceae bacteria harboring Klebsiella pneumoniae carbapenemase are a serious worldwide threat. The molecular identification of these pathogens is not routine in Brazilian hospitals, and a rapid phenotypic screening test is desirable. This study aims to evaluate the modified Hodge test as a phenotypic screening test for Klebsiella pneumoniae carbapenemase. METHOD: From April 2009 to July 2011, all Enterobacteriaceae bacteria that were not susceptible to ertapenem according to Vitek2 analysis were analyzed with the modified Hodge test. All positive isolates and a random subset of negative isolates were also assayed for the presence of blaKPC. Isolates that were positive in modified Hodge tests were sub-classified as true-positives (E. coli touched the ertapenem disk) or inconclusive (distortion of the inhibition zone of E. coli, but growth did not reach the ertapenem disk). Negative results were defined as samples with no distortion of the inhibition zone around the ertapenem disk. RESULTS: Among the 1521 isolates of Enterobacteriaceae bacteria that were not susceptible to ertapenem, 30% were positive for blaKPC, and 35% were positive according to the modified Hodge test (81% specificity). Under the proposed sub-classification, true positives showed a 98% agreement with the blaKPC results. The negative predictive value of the modified Hodge test for detection was 100%. KPC producers showed high antimicrobial resistance rates, but 90% and 77% of these isolates were susceptible to aminoglycoside and tigecycline, respectively. CONCLUSION: Standardizing the modified Hodge test interpretation may improve the specificity of KPC detection. In this study, negative test results ruled out 100% of the isolates harboring Klebsiella pneumoniae carbapenemase 2. The test may therefore be regarded as a good epidemiological tool.
Clinical Sciences
The influence of anthropometric factors on postural balance: the relationship between body composition and posturographic measurements in young adults Alonso, Angélica Castilho Luna, Natália Mariana S. Mochizuki, Luis Barbieri, Fábio Santos, Sileno Greve, Julia Maria D'Andréia

Abstract in English:

OBJECTIVE: The aim of the present study was to evaluate the influence of anthropometric characteristics and gender on postural balance in adults. One hundred individuals were examined (50 males, 50 females; age range 20-40 years). METHODS: The following body composition measurements were collected (using bone densitometry measurements): fat percentage (% fat), tissue (g), fat (g), lean mass (g), bone mineral content (g), and bone mineral density (g/cm2). In addition, the following anthropometric measurements were collected: body mass (kg), height (cm), length of the trunk-cephalic region (cm), length of the lower limbs (cm) and length of the upper limbs (cm). The following indices were calculated: body mass index (kg/m²), waist-hip ratio and the support base (cm²). Also, a postural balance test was performed using posturography variables with open and closed eyes. RESULTS: The analysis revealed poor correlations between postural balance and the anthropometric variables. A multiple linear regression analysis demonstrated that the whole group (female and male) height explained 12% of the medial-lateral displacement, 10% of the speed of oscillation, and 11% of the displacement area. The length of the trunk-cephalic length explained 6% of the displacement in the anteroposterior direction. With eyes closed, the support base and height explained 18% of the medial displacement, and the lateral height explained 10% of the displacement speed and 5% of the scroll area. CONCLUSION: Measured using posturography, the postural balance was only slightly influenced by the anthropometric variables, both with open and closed eyes. Height was the anthropometric variable that most influenced postural balance, both in the whole group and separately for each gender. Postural balance was more influenced by anthropometric factors in males than females.
Clinical Sciences
Serum adenosine deaminase, catalase and carbonic anhydrase activities in patients with bladder cancer Pirinççi, Necip Geçit, Ilhan Güneş, Mustafa Yüksel, Mehmet Bilgehan Kaba, Mehmet Tanık, Serhat Demir, Halit Aslan, Mehmet

Abstract in English:

