Effectiveness Of Self-Instructional Module (Sim) On Paternal Attitude Of Expectant Fathers And Maternal Satisfaction On Perinatal Outcome

Introduction: Paternal involvement (PI) has been recognized to have an impact on pregnancy and in-fant outcomes. The mother抯 satisfaction during the birthing process is the most frequently reported in-dicator in the evaluation of the quality of maternity services. The aim of the study is to assess the effec-tiveness of self-instructional module on paternal attitude towards perinatal outcome and maternal satis-faction on paternal attitude. Methodology: A cross-sectional study was conducted on 320 expectant fathers attending antenatal clin-ic. A five-point rating scale was used to assess the attitude of paternal on pregnancy and labour outcome and check list to assess the postnatal mother satisfaction. Results: The scores improved significantly after intervention, in experiment group, the pre-test, mean score was 78.61 and the post-test mean score was 120.56, whereas in the control group, the pre-test mean score of 79.43 and the post-test mean score was 80.25. In the experimental group, 81.88% of mothers were satisfied whereas 18.12% were not satisfied. In control group, 48.75% were satisfied, while 51.25% were not satisfied. Conclusion: Most fathers were very positive about their partner抯 pregnancy. They, however, need to be motivated to use that knowledge into practice.

Hepatitis E virus infection increases the risk of diabetes and severity of liver disease in patients with chronic hepatitis C virus infection

OBJECTIVES: Co-infection with hepatitis A or B viruses may aggravate liver injury in patients infected with hepatitis C virus (HCV). However, few studies have assessed co-infection with hepatitis E virus (HEV) and HCV. Therefore, this study aimed to assess the prevalence and impact of HEV infection among Brazilian patients with chronic HCV infection. METHODS: This observational study included adult patients with chronic HCV infection who were naive to antiviral therapy from January 2013 to March 2016. A total of 181 patients were enrolled, and HEV serology and PCR were performed for all patients. RESULTS: Seropositivity for anti-HEV IgG was detected in 22 (12.0%) patients and anti-HEV immunoglobulin M in 3 (1.6%). HEV RNA showed inconclusive results in nine (4.9%) patients and was undetectable in the remaining patients. HEV serology positive patients had more severe liver disease, characterized by liver fibrosis ≥3 versus ≤2 (p<0.001), Aspartate Aminotransferase-to-Platelet Ratio Index of ≥1.45 (p=0.003), and Fibrosis-4 score of ≥3.25 (p=0.001). Additionally, the odds of HEV-positive patients developing diabetes mellitus were 3.65 (95% CI 1.40-9.52) times the corresponding odds of HEV-negative patients. A case-control-based histological analysis (n=11 HEV-HCV-positive patients and n=22 HCV-positive patients) showed no significant differences between the groups. CONCLUSIONS: This prevalence is higher than that reported in previous studies of the general population in Brazil. Thus, HEV infection may influence the severity of liver disease and may represent an additional risk of developing diabetes mellitus in patients with HCV infection.

Estimating the average length of hospitalization due to pneumonia: a fuzzy approach

Exposure to air pollutants is associated with hospitalizations due to pneumonia in children. We hypothesized the length of hospitalization due to pneumonia may be dependent on air pollutant concentrations. Therefore, we built a computational model using fuzzy logic tools to predict the mean time of hospitalization due to pneumonia in children living in São José dos Campos, SP, Brazil. The model was built with four inputs related to pollutant concentrations and effective temperature, and the output was related to the mean length of hospitalization. Each input had two membership functions and the output had four membership functions, generating 16 rules. The model was validated against real data, and a receiver operating characteristic (ROC) curve was constructed to evaluate model performance. The values predicted by the model were significantly correlated with real data. Sulfur dioxide and particulate matter significantly predicted the mean length of hospitalization in lags 0, 1, and 2. This model can contribute to the care provided to children with pneumonia.

