Clinical characteristics and variables associated with COVID-19 morbidity and mortality in Luanda, Angola, in the first year of the pandemic

Background: The impact of SARS-CoV-2 infection in Africa is still unclear. In comparison to Europe and North America, morbidity and death rates are lower. Several factors have been proposed, including geographical variation in virus impact, environmental factors, differences in age distribution, and the impact of infectious diseases such as malaria, HIV infection and tuberculosis. Objectives: We investigated the clinical characteristics and putative determinants linked with COVID-19 in Angolan patients. Methods: Cross-sectional study undertaken at Military Hospital, Luanda, from March 2020 to March 2021. The survey collected sociodemographic and clinical information. Results: The sample included 1,683 patients aged ≥18 years, 64% men, with mean age of 46.3 years. SARS-CoV-2 was positive in 39% of the cases with RT-PCR. Patients ≥46 years with a level of education of ≥12 years had a considerably higher likelihood of testing positive. About 58% of positive patients had at least one comorbidity, of which hypertension and Diabetes were associated with SARS-CoV-2 infection. HIV and pulmonary TB were putative protective factors. About 14% of positive patients died. Most deaths occurred in patients ≥46 years, with less education and unemployed. Working as a healthcare practitioner was linked to a protective effect. Malignant diseases were the most common comorbidities associated with death. Conclusions: We identified putative factors related to SARS-CoV-2 infection and mortality. HIV and TB were protective and not associated with mortality. Further study with a broader scope should be conducted to explain the main features related to COVID-19 mortality in Angola

Prevalencia de Malassezia spp en pacientes con diabetes mellitus tipo 2 de acuerdo con el control glucémico / Prevalence of Malassezia spp in type 2 diabetes mellitus according to glycemic control

Resumen ANTECEDENTES: Malassezia spp es un saprófito de la piel, relacionada con diversas afecciones cutáneas, se ha reportado frecuencia elevada en pacientes con inmunosupresión. OBJETIVO: determinar la prevalencia de Malassezia spp en individuos con diabetes mellitus tipo 2 de acuerdo con el control glucémico. MATERIAL Y MÉTODO: estudio abierto, observacional, descriptivo y transversal, efectuado en pacientes voluntarios que participaron en la 24ª Carrera Nacional del Paciente con Diabetes el 15 de octubre de 2016 en la Ciudad de México, en quienes se realizó toma de glucemia capilar preprandial y hemoglobina glicosilada, así como pesquisa de Malassezia spp mediante frotis de la región malar, teñido con azul de metileno. RESULTADOS: se incluyeron 49 pacientes con diabetes mellitus tipo 2; hubo predominio de 31 pacientes sin buen control glucémico (67%) en comparación con 16 pacientes controlados (33%). Los frotis con levaduras escasas (+) estuvieron presentes en 21 (59%) pacientes sin control y en 7 (41%) pacientes con control; los frotis con cantidad de levaduras moderada (++) se observaron en 7 (74%) pacientes sin control y en 5 (26%) pacientes con control; los frotis con levaduras abundantes estuvieron presentes en 7 (63%) pacientes sin control y en 2 (37%) pacientes con control. CONCLUSIÓN: en nuestro estudio la prevalencia de Malassezia spp en pacientes con diabetes mellitus tipo 2 fue del 100%, con menor número de levaduras en los que tenían control glucémico adecuado, lo que puede indicar que la posibilidad de tener esta levadura aumenta con el descontrol glucémico y probablemente denota el grado de inmunosupresión en estos pacientes.