OBJECTIVES: The relationship between adenosine deaminase and various cancers has been investigated in several studies. However, serum adenosine deaminase activity and carbonic anhydrase and catalase activities in patients with bladder cancer have not previously been reported. Therefore, the aim of this study was to measure serum adenosine deaminase, carbonic anhydrase and catalase activities in patients with bladder cancer. MATERIALS AND METHODS: Forty patients with bladder cancer and 30 healthy controls were enrolled in the study. Serum adenosine deaminase, carbonic anhydrase and catalase activities were measured spectrophotometrically. RESULTS: Serum adenosine deaminase, carbonic anhydrase and catalase activities were significantly higher in patients with bladder cancer than controls (all significant, p<0.001). CONCLUSIONS: These markers might be a potentially important finding as an additional diagnostic biochemical tool for bladder cancer.
Basic Researches
Antioxidant enzyme activity and malondialdehyde levels can be modulated by Piper betle, tocotrienol rich fraction and Chlorella vulgaris in aging C57BL/6 mice Aliahmat, Nor Syahida Noor, Mohd Razman Mohd Yusof, Wan Junizam Wan Makpol, Suzana Ngah, Wan Zurinah Wan Yusof, Yasmin Anum Mohd

Abstract in English:

OBJECTIVE: The aim of this study was to determine the erythrocyte antioxidant enzyme activity and the superoxide dismutase, catalase, glutathione peroxidase, and plasma malondialdehyde levels in aging mice and to evaluate how these measures are modulated by potential antioxidants, including the tocotrienol-rich fraction, Piper betle, and Chlorella vulgaris. METHOD: One hundred and twenty male C57BL/6 inbred mice were divided into three age groups: young (6 months old), middle-aged (12 months old), and old (18 months old). Each age group consisted of two control groups (distilled water and olive oil) and three treatment groups: Piper betle (50 mg/kg body weight), tocotrienol-rich fraction (30 mg/kg), and Chlorella vulgaris (50 mg/kg). The duration of treatment for all three age groups was two months. Blood was withdrawn from the orbital sinus to determine the antioxidant enzyme activity and the malondialdehyde level. RESULTS: Piper betle increased the activities of catalase, glutathione peroxidase, and superoxide dismutase in the young, middle, and old age groups, respectively, when compared to control. The tocotrienol-rich fraction decreased the superoxide dismutase activity in the middle and the old age groups but had no effect on catalase or glutathione peroxidase activity for all age groups. Chlorella vulgaris had no effect on superoxide dismutase activity for all age groups but increased glutathione peroxidase and decreased catalase activity in the middle and the young age groups, respectively. Chlorella vulgaris reduced lipid peroxidation (malondialdehyde levels) in all age groups, but no significant changes were observed with the tocotrienol-rich fraction and the Piper betle treatments. CONCLUSION: We found equivocal age-related changes in erythrocyte antioxidant enzyme activity when mice were treated with Piper betle, the tocotrienol-rich fraction, and Chlorella vulgaris. However, Piper betle treatment showed increased antioxidant enzymes activity during aging.
Basic Researches
Effects of the administration of pentoxifylline and prednisolone on the evolution of portal fibrogenesis secondary to biliary obstruction in growing animals: immunohistochemical analysis of the expression of TGF-β and VEGF Andrade, Wagner de Castro Silva, Luiz Fernando Ferraz da Coelho, Maria Cecilia de Mendonça Tannuri, Ana Cristina Aoun Alves, Venancio Avancini Ferreira Tannuri, Uenis

Abstract in English:

OBJECTIVE: During the neonatal and infancy periods, some chronic liver diseases may lead to progressive hepatic fibrosis, which is a condition that can ultimately result in the loss of organ function and severe portal hypertension necessitating hepatic transplantation. In a previous report, pharmacological interventions were demonstrated to modulate hepatic fibrosis induced by bile duct ligation in young rats. The administration of pentoxifylline or prednisolone, or the combination of both, resulted in reduced fibrogenesis in portal spaces. The objectives of the present study were to evaluate the expression of transforming growth factor β and vascular endothelial growth factor after bile duct ligation in young rats and to assess the effect of those same drugs on cytokine expression. METHODS: In this experimental study, 80 young rats (21 or 22 days old) were submitted either to laparotomy and common bile duct ligation or to sham surgery. The animals were allocated into four groups according to surgical procedure, and the following treatments were administered: (1) common bile duct ligation + distilled water, (2) sham surgery + distilled water, (3) common bile duct ligation + pentoxifylline, or (4) common bile duct ligation + prednisolone. After 30 days, a hepatic fragment was collected from each animal for immunohistochemical analysis using monoclonal antibodies against transforming growth factor β and vascular endothelial growth factor. Digital morphometric and statistical analyses were performed. RESULTS: The administration of pentoxifylline reduced the transforming growth factor β-marked area and the amount of transforming growth factor β expressed in liver tissue. This effect was not observed after the administration of prednisolone. There was a significant reduction in vascular endothelial growth factor expression after the administration of either drug compared with the non-treatment group. CONCLUSIONS: The administration of pentoxifylline to cholestatic young rats resulted in the diminished expression of transforming growth factor β and vascular endothelial growth factor in liver tissue. The administration of steroids resulted in the diminished expression of vascular endothelial growth factor only. These pathways may be involved in hepatic fibrogenesis in young rats submitted to bile duct ligation and exposed to pentoxifylline or prednisolone.
Basic Researches
Hypertonic saline solution reduces the inflammatory response in endotoxemic rats Theobaldo, Mariana Cardillo Barbeiro, Hermes Vieira Barbeiro, Denise Frediani Petroni, Ricardo Soriano, Francisco Garcia