Strong correlation by ultrasonography of hepatomegaly and the presence of co-infection in HIV/HCV cirrhotic patients

OBJECTIVES: Progression of hepatic fibrosis is accelerated in patients co-infected with human immunodeficiency virus and hepatitis C virus compared to hepatitis C virus mono-infected patients. This study aimed to compare ultrasound features and selected clinical and biochemical variables between patients with human immunodeficiency virus/hepatitis C virus co-infection (n = 16) versus hepatitis C virus mono-infection (n = 16). METHODS: Each patient underwent abdominal ultrasound, and a specific evaluation was performed in order to detect findings consistent with chronic liver disease. Characterization of spleen size, liver structural pattern, diameter of the portal, spleen, and mesenteric veins was based on classical ultrasound parameters. Propensity score was used for control of selection bias and performed using binary logistic regression to generate a score for each patient. The Fisher and Mann-Whitney tests were used to evaluate categorical variables and continuous variables, respectively. RESULTS: On univariate analysis right hepatic lobe size was larger in human immunodeficiency virus/hepatitis C virus patients (157.06 ± 17.56 mm) compared to hepatitis C virus mono-infected patients (134.94 ± 16.95 mm) (p = 0.0011). The left hepatic lobe was also significantly larger in human immunodeficiency virus/hepatitis C virus patients Cirrhosis (115.88 ±22.69 mm) versus hepatitis C virus mono-infected patients (95.06 ±24.18 mm) (p= 0.0177). Also, there was a strong correlation between hepatomegaly and co-infection (p=0.005). CONCLUSION: Human immunodeficiency virus infection was the primary variable influencing liver enlargement in this population. Hepatomegaly on ultrasound was more common among cirrhotic human immunodeficiency virus/hepatitis C virus co-infected patients than among cirrhotic hepatitis C virus mono-infected patients. This aspect is very important in the management of human immunodeficiency virus/hepatitis C virus co-infected patients, because screening for hepatocellular carcinoma is necessary in this population.

MTP -493G/T gene polymorphism is associated with steatosis in hepatitis C-infected patients

The reduction of hepatic microsomal transfer protein (MTP) activity results in fatty liver, worsening hepatic steatosis and fibrosis in chronic hepatitis C (CHC). The G allele of the MTP gene promoter, -493G/T, has been associated with lower transcriptional activity than the T allele. We investigated this association with metabolic and histological variables in patients with CHC. A total of 174 untreated patients with CHC were genotyped for MTP -493G/T by direct sequencing using PCR. All patients were negative for markers of Wilson’s disease, hemochromatosis and autoimmune diseases and had current and past daily alcohol intake lower than 100 g/week. The sample distribution was in Hardy-Weinberg equilibrium. Among subjects with genotype 1, 56.8 percent of the patients with fibrosis grade 3+4 presented at least one G allele versus 34.3 percent of the patients with fibrosis grade 1+2 (OR = 1.8; 95 percentCI = 1.3-2.3). Logistic regression analysis with steatosis as the dependent variable identified genotypes GG+GT as independent protective factors against steatosis (OR = 0.4, 95 percentCI = 0.2-0.8; P = 0.01). The results suggest that the presence of the G allele of MTP -493G/T associated with lower hepatic MTP expression protects against steatosis in our CHC patients.

Anxiolytic effects of Equisetum arvense Linn. extracts in mice.

The petroleum ether (PE), chloroform (CH), ethanol (ETH) and water extracts of E. arvense stems were evaluated for anti-anxiety activity in mice using elevated plus maze model. Ketamine induced hypnosis and actophotometer was used to evaluate sedative effect with various extracts in mice. The results were compared with standard drug diazepam. The ethanolic extract of E. arvense (50 and 100 mg/kg) significantly increased the time-spent and the percentage of the open arm entries in the elevated plus-maze model which was comparable to diazepam. Ethanolic extract (100 mg/kg) prolonged the ketamine-induced total sleeping time and decreased the locomotor activity in mice. The results suggest that the ethanolic extract of E. arvense seems to possess anxiolytic effect with lower sedative activity than that of diazepam. The results could be attributed to the flavonoid content of the ethanolic extract.

Chronic subdural empyema and cranial vault osteomyelitis due to Salmonella paratyphi A.

Intracranial infections, especially subdural empyema, due to salmonella are rare. Subdural empyema caused by Salmonella paratyphi A has been documented only once earlier in the literature. Hence, we report a case of subdural empyema and osteomyelitis of cranial vault due to S. paratyphi A. A 42- year-old male presented with headache and purulent discharge from right parietal burr hole wound site. Patient gave a history of head injury two years ago. He underwent burr hole evacuation of chronic subdural haematoma, excision of outer membrane and right parietal craniectomy. The cultures grew S. paratyphi A. Recovery was uneventful following surgical intervention and antibiotic therapy.

Does hepatocellular carcinoma in non-alcoholic steatohepatitis exist in cirrhotic and non-cirrhotic patients?

