Development of standardized extractive solution from Lippia sidoides by factorial design and their redox active profile

AbstractThe aim of this study was to evaluate the influences of variables of preparation on total flavonoids content from extractive solution of Lippia sidoides Cham., Verbenaceae. Thus a 23 factorial design was used to study the importance of plant proportion, the extraction method and solvent on the extraction of flavonoid. The methodology of determination of chemicals in factorial design was validated according to the parameters required by Brazilian Health Agency. The extraction solution was selected through a full factorial design where the best conditions to achieve the highest content of flavonoids were: 7.5% (w/v) of plant with ethanol 50% (v/v) as solvent. The polyphenols content was determined by LC method and its relationship with the antioxidant and free radical scavenging activities was evaluated. The free radical scavenging activities and antioxidant potentials were determined for different concentrations using various in vitro models. Our results indicate that extracts exhibited a significant dose-dependent antioxidant effect as evaluated by TRAP/TAR assays. Besides, we observed an antioxidant activity against hydroxyl radicals and nitric oxide, and protection against lipid peroxidation in vitro. Our results suggest that the extract presents significant in vitro antioxidant potential indicating promising perspectives for its use as pharmaceutical/or food additive.

Periurethral constrictor: late results of the treatment of post prostatectomy urinary incontinence

OBJECTIVES: We evaluated retrospectively, the long-term outcome of patients with post-prostatectomy urinary incontinence (PPUI) after placement of the Periurethral Constrictor (PUC). MATERIALS AND METHODS: Fifty-six men with severe PPUI were studied, with a mean age of 68.5 years old. Fifty-one men had PPUI due to radical surgery having the device placed around the bulbous urethra, and five individuals with benign prostatic hypertrophy (BPH) had placement around the bladder neck. The mean follow-up was 82.2 months. RESULTS: Twenty-two patients (39.28 percent) became continent (0 to 1 pad a day) and 34 (60.72 percent) were incontinent. Complications were as follows: urethral erosion in 15 (26.78 percent); mechanical malfunction in 2 (3.5 percent); infection in 2 (3.5 percent); urinary fistula in 1 (1.7 percent); Urinary tract infection1 (1.7 percent). Twenty-three patients needed to have the device removed (41.07 percent). Success rate (continent me) was 30.35 percent. CONCLUSION: In the present series the PUC was not effective for the treatment of severe PPUI in the long-term follow-up.

Vascular and metabolic response to statin in the mildly hypertensive hypercholesterolemic elderly

INTRODUCTION: Much evidence indicates the importance of the endothelium and hypercholesterolemia in atherosclerosis, as well as the decline in endothelial function with aging. However, it is unclear if treating dyslipidemia in elderly patients improves endothelial function and reduces C-reactive protein levels. OBJECTIVES: To evaluate vasomotor function, lipids and C-reactive protein in mildly hypertensive and hypercholesterolemic elderly patients treated with atorvastatin. METHODS: Forty-seven elderly Brazilian subjects (> 65 years old) with LDL cholesterol (LDL-c) > 130 mg/dL were randomly assigned, in a double-blinded manner, to receive either placebo (n = 23) or 20 mg/day of atorvastatin (n = 24) for 4 weeks. Exclusion criteria included diabetes, serious hypertension, obesity, steroid use, hormone replacement, and statin use within the previous six months. All patients underwent clinical examinations, laboratory tests (glucose, lipids, liver enzymes, creatine phosphokinase and high sensitivity C-reactive protein) and assessment of vasomotor function by high-resolution ultrasound examination of the brachial artery (flow-mediated dilation and sublingual nitrate), both before and after treatment. RESULTS: The patients were 65 to 91 years old; there was no significant difference between basal flow-mediated dilation of placebo (7.3 ± 6.1 percent) and atorvastatin (4.5 ± 5.1 percent; p = 0.20). The same was observed after treatment (6.6 ± 6.2 vs. 5.0 ± 5.6; p = 0.55). The initial nitrate dilatation (8.1 ± 5.4 percent vs. 10.8 ± 7.5 percent; p = 0.24) and that after 4 week treatment (7.1 ± 4.7 percent vs. 8.6 ± 5.0 percent; p = 0.37) were similar. Atorvastatin produced a reduction of 20 percent of the C-reactive protein and 42 percent in the LDL-c; however, there were no changes in the flow-mediated dilation. CONCLUSIONS: Atorvastatin produced a significant change of lipids and C-reactive protein; however, there were no changes in vasomotor ...