Abstract in English:

OBJECTIVE: Volume replacement in septic patients improves hemodynamic stability. This effect can reduce the inflammatory response. The objective of this study was to evaluate the effect of 7.5% hypertonic saline solution versus 0.9% normal saline solution for volume replacement during an inflammatory response in endotoxemic rats. METHODS: We measured cytokines (serum and gut), nitrite, and lipid peroxidation (TBARS) as indicators of oxidative stress in the gut. Rats were divided into four groups: control group (C) that did not receive lipopolysaccharide; lipopolysaccharide injection without treatment (LPS); lipopolysaccharide injection with saline treatment (LPS +S); and lipopolysaccharide injection with hypertonic saline treatment (LPS +H). Serum and intestine were collected. Measurements were taken at 1.5, 8, and 24 h after lipopolysaccharide administration. RESULTS: Of the four groups, the LPS +H group had the highest survival rate. Hypertonic saline solution treatment led to lower levels of IL-6, IL-10, nitric oxide, and thiobarbituric acid reactive substances compared to 0.9% normal saline. In addition, hypertonic saline treatment resulted in a lower mortality compared to 0.9% normal saline treatment in endotoxemic rats. Volume replacement reduced levels of inflammatory mediators in the plasma and gut. CONCLUSION: Hypertonic saline treatment reduced mortality and lowered levels of inflammatory mediators in endotoxemic rats. Hypertonic saline also has the advantage of requiring less volume replacement.
Basic Researches
The effects of exercise modalities on adiposity in obese rats Speretta, Guilherme Fleury Fina Rosante, Marisa Cristina Duarte, Fernanda Oliveira Leite, Richard Diego Lino, Anderson Diogo de Souza Andre, Rafael Arquias Silvestre, João Guilherme de Oliveira Araujo, Heloisa Sobreiro Selistre de Duarte, Ana Claudia Garcia de Oliveira

Abstract in English:

OBJECTIVE: The aim of the present study was to evaluate the effect of both swimming and resistance training on tumor necrosis factor-alpha and interleukin-10 expression, adipocyte area and lipid profiles in rats fed a high-fat diet. METHODS: The study was conducted over an eight-week period on Wistar adult rats, who were divided into six groups as follows (n = 10 per group): sedentary chow diet, sedentary high-fat diet, swimming plus chow diet, swimming plus high-fat diet, resistance training plus chow diet, and resistance training plus high-fat diet. Rats in the resistance training groups climbed a vertical ladder with weights on their tails once every three days. The swimming groups swam for 60 minutes/day, five days/week. RESULTS: The high-fat diet groups had higher body weights, a greater amount of adipose tissue, and higher tumor necrosis factor-alpha expression in the visceral adipose tissue. Furthermore, the high-fat diet promoted a negative change in the lipid profile. In the resistance training high-fat group, the tumor necrosis factor-alpha expression was lower than that in the swimming high-fat and sedentary high-fat groups. Moreover, smaller visceral and retroperitoneal adipocyte areas were found in the resistance training high-fat group than in the sedentary high-fat group. In the swimming high-fat group, the tumor necrosis factor-alpha expression was lower and the epididymal and retroperitoneal adipocyte areas were smaller compared with the sedentary high-fat group. CONCLUSION: The results showed that both exercise modalities improved the lipid profile, adiposity and obesity-associated inflammation in rats, suggesting their use as an alternative to control the deleterious effects of a high-fat diet in humans.
Rapid Communication
Does lack of improvement in the first two weeks predict treatment resistance in recent-onset psychosis? Kayo, Monica Tassell, Ivson Hiroce, Vivian Menezes, Anny Elkis, Helio
Case Reports
Inevitable hemodialysis for treating resistant hypertension in a patient with Leriche syndrome Yilmaz, Murvet Kaptanogullari, Ozlem Harmankaya Caliskan, Can Arar, Ayse Sinangil Akgol, Cuneyt Erturk, Kayhan Unsal, Abdulkadir
Case Reports
Association of myelodysplastic syndrome with CD5+, CD23+ monoclonal B-cell lymphocytosis Sandes, Alex F. Chauffaille, Maria de Lourdes L. F. Orfao, Alberto Siufi, Graziella C. Silva, Maria Regina R. Yamamoto, Mihoko
Case Reports
Acute abdominal pain in a 24-year-old woman: Fitz-Hugh-Curtis syndrome associated with pyelonephritis Di Rocco, Giorgio Giannotti, Domenico Collalti, Marco Mele, Rita Pontone, Stefano Frezzotti, Francesca Redler, Adriano Patrizi, Gregorio
Case Reports
Rare association of cutaneous vasculitis, IgA nephropathy and antiphospholipid antibody syndrome with tuberculous lymphadenitis Bueno Filho, Roberto Cordeiro, Alberto Pinto Almeida, Flavia Tremeschin de Shaletich, Catarina Costa, Roberto Silva Roselino, Ana Maria F.
Case Reports
Birt-Hogg-Dubé syndrome: metalloproteinase activity and response to doxycycline Pimenta, Suzana Pinheiro Baldi, Bruno Guedes Nascimento, Ellen Caroline Toledo do Mauad, Thais Kairalla, Ronaldo Adib Carvalho, Carlos Roberto Ribeiro
Case Reports
Fractures in connection with an atypical form of craniodiaphyseal dysplasia: case report of a boy and his mother Kaissi, Ali Al Csepan, Robert Hofstaetter, Jochen G. Klaushofer, Klaus Ganger, Rudolf Grill, Franz
Case Reports
Challenges in patients supported with extracorporeal membrane oxygenation in Brazil Mendes, Pedro Vitale Moura, Ewandro Barbosa, Edzangela Vasconcelos Santos Hirota, Adriana Sayuri Scordamaglio, Paulo Rogerio Ajjar, Fabiana Maria Costa, Eduardo Leite Vieira Azevedo, Luciano Cesar Pontes Park, Marcelo
Case Reports
Right coronary artery originating from the distal left circumflex artery, evaluation using three imaging techniques Turfan, Murat Aydın, Cemalettin Elbey, Mehmet Ali Erdoğan, Ercan Asoglu, Emin Basel, Halil Göktekin, Ömer
Case Reports
Glove port single-incision laparoscopic splenectomy and the treatment of its complications Ismail, Erkin Akyol, Cihangir Basceken, Salim Ilksen Tantoglu, Utku Kayılıoglu, Ilgaz Cakmak, Atıl
Case Reports
Congenital aneurysmal circumflex coronary artery fistula in a pregnant woman Roscani, Meliza Goi Zanati, Silmeia Garcia Salmazo, Pericles S. Carvalho, Fabio C. Magalhães, Claudia G. Borges, Vera T.M. Bregagnollo, Edson A. Matsubara, Beatriz B. Hueb, João Carlos
Case Reports
Successful treatment of thrombotic thrombocytopenic purpura associated with mitral valve replacement Liu, Yong Zhu, Jian Xi, Er-Ping Jiang, Wei Xia, Feng Zhu, Shui-Bo
Case Reports
Respiratory failure after lung transplantation: extra-corporeal membrane oxygenation as a rescue treatment Pêgo-Fernandes, Paulo Manuel Hajjar, Ludhmila Abrahão Galas, Filomena Regina Barbosa Gomes Samano, Marcos Naoyuki Ribeiro, Alexandre Kazantzi Fonseca Park, Marcelo Soares, Rodolfo Osawa, Eduardo Jatene, Fabio Biscegli
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