Abstract BACKGROUND: Malassezia spp is a saprophyte of the skin, related to diverse cutaneous affections, and has been reported a high frequency in patients with immunosuppression. OBJECTIVE: To determine the prevalence of Malassezia spp in individuals with type 2 diabetes mellitus according to glycemic control. MATERIAL AND METHOD: An open, observational, descriptive and cross-sectional study was performed in volunteer patients who participated in the 24th National March of the Patient with Diabetes in Mexico City on October 15, 2016; where preprandial capillary glycemia and glycosylated hemoglobin were taken. We took a scraping of the malar region skin to find Malassezia spp, smears stained with methylene blue. RESULTS: A total of 49 patients with type 2 diabetes mellitus were included; there were a predominance of 31 patients without glycemic control (67%) in comparison with 16 controlled patients (33%). Smears with low yeast (+) were present in 21 (59%) uncontrolled patients and in 7 (41%) controlled patients; smears with a moderate amount of yeast (++) were present in 7 (74%) uncontrolled patients and in 5 (26%) controlled patients; smears with abundant yeasts were present in 7 (63%) uncontrolled patients and in 2 (37%) controlled patients. CONCLUSION: In our study the prevalence of Malassezia spp in patients with type 2 diabetes mellitus was of 100%, with a lower number of yeasts in patients with adequate glycemic control; this can indicate that the possibility of presenting this yeast increases with bad glycemic control and probably denotes the degree of immunosuppression in these patients.

Efecto de Microemulsiones de Aceites Esenciales Sobre el Eritrocito Humano y Bacterias Patógenas / Effect of Microemulsions of Essential Oils on Human Erythrocyte and Pathogens Bacteria

RESUMEN: El objetivo del presente trabajo fue evaluar el efecto de las microemulsiones de aceite esencial de romero (AER) y árbol de té (AET) sobre el eritrocito humano y microorganismos patógenos. Para ello, se elaboraron microemulsiones de AER y AET al 8.0% (v/v), 5.0% (v/v) y 2.5% (v/v). Las microemulsiones fueron probadas sobre el eritrocito humano para determinar el porcentaje de hemólisis, el porcentaje de inhibición de hemólisis y su actividad antibacterial contra E. coli O157:H7 y S. aureus. Las microemulsiones con AER no presentaron actividad hemolítica significativa, caso contrario con las microemulsiones de AET al 8.0% (≈70%) y 5.0% (33%) que presentaron mayor actividad hemolítica. Las microemulsiones de AER protegieron significativamente al eritrocito contra la presencia de radicales libres, en comparación con aquellas de AET (p< 0.05). Además, las emulsiones de AET al 8.0% mostraron efectos antibacterianos contra E. coli O157:H7 y S. aureus mientras que AER al 8.0% solo mostraron efecto contra E. coli O157:H7. La limitante del estudio fue que no utilizamos células nucleadas para establecer si los aceites esenciales dañan el material nuclear. Sin embargo, observamos que el tipo y la cantidad de aceite utilizado pueden tener implicaciones serias sobre la membrana eritrocitaria. Se concluye que las microemulsiones de AER presentaron mejor efecto protector eritrocitario, mientras que las microemulsiones de AET presentaron mejor actividad antibacterial contra las bacterias estudiadas, pero con mayor efecto tóxico sobre el eritrocito.

ABSTRACT: The aim of the study was to evaluate the effect of microemulsions of rosemary (AER) and tea tree (AET) essential oils on human erythrocyte and pathogen bacteria. Microemulsions of each oil were prepared at 8.0% (v/v), 5.0% (v/v) and 2.5% (v/v), and they were tested on human erythrocyte to determine the hemolysis percentage, hemolysis inhibition percentage and the antibacterial capacity against E. coli O157:H7 and S. aureus. All AER microemulsions showed no significant hemolytic activity. On the contrary, AET microemulsions showed hemolytic effect but those in concentrations of 8.0% (≈70 %) and 5.0% (33%) showed the highest effect. In addition, AER microemulsions showed protective effect against free radicals in comparison with the AET microemulsions (p< 0.05). On the other hand, the AET microemulsion at 8.0% showed antibacterial effect against E. coli O157:H7 and S. aureus, and the AER at 8.0% showed antibacterial effect against E. coli O157:H7. The limitation of this study was that nucleated cells were not used to observe the damage of the essential oils on nuclear material. However, the observed damage of erythrocyte's membrane is depending on type and amount of used oil. Therefore, it can be concluded that the AER microemulsions showed better protective effect of erythrocytes, while AET microemulsions showed better antibacterial effect against the tested bacteria, although with toxic effect on the erythrocytes.