Non-alcoholic steatohepatitis (NASH) has been associated with hepatocellular carcinoma (HCC) often arising in histologically advanced disease when steatohepatitis is not active (cryptogenic cirrhosis). Our objective was to characterize patients with HCC and active, histologically defined steatohepatitis. Among 394 patients with HCC detected by ultrasound imaging over 8 years and staged by the Barcelona Clinic Liver Cancer (BCLC) criteria, we identified 7 cases (1.7 percent) with HCC occurring in the setting of active biopsy-proven NASH. All were negative for other liver diseases such as hepatitis C, hepatitis B, autoimmune hepatitis, Wilson disease, and hemochromatosis. The patients (4 males and 3 females, age 63 ± 13 years) were either overweight (4) or obese (3); 57 percent were diabetic and 28.5 percent had dyslipidemia. Cirrhosis was present in 6 of 7 patients, but 1 patient had well-differentiated HCC in the setting of NASH without cirrhosis (fibrosis stage 1) based on repeated liver biopsies, the absence of portal hypertension by clinical and radiographic evaluations and by direct surgical inspection. Among the cirrhotic patients, 71.4 percent were clinically staged as Child A and 14.2 percent as Child B. Tumor size ranged from 1.0 to 5.2 cm and 5 of 7 patients were classified as early stage; 46 percent of all nodules were hyper-echoic and 57 percent were <3 cm. HCC was well differentiated in 1/6 and moderately differentiated in 5/6. Alpha-fetoprotein was <100 ng/mL in all patients. HCC in patients with active steatohepatitis is often multifocal, may precede clinically advanced disease and occurs without diagnostic levels of alpha-fetoprotein. Importantly, HCC may occur in NASH in the absence of cirrhosis. More aggressive screening of NASH patients may be warranted.

Caracterización y control metabólico de los pacientes con diabetes mellitus tipo 2 insulino-requirentes en control; en el hospital Dr. Gustavo Fricke / Characterization and metabolic control in patients with diabetes mellitus type 2 requiring insulin under therapy at Dr. Gustavo Fricke Hospital

La diabetes mellitus (DM) es una de las patologías que genera mayor discapacidad y mortalidad en el mundo. Muchos estudios han comprobado que un óptimo control de la enfermedad con acciones fundamentadas en el control metabólico, constituye una herramienta clave para disminuir la magnitud de sus complicaciones agudas y crónicas. En este contexto se desarrolla el presente estudio, con el objetivo de describir la situación de los pacientes diabéticos tipo 2 insulino requirentes en control en el Policlínico de Endocrinología del Hospital Dr. Gustavo Fricke de Viña del Mar. Este se realizó de forma transversal descriptivo, a partir de las 939 cartolas de control y seguimiento de estos pacientes, de las cuales 474 cumplieron los criterios de inclusión. Se estudiaron las variables relacionadas con la caracterización de los pacientes, el nivel de control metabólico y la presencia de complicaciones y factores de riesgo concomitantes. El promedio de controles, durante el período de estudio de 18 meses (Enero 2006-Junio 2007), fue de 2,8. El 19,4 por ciento presentaba un buen control metabólico según glicemias de ayunas. La hipertensión arterial, dislipidemia y obesidad se presentaron asociadas en un 65 por ciento, 55 por ciento y 31 por ciento respectivamente. Un 31 por ciento presenta algún grado de nefropatía, 23 por ciento neuropatía periférica y 7 por ciento pie diabético. Del 30 por ciento que registra al menos un examen de fondo de ojo realizado, el 64 por ciento era patológico. No se encontraron diferencias en el control metabólico de los pacientes dependiendo si disponían o no de equipos de automonitoreo. Se concluye que la población de pacientes DM2IR controlados en el HGF ha aumentado, su control metabólico es deficiente y el número de complicaciones crónicas, así como la asociación con otros factores de riesgo, es elevado. La "tarjeta de control y seguimiento", representa una buena herramienta, que debiera ser mejor utilizada.