Influencia de la apariencia de las mamas en la calidad de vida: diferencias entre población preoperatoria de mamoplastía de reducción y población control / Criterion validity of a questionnaire to assess quality of life associated to the appearance of breasts in women

Objetivo: El Breast Q Reduction and Mastopexy Module es un instrumento específico para la evaluación de calidad de vida asociado a mamas desde la perspectiva del paciente, recientemente validado para uso en español en Chile. Cuenta con evaluación pre y postoperatoria. El objetivo del presente estudio es conocer la validez de criterio al comparar las distribuciones en distintas poblaciones de individuos así como la diferencia del puntaje entre el pre y postoperatorio. Materiales y Métodos: El instrumento validado en español Breast Q Reduction-Mastopexy Module fue sometido a prueba para evaluar su validez de criterio comparando los resultados de la escala en pacientes que deseaban someterse a cirugía versus 2 grupos control, uno de pacientes hospitalizados por otra causa y otro de estudiantes de medicina. Resultados: Se aplicó la encuesta a 46 mujeres, 6 pacientes preoperatorios de mamoplastía de reducción, 20 alumnas de medicina y 20 pacientes hospitalizadas por otra causa. Hubo diferencias estadísticamente significativas entre las pacientes y los grupos control en los dominios autoimagen corporal (p = 0,0001), desempeño social (p = 0,0035) y síntomas físicos (p = 0,0058), no se observaron diferencias en el dominio de sexualidad (p = 0,1432), sin embargo, sólo 4/6 pacientes contestaron la encuesta ya que las otras 2 declararon no tener vida sexual. Conclusiones: Estos resultados preliminares sugieren que la versión en español del Breast Q Reduction-Mastopexy Module es un instrumento útil para evaluar calidad de vida asociada a las mamas en mujeres chilenas.

Background: The Breast QoL Reduction and Mastopexy Module assesses quality of life associated to breast appearance from the point of view of the patient. Its Spanish version was recently validated in Chile. Aim: To assess the criterion validity of the instrument applying it in different populations of women and in the pre and post-operative periods. Material and Methods: The questionnaire was applied to six women subjected to reduction mammoplasty in the pre and post-operative period. It was also applied to 20 women hospitalized for other causes and 20 female medical students. Results: There were significant differences between operated women and their non-operated counterparts in the domains body self-image, social performance and physical symptoms. No differences in sexuality were found. However this last question was answered only by four operated patients, since two declared not to have sex life. Conclusions: The questionnaire is useful to assess quality of life associated to the appearance of breasts.

Desarrollo de rssistencia a nematodos gastrointstinales en ovinos de pelo desaafiados con diferentes niveles de infección / Develoment of reesistance to gastrointstinal nematode in hair sheep cchallenged with different levels of ineection

Se utilizaron 24 corderos Katahdin x Pelibuey, distribuidos al azar en cuatro grupos desafiados con los siguientes tratamientos: a) 25 larvas infectantes (L3) de nematodos gastrointestinales (NGI) por kg de peso vivo (PV); b) 50 L3 PV, c) 100 L3 PV y el grupo testigo (0 larvas). El experimento se dividió en tres etapas: 1) infección experimental y estabulación de corderos, 2) reinfección en pastoreo y 3) estabulación. En cada etapa se determinó el número de huevos de nematodos por gramo de heces (HPG), el peso vivo (PV) y el volumen celular aglomerado (VCA). El análisis se realizó con medidas repetidas en el tiempo. Los corderos infectados con 100 L3 tuvieron mayor HPG (1.642 ± 1.183) que los infectados con 50 L3 (1.140 ± 1.313 HPG) y los de 25 L3 (458 ± 371 HPG). Con 50 L3 los corderos tuvieron el menor VCA (23,7 ± 4,8%). Con 100 L3 se observó menor VCA que el grupo testigo y el de 25 L3 (26,2 ± 3,9; 28,0 ± 4,1 y 27,3 ± 4,2 %, respectivamente). Las ganancias de peso se redujeron respecto al testigo en un 22% en los de 25 larvas, 60% en los de 50 larvas y 61% en los de 100 larvas. El grupo infectado con 100 larvas obtuvo, durante la segunda etapa, el menor HPG (2.033 ± 2.553 HPG), un incremento del VCA (27,8%) y mayor ganancia de peso (3,7 kg) que los otros grupos, por lo que se concluye que con la dosis de 100 L3 se obtienen menores conteos fecales de huevos de NGI, mayor VCA y mejor ganancia de peso bajo condiciones de reinfección en pastoreo.

24 Katahdin x Pelibuey male lambs were used. The lambs were random in four groups with the following treatments: a) 25 infective larvae (L3) of gastrointestinal nematodes (GIN) per kg of body weight (BW), b) 50 L3 BW, c) 100 L3 BW and the control group (0 L3). The experiment was divided into three stages: 1) Experimental infection in stabling, 2) grazing infection and 3) housed lambs. At each stage were determined the number of nematode eggs per gram of feces (EPG), body weight and packed cell volume (PCV). The data analysis was performed using a repeated measures model in time. The lambs infected with 100 L3 had higher EPG (1642 ± 1183) in comparison with the treatment of 50 L3 (1140 ± 1313 EPG) and 25 L3 (458 ± 371 EPG). With 50 L3 the lambs had the lowest PCV (23.7 ± 4.8%). With the application of 100 L3 also had lower PCV than control group and 25 L3 (26.2 ± 3.9, 28.0 ± 4.1 and 27.3 ± 4.2%, respectively). It was observed a decrease in weight gain of all infected groups compared to the control group, by 22% in lambs with 25 larvae, 60% in the 50 larvae and 61% in animals of 100 larvae. During the second stage, the group infected with 100 larvae there was a reduction of EPG (2033 ± 2553 EPG), an increase in PCV (27.8%) and increased kg (3.7 kg) with respect to other infected for this reason was concluding that lambs receiving 100 L3 had lowest nematode faecal egg count, highest PCV and gain daily weight during the grazing reinfection.

Short-term and long-term antibody response by mice after immunization against Neisseria meningitidis B or diphtheria toxoid

Serogroup B Neisseria meningitidis (MenB) is a major cause of invasive disease in early childhood worldwide. The only MenB vaccine available in Brazil was produced in Cuba and has shown unsatisfactory efficacy when used to immunize millions of children in Brazil. In the present study, we compared the specific functional antibody responses evoked by the Cuban MenB vaccine with a standard vaccine against diphtheria (DTP: diphtheria, tetanus, pertussis) after primary immunization and boosting of mice. The peak of bactericidal and opsonic antibody titers to MenB and of neutralizing antibodies to diphtheria toxoid (DT) was reached after triple immunization with the MenB vaccine or DTP vaccine, respectively. However, 4 months after immunization, protective DT antibody levels were present in all DTP-vaccinated mice but in only 20% of the mice immunized against MenB. After 6 months of primary immunization, about 70% of animals still had protective neutralizing DT antibodies, but none had significant bactericidal antibodies to MenB. The booster doses of DTP or MenB vaccines produced a significant antibody recall response, suggesting that both vaccines were able to generate and maintain memory B cells during the period studied (6 months post-triple immunization). Therefore, due to the short duration of serological memory induced by the MenB vaccine (VA-MENGOC-BC® vaccine), its use should be restricted to outbreaks of meningococcal disease.

Caracterização dos taninos condensados das espécies maniçoba (Manihot pseudoglazovii), flor-de-seda (Calotropis procera), feijão-bravo (Capparis flexuosa, L) e jureminha (Desmanthus virgatus) / Characterization of condensed tannin of the species maniçoba (Manihot pseudoglaziovii), flor-de-seda (Calotropis procera), feijão-bravo (Capparis flexuosa) and jureminha (Desmanthus virgatus)