Diabetes mellitus (DM) is one of the diseases that causes more incapacity and mortality in the world. Many studies have verified that an optimal control of the disease, with actions based on metabolic control, constitutes a key tool to diminish the magnitude of the acute and chronic complications. Against this background, the present study was developed with the aim of describing the situation of diabetic type 2 patients with insulin therapy under follow up in the Endocrinology Clinic at Hospital Dr. Gustavo Fricke, in Viña del Mar. Using a descriptive cross-sectional form, of the 939 patient follow up control cards, 474 fulfilled the inclusion criteria. The characterization variables were the level of metabolic control and the presence of complications and concomitant risk factors. Control average during the period of study of 18 months (January 2006-June 2007), was 2,8 times; 19.4 percent displayed good metabolic control according to fasting blood sugar. Arterial hypertension, hyperlipidemia and obesity were associated in 65 percent, 55 percent and 31 percent respectively. Thirty one percent of the cases presented some degree of nephropathy, 23 percent peripheral neuropathy and 7 percent diabetic foot. Of the 30 percent that registers at least a basic ophthalmoscopy, 64 percent were pathological. No differences were detected in the metabolic control of the patients depending if they had or not auto monitoring devices. Conclusions of the study are that DM2IR patients under control at our hospital have increased, their metabolic control is deficient, they have an elevated number of chronic complications as well as an association with other factors of risk. The "control and pursuit card" represents a good tool that should be better used.

Candida spp. other than Candida albicans: a major cause of fungaemia in a tertiary care centre.

This study was conducted to determine the frequency of different Candida spp. isolated from different parts of the hospital, associated risk factors and mortality rate. A total of 59 cases were selected for prospective analysis over a period of one and half years. Blood samples collected were processed by BACTEC (9240) method. Candidaemia was diagnosed by positive blood culture at least from two blood culture samples or from a clinically significant single blood culture sample. Candida spp. were identified by standard techniques. Most frequent isolates were C. tropicalis (35.6%), C. parapsilosis (28.8%), C. glabrata (11.9%) and C. pelliculosa (11.9%). Candida albicans was isolated only in 3.4% cases. Neonatology department accounted for highest number of isolates (27.1%), followed by gastrointestinal surgery (15.3%) and cardiac surgery (13.6%). Mortality was noted in 16.9%. Probable risk factors determined were intensive care unit stay (74.6%), antibiotic therapy (50.8%), central line (42.4%), urinary catheter (32.2%), ventilator (23.7%), malignancy (20.3%) and abdominal surgery (15.3%).

Liver mitochondrial dysfunction and oxidative stress in the pathogenesis of experimental nonalcoholic fatty liver disease

Oxidative stress and hepatic mitochondria play a role in the pathogenesis of nonalcoholic fatty liver disease. The aim of the present study was to evaluate the role of hepatic mitochondrial dysfunction and oxidative stress in the pathogenesis of the disease. Fatty liver was induced in Wistar rats with a choline-deficient diet (CD; N = 7) or a high-fat diet enriched with PUFAs-omega-3 (H; N = 7) for 4 weeks. The control group (N = 7) was fed a standard diet. Liver mitochondrial oxidation and phosphorylation were measured polarographically and oxidative stress was estimated on the basis of malondialdehyde and glutathione concentrations. Moderate macrovacuolar liver steatosis was observed in the CD group and mild liver steatosis was observed in the periportal area in the H group. There was an increase in the oxygen consumption rate by liver mitochondria in respiratory state 4 (S4) and a decrease in respiratory control rate (RCR) in the CD group (S4: 32.70 ± 3.35; RCR: 2.55 ± 0.15 ng atoms of O2 min-1 mg protein-1) when compared to the H and control groups (S4: 23.09 ± 1.53, 17.04 ± 2.03, RCR: 3.15 ± 0.15, 3.68 ± 0.15 ng atoms of O2 min-1 mg protein-1, respectively), P < 0.05. Hepatic lipoperoxide concentrations were significantly increased and the concentration of reduced glutathione was significantly reduced in the CD group. A choline-deficient diet causes moderate steatosis with disruption of liver mitochondrial function and increased oxidative stress. These data suggest that lipid peroxidation products can impair the flow of electrons along the respiratory chain, causing overreduction of respiratory chain components and enhanced mitochondrial reactive oxygen species. These findings are important in the pathogenesis of nonalcoholic fatty liver disease.

Correlations between biochemical findings and nonalcoholic fatty liver disease (NAFLD) in morbidly obese patients

Controversies about frequency, diagnosis and possibility of progression toward chronic disease of fatty degeneration of the liver in morbidly obese patients exist. Aim - To make an analysis considering the frequency and correlation of NAFLD with bariatric operations / Existem controvérsias sobre a frequência, diagnóstico e possibilidade de progressão para doença crônica da degeneração gordurosa do fígado em portadores de obesidade. Objetivo - analisar a frequência e correlação da NAFD com a cirurgia bariátrica. Pacientes e método - análise retrospectiva em 60 pacientes candidatos à cirurgia bariátrica com indicação de gastroplastia com derivação intestinal em Y de Roux...