Caracterizaram-se os taninos condensados (TC) e determinaram-se a composição bromatológica e a digestibilidade in vitro da matéria seca (DIVMS) das espécies maniçoba (Manihot pseudoglazovii Pax & Hoffman), flor-de-seda (Calotropis procera), feijão-bravo (Capparis flexuosa, L) e jureminha (Desmanthus virgatus (L.) Willd). As concentrações em tanino solúvel, tanino ligado ao resíduo e tanino total (TT) das espécies foram determinadas pelo método butanol-HCL e a adstringência pelo método de difusão radial. Para a DIVMS, foi utilizado método de dois estágios. Foram observadas diferenças entre as espécies (P<0,01) quanto à concentração e adstringência dos taninos. As maiores concentrações foram encontradas na jureminha, 2,4 por cento TT e 13,7-3 de adstringência. Não foi detectado tanino na flor-de-seda. O teor em PB foi acima de 16 por cento em todas as espécies estudadas, e o FDA e lignina abaixo de 39 e 15 por cento, respectivamente. A DIVMS foi baixa na jureminha, 43 por cento, e alta na flor-de-seda, 80 por cento. A correlação entre a DIVMS e a concentração em taninos condensados foi baixa (r=0,097)

Condensed tannins (CT) of the species maniçoba (Manihot pseudoglaziovii), flor-de-seda (Calotropis procera), feijão-bravo (Capparis flexuosa) and jureminha (Desmanthus virgatus) were characterized and the chemical composition and in vitro dry matter digestibility (IVDMD) of those species were determined. Concentration of soluble tannin (ST), bound tannin (BT) and total tannin (TT) of the plants was determined using butanol-HCL method; astringency was determined, using radial diffusion method, and the IVDMD was determined using two-stages method. Concentration and astringency of condensed tannins varied between species (P<0.01). Jureminha was the species that presented the highest value (2.4 percent TT and 13.7-3 astringency). No tannins were detected in flor-de-seda. Crude protein was higher than 16 percent in all studied species, and the ADF and lignin values were lower than 39 and 15 percent, respectively. The IVDMD was low in jureminha (43 percent) and high in flor-de-seda (80 percent). The correlation between IVDMD and TT was low (r²=0.097)

Evaluación de integración sensorial en adultos con esquizofrenia / Sensory integration evaluation in adults with schizophrenia

En la actualidad, los avances en salud y el concepto de relación entre mente y cuerpo han exigido investigar y proponer estrategias cada vez más integrales para abarcar enfermedades tan complejas como la Esquizofrenia. Entre ellas, aparece la Integración Sensorial como una propuesta para explicar algunos de los déficits y proponer intervenciones. El Modelo de Integración Sensorial, ha sido tradicionalmente usado por los Terapeutas Ocupacionales en niños. En nuestro país no existen publicaciones acerca de la utilización del Modelo de Integración Sensorial en personas adultas con diagnóstico de Esquizofrenia, tampoco existen herramientas que evalúen el procesamiento sensorial en esta población. El objetivo de esta publicación, es revisar los estudios internacionales existentes en relación al tema y realizar una propuesta a los Terapeutas Ocupacionales para evaluar las posibles alteraciones de Integración Sensorial en personas adultas con diagnóstico de Esquizofrenia y cómo éstas alteraciones influyen en el desempeño ocupacional.

In recent times, the advances in health science and the concept of mind and body have pushed for further investigation and the proposal of even more integral strategies to treat complex illnesses like Schizophrenia. Among these, the Sensory Integration approach appears as a new focus that may explain some of the deficits and propose alternatives for treatment. The Sensory Integration framework has been traditionally used by Occupational Therapists in work with children. In our country there are no publications regarding the use of Sensory Integration in adults diagnosed with Schizophrenia, there is also a lack of tools to evaluate sensory processing among this population. The aim of this publication is to review existing international studies on this topic and to develop a proposal for Occupational Therapists to assess possible Sensory Integration dysfunction in adults diagnosed with Schizophrenia and how these alterations may influence their occupational performance.

Evaluación de la toxicidad aguda y la acción hipolipemiante del aceite de Plukenetia volúbilis, Sacha Inchi / Evaluation of acute toxicity and hypolipemic action of Plukenetia volúbilis, Sacha Inchi

Se evaluó el efecto tóxico agudo del aceite de Plukenetia volúbilis (Sacha Inchi), determinando la Dosis Letal -50 (DL50) en 42 ratones de la cepa Nish, distribuidos en siete grupos de seis ratones cada uno, a los cuales se les administró, vía oral, dosis crecientes del aceite. Para evaluar el efecto hipolipemiante utilizamos 55 ratas albinas machos de la raza Holtzman, con un peso entre 194 g y 290 g y dos meses de edad. Se utilizó una dieta con 15 por ciento de grasas saturadas para elevar los lípidos séricos durante todo el tiempo del experimento. Utilizamos tres dosis diferentes de aceite de Sacha Inti, administradas durante 14 días consecutivos, comparando sus efectos con un control positivo (Lovastatina) y un control negativo (SF). Se controló el peso de los animales y los valores de colesterol, HDL y triglicéridos sanguíneos en tres tiempos diferentes. El análisis estadístico se realizó mediante el programa STATA 8.2. La DL50 fue de 111,65 mg/kg; hubo una reducción significativa de los valores sanguíneos de triglicéridos y LDL, mas no de colesterol y peso de los animales.

The acute toxic of Plukenetia volúbilis (Sacha Inchi) oil was evaluated. We calculated the Medial Lethal Dose (DL50) on 42 mice of the Nish strain, distributed in seven groups of six mice each, to whom a different and increasing dose was administered by oral route. To determine the hypolipidemic effect, we used 55 male albino rats of the Holtzman breed, whose weight fluctuateed between 194 and 290 g. The animals were fed with 15% of a saturateed fat diet for 14 days to produce hyperlipidemia during the whole period of the experiment. Treatment with Sacha Inchi oil in three different doses during 14 consecutive days was compared to the effects of a positive (lovastatine) and a negative control (physiological serum). The weight, cholesterol, HDL, LDL, VLDL, and triglycerides, were controlled in three different periods of time. Statistics analysis was made using the STATA 8.2 program. The DL50 was detrmined at 111,65 mg/Kg and the level of tryclicerides and LDL were statistically reduced, but not the cholesterol values or the animals' weight.

Building multiple sequence alignments with a flavor of HSSP alignments

Homology-derived secondary structure of proteins (HSSP) is a well-known database of multiple sequence alignments (MSAs) which merges information of protein sequences and their three-dimensional structures. It is available for all proteins whose structure is deposited in the PDB. It is also used by STING and (Java)Protein Dossier to calculate and present relative entropy as a measure of the degree of conservation for each residue of proteins whose structure has been solved and deposited in the PDB. However, if the STING and (Java)Protein Dossier are to provide support for analysis of protein structures modeled in computers or being experimentally solved but not yet deposited in the PDB, then we need a new method for building alignments having a flavor of HSSP alignments (myMSAr). The present study describes a new method and its corresponding databank (SH2QS--database of sequences homologue to the query [structure-having] sequence). Our main interest in making myMSAr was to measure the degree of residue conservation for a given query sequence, regardless of whether it has a corresponding structure deposited in the PDB. In this study, we compare the measurement of residue conservation provided by corresponding alignments produced by HSSP and SH2QS. As a case study, we also present two biologically relevant examples, the first one highlighting the equivalence of analysis of the degree of residue conservation by using HSSP or SH2QS alignments, and the second one presenting the degree of residue conservation for a structure modeled in a computer, which , as a consequence, does not have an alignment reported by HSSP.

The Star STING server: a multiplatform environment for protein structure analysis

Star STING is the latest version of the STING suite of programs and corresponding database. We report on five important aspects of this package that have acquired some new characteristics, designed to add key advantages to the whole suite: 1) availability for most popular platforms and browsers, 2) introduction of the STING_DB quality assessment, 3) improvement in algorithms for calculation of three STING parameters, 4) introduction of five new STING modules, and 5) expansion of the existing modules. Star STING is freely accessible at: http://sms.cbi.cnptia.embrapa.br/SMS/, http://trantor.bioc.columbia.edu/SMS, http://www.es.embnet.org/SMS/, http://gibk26.bse.kyutech.ac.jp/SMS/ and http://www.ar.embnet.org/SMS.

PDB-Metrics: a web tool for exploring the PDB contents

PDB-Metrics (http://sms.cbi.cnptia.embrapa.br/SMS/pdb_metrics/index.html) is a component of the Diamond STING suite of programs for the analysis of protein sequence, structure and function. It summarizes the characteristics of the collection of protein structure descriptions deposited in the Protein Data Bank (PDB) and provides a Web interface to search and browse the PDB, using a variety of alternative criteria. PDB-Metrics is a powerful tool for bioinformaticians to examine the data span in the PDB from several perspectives. Although other Web sites offer some similar resources to explore the PDB contents, PDB-Metrics is among those with the most complete set of such facilities, integrated into a single Web site. This program has been developed using SQLite, a C library that provides all the query facilities of a database management system

Accurate blood pressure recording: is it difficult?