Thiol-independent activity of a cholesterol-binding enterohemolysin produced by enteropathogenic Escherichia coli

Enterohemolysin produced by Escherichia coli associated with infant diarrhea showed characteristics similar to those of thiol-activated hemolysins produced by Gram-positive bacteria, including inactivation by cholesterol, lytic activity towards eukaryotic cells and thermoinstability. However, enterohemolysin activity was not inactivated by oxidation or by SH group-blocking agents (1 mM HgCl2, 1 mM iodoacetic acid) and the hemolysin (100 æg/ml) was not lethal to mice, in contrast to the lethality of the thiol-activated hemolysin family to animals. Earlier reports showed that intravenous injection of partially purified streptolysin O preparations (0.2 æg) was rapidly lethal to mice. These results suggest that E. coli enterohemolysin is not a thiol-activated hemolysin, despite its ability to bind cholesterol, probably due to the absence of free thiol-group(s) that characterize the active form of the thiol-activated hemolysin molecule.

Pancreatic tuberculosis.

Tuberculosis infrequently involves pancreas. The clinical features in patients with pancreatic tuberculosis are usually non-specific. The radiological features mimic pancreatic malignancy or pancreatitis. Ultrasound or CT scan guided fine needle aspiration cytology or biopsy may show caseating granulomatous inflammation. The present report includes two cases of pancreatic tuberculosis and review of relevant literature. One of our patients was diagnosed at laparotomy and the other with a CT scan guided fine needle aspiration cytology. Both patients responded well to anti tubercular chemotherapy and are now asymptomatic.

Monitoria Acadêmica em Semiologia Médica: Descrição e Avaliação de uma Nova Experiência

Resumo: O presente artigo refala uma nova experiência de metodologia de ensino -aprendizagem descritas pelos próprios monitores, desenvolvida no curso de Medicina da Universidade Estadual de Londrina, junto à disciplina de Semiologia. Esta monitoria acadêmica caracterizou-se pelas seguintes inovações: 1) Autonomia do monitor na elaboração do programa de atividades e, 2) Avaliação concomitante do método, através de questionários elaborados pelos monitores, aplicados periodicamente com o objetivo de identificar e caracterizar os principais fatores, prejudiciais e/ou benéficos, a fim de otimizar tal atividade acadêmica. Os autores descrevem o processo de seleção dos monitores, atividades desenvolvidas, dificuldades encontradas, resultados obtidos, e concluem que a modalidade de ensino com a utilização de monitores, mostra-se de extrema utilidade e importância no processo de formação médica, propiciando a transmissão de conhecimentos, aquisição de raciocínio crítico e estímulo à futura carreira universitária.

Summary: This article describes a new experiences of teaching methodology developed by the Medical Anamnesis and Physical Diagnosis at the School of Medicine of Universidade Estadual de Londrina. This academic teaching methodology was caracterized by: 1) The independence of the monitors to determinate the schedule of the activities and, 2) Continuous evaluation of the method, applied periodically to identify the major problems in order to improve the teaching method. The authors describe the selecting process of the monitors, activities carried out, unexpected difficulties, results anel conclude that· the proposed methodology is extremely useful in Medical Education and play an important role in improving knowledge, reasoning and stimulating a future University carrier.

Esquistossomose murina esperimental: estudo imunohistoquímicos das células ganglionares mioentéricas / Experimental murine Schistosomiasis: an immunohistochemical study of the ganglionic myoenteric cells

Para estudar a influência do processo granulomatoso esquistossomóticosobre as células ganglionares mioentéricas, foram utilizados 30 camundongos albinos Swiss infectadoscom 50 cercárias da cepa SLM do S. mansoni.O grupo controle foi constituído por dez animais näo infectados. Após sessenta dias de infecçäo, cortes histológicos do intestino delgadocorados por hematoxilina-eosina e P.A.S. demonstraram granulomas periovulares em todas as camadas da parede intestinal. Através do método imunohistoquímico indireto, usando-se a enolase neurônio-específica como marcador, observou-se desorganizaçäo do plexo mioentêrico em áreas contendo granulomas. Além disso, ocorreu rarefaçäo das estaçöes ganglionares, com aparente destruiçäo de células neuronais. A possível contribuiçäo dessas alteraçöes para a sintomatologia da esquistossomose humana é avaliada