BACKGROUND: Blood pressure (BP) measurement is a routine procedure but errors are frequently committed during BP recording. AIMS AND SETTINGS: The aim of the study was to look at the prevalent practices in the institute regarding BP recording. The study was conducted in the Medicine Department at Government Medical College, Chandigarh, a teaching institute for MBBS students. METHODS: A prospective, observational study was performed amongst the 80 doctors in a tertiary care hospital. All of them were observed by a single observer during the act of BP recording. The observer was well versed with the guidelines issued by British Hypertension Society (BHS) and the deviations from the standard set of guidelines issued by BHS were noted. The errors were defined as deviations from these guidelines. STATISTICAL METHODS: The results were recorded as percentage of doctors committing these errors. RESULTS: In our study, 90% used mercury type sphygmomanometer. Zero error of the apparatus, hand dominance was not noted by any one. Every one used the standard BP cuff for recording BP. 70% of them did not let the patient rest before recording BP. 80% did not remove the clothing from the arm. None of them recorded BP in both arms. In out patient setting, 80% recorded blood pressure in sitting position and 14% in supine position. In all the patients where BP was recorded in sitting position BP apparatus was below the level of heart and 20% did not have their arm supported. 60% did not use palpatory method for noticing systolic BP and 70% did not raise pressure 30-40 mm Hg above the systolic level before checking the BP by auscultation. 80% lowered the BP at a rate of more than 2 mm/s and 60% rounded off the BP to nearest 5-10 mm Hg. 70% recorded BP only once and 90% of the rest re inflated the cuff without completely deflating and allowing rest before a second reading was obtained. Conclusion: The practice of recording BP in our hospital varies from the standard guidelines issued by the BHS.

Hereditary hemochromatosis in a Brazilian university hospital in São Paulo State (1990-2000)

Hereditary hemochromatosis (HH) is the most common genetic disease among individuals of European descent. Two mutations (845G-->A, C282Y and 187C-->G, H63D) in the hemochromatosis gene (HFE gene) are associated with HH. About 85-90% of patients of northern European descent with HH are C282Y homozygous. The prevalence of HH in the Brazilian population, which has a very high level of racial admixture, is unknown. The aims of the present study were to identify individuals with diagnostic criteria for HH among patients with a body iron overload attended at the university hospital of the Faculty of Medicine of Ribeirao Preto from 1990 to 2000, and to evaluate the prevalence of HFE mutations. We screened first-degree relatives for HFE mutations. Four of 72 patients (three men and one woman, mean age 47 years) fulfilled the criteria for HH. HFE mutations were studied in three patients [two C282Y homozygotes (patients 1 and 2) and one H63D heterozygote]. Patient 1 had four children (all C282Y heterozygotes with no iron overload) and seven brothers and sisters: two sisters (66 and 76 years old) were C282Y homozygotes and both had an iron overload (a liver biopsy in one showed severe iron deposits), one sister (79 years old) was a compound heterozygote with no iron overload, one brother (78 years old) was a C282Y heterozygote with no iron overload, two individuals were H63D heterozygotes (one brother, 49 years old, obese, with a body iron overload and abnormal liver enzymes - a biopsy showed non-alcoholic steatohepatitis, and one 70-year-old sister with no iron overload). Patient 2 had two children (22 and 24 years old who were C282Y heterozygotes with no iron overload) but no brothers or sisters. These results showed that HH was uncommon among individuals attended at our hospital, although HFE mutations were found in all patients. Familial screening is valuable for the early diagnosis of individuals at risk since it allows treatment to be initiated before the onset of the clinical manifestations of organ damage associated with HH

Metastasis to thyroid from lung carcinoma.

Metastasis to thyroid gland are rare. The primary sites which metastasize to thyroid gland include the breast, lung, kidney and stomach. Among lung cancer metastasizing to the thyroid, adenocarcinomas are the commonest followed by squamous, small cell and large cell carcinomas. The bronchioloalveolar carcinoma has not been reported to metastasize to the thyroid. In this case report we document this rare occurrence.

Circadian pattern in cerebro vascular disorders.

Over the last decade, various studies have been reported to evaluate the circadian pattern of cardiovascular and cerebro-vascular diseases. The data from Indian population is lacking. We undertook this prospective observational study to evaluate the circadian variation in disorders like cerebro-vascular accidents and transient ischemic attacks. Total of 146 patients (events) were studied. Only 10 patients had TIA's. 55% had hemorrhage and 45% had infarction. The 24 hours period was divided into 6 equal portions of 4 hours each. The maximum events were seen between 4 am to 8 am and 12 noon to 4 pm (23.28%) each. Minimum events were seen between 12 midnight to 4 am 14/146 - 9.58%). The circadian variation in occurrence of cerebro-vascular disorders was present with two equal peaks.

Wasp sting induced neurological manifestations.

Wasp stings generally cause local reactions like pain, wheal, flare, edema and swelling, which are generally self-limiting. Multiple stings can lead to vomiting, diarrhea, generalized edema, dyspnea, hypotension, collapse, renal failure or death. Unusually, they may cause serum sickness, vasculitis, neuritis or encephalitis. We report a case of a 40 year old male who developed focal neurological deficit 10 hours following a wasp sting, which was confirmed to be ponto-cerebellar infarction on MRI scan, and recovered within five days.

Left atrial myxoma presenting as pseudobulbar palsy.

A case of left atrial (LA) myxoma presenting as pseudobulbar palsy, due to multiple cerebral infarcts, without any cardiac manifestations, is presented. LA myxoma is rare cause of embolization to CNS causing ischemic infarcts. Due to multiple CNS infarcts patient can present with varied clinical picture and pseudobulbar palsy is not a very common presentation. It was a real diagnostic dilemma before LA myxoma was diagnosed on echocardiography.

Determinación de Lp(a) sérica en individuos de Maracaibo y Casigua el Cubo, Estado Zulia / Determination of Lp serum in individuals of Maracaibo and Casigua the Cubo, Zulia state

Uno de los marcadores de mayor importancia y que al mismo tiempo representa un factor independiente de riesgo para enfermedad coronaria es la Lipoproteína (A)[Lp(a)]. Actualmente se desconocen los valores normales de Lp(a) en nuestra población, por lo que el objetivo del presente estudio fue determinar la concentración sérica de la misma, en una muestra poblacional de las localidades de Maracaibo y Casigua El Cubo, Estado Zulia. Para ello se seleccionaron al azar 184 individuos (98 hombres y 86 mujeres) de ambos sexos, mayores de 10 años, de ambas localidades, sin antecedentes personales o familiares de cardiopatía isquémica prematura, a los cuales se les realizó historia clínica completa y toma de muestras sanguínea por venipunción previo ayuno de 8 horas. Para la determinación de Lp(a) sérica se utilizó un kit comercial ELISA de doble anticuerpo monoclonal. Los niveles séricos de Lp(a) no mostraron diferencia significativa con relación al sexo en la población de Casigua El Cubo (Hombres 29 mg/dl vs Mujeres 30 mg/dl) pero sí en la ciudad de Maracaibo (Hombres 30mg/dl vs Mujeres 27mg/dl; p<0.05). No hubo diferencia significativa al comprar ambas localidades (Maracaibo 29 mg/dl vs Casigua 30mg/dl), por lo que se realizó la distribución por grupos etarios, no encontrándose diferencia significativa al realizar la comparación múltiple. Podemos concluir que la concentración de Lp(a) sérica en individuos sanos de la ciudad de Maracaibo y la población de Casigua El Cubo se encuentra en el límite superior de los valores considerados como normales. Se recomienda por tanto que en individuos con niveles de Lp(a) por encima de 30 mg/dl tengan un control estricto de los factores de riesgo modificables para enfermedades cardiovasculares, en orden de disminuir la morbi-mortalidad por cardiopatía isquémica en estos individuos