Risco de suicídio em pacientes em hemodiálise: evolução e mortalidade em três anos / Risk of suicide in hemodyalisis patient: evolution and mortality in three years

A morte por suicídio em pacientes portadores de insuficiência renal crônica (IRC) em diálise tem sido reportada há décadas. No Brasil, raros são os estudos que têm mensurado sua prevalência, evolução e mortalidade. OBJETIVO: Identificar a presença de risco de suicídio, em duas unidades de diálise e analisar a evolução e a mortalidade por três anos. MÉTODO: O MINI foi utilizado em três etapas. Foram obtidas as freqüências do transtorno e sua evolução foi acompanhada. A curva de Kaplan-Meier e a regressão de Cox foram aplicadas para estudar a mortalidade. RESULTADOS: Participaram 244 pacientes na primeira etapa, 200, na segunda etapa e 110, na terceira etapa. O risco de suicídio foi diagnosticado em 40 pacientes na primeira etapa, 49, na segunda etapa e sete na terceira etapa. Da primeira para a segunda etapa, nove pacientes morreram, 29 continuaram e 20 outros pacientes passaram a apresentar a condição. Da segunda para a terceira etapa, 13 deles morreram, sete continuaram a apresentar e 29 evoluíram para outro transtorno. A incidência de óbitos naqueles sem o transtorno foi de 3,35 e naqueles com risco de suicídio, 9,91 (RR = 2,87; IC 95 por cento [1,69-4,87]). CONCLUSÕES: O risco de suicídio teve alta prevalência, e a mortalidade associada a esta condição é elevada.

Risk of suicide is associated with high rates of death in chronic hemodialysis patients. In Brazil only few studies have measured your prevalence, evolution and mortality. OBJECTIVE: Study the prevalence, evolution and mortality of risk of suicide in two nephrology units for three years. METHODS: The Mini was used in three moments. Frequency and evolution of Risk of Suicide was analyzed. Kaplan-Meier Curve and Cox Regression was used to study the mortality. RESULTS: 244 patients in 1st step, 200 in 2nd and 110 in 3rd. Risk of suicide was diagnosticated in 40 in 1st, 49 in 2nd and seven in 3rd period. Between the 1st and 2nd period, nine patients death, 29 followed with the condition and 20 others patients presented risk of suicide. Between the 2nd and 3rd period thirteen death, seven followed with the condition and 29 changed the disorder. The death incidence in patients without disorder was 3.35 and in patients with risk was, 9.91 (RR = 2.87; IC de 95 percent [1.69-4.87]). CONCLUSIONS: The prevalence of risk of suicide was high, and this condition was associated with high rates of mortality.

Prevalência de transtornos psiquiátricos em pacientes em hemodiálise no estado da Bahia / Prevalence of psychiatric disorders in patients in hemodialysis in the state of Bahia

INRODUÇÃO: Limitações da qualidade de vida dos pacientes com insuficiência renal crônica (IRC) em programa de hemodiálise estão associadas a maior prevalência de transtornos psiquiátricos. O diagnóstico precoce e preciso pode contribuir na elaboração de estratégias de tratamento. OBJETIVO: Estudar a prevalência e o padrão dos transtornos psiquiátricos em pacientes hemodialisados, identificando variáveis relacionadas com sua ocorrência. MÉTODOS: Foram estudados 244 pacientes e analisadas as variáveis associadas à ocorrência de transtornos psiquiátricos. Os pacientes foram avaliados através do Mini-International Neuropsychiatric Interview (MINI). RESULTADOS: Pelo menos um diagnóstico psiquiátrico foi apresentado por 91 pacientes (37,3 por cento). Os de ocorrência mais freqüente foram distimia (17,6 por cento), risco de suicídio (16,4 por cento) e episódio depressivo maior (8,6 por cento). O sexo feminino apresentou maior risco de transtornos psiquiátricos (razão de chance [RC] = 2,77; intervalo de confiança [IC] 95 por cento: 1,42-5,41). Os pacientes viúvos, separados e solteiros apresentaram maior risco de transtornos psiquiátricos do que os casados (RC= 5,507;IC95 por cento:1,348-22,551). Aqueles com menos de dois anos em diálise apresentaram risco maior (RC = 2,075; IC 95 por cento: 1,026-4,197). Os pacientes com clearance fracional de uréia (Kt/V) abaixo de 0,9 tiveram maior chance de apresentar transtornos psiquiátricos (RC = 3,955; IC 95 por cento: 1,069-11,012). CONCLUSÕES: A prevalência de transtornos psiquiátricos foi alta. Os transtornos afetivos foram os mais freqüentes. Nas mulheres e naqueles com Kt/V baixo, o risco foi maior. Nos pacientes casados e naqueles com mais de dois anos em tratamento o risco foi menor.

INTRODUCTION: Limiting factors of dialysis patients' quality of life are associated with high rates of psychiatric disease. Since effective treatment of psychiatric diseases can positively affect dialysis patients' prognosis and survival, there is a need for an early diagnosis. In Brazil only few studies have measured the prevalence of these disorders. OBJECTIVE: Study the prevalence and pattern of psychiatric disorders in chronic hemodialysis patients and assess the association between these diseases and some variables. METHODS: Two hundred forty-four patients were enrolled in two nephrology units at the state of Bahia, Brazil. The Mini-International Neuropsychiatric Interview (MINI) was used in all patients. RESULTS: Ninety-one patients (37.3 percent) presented at least one psychiatric diagnosis. The most common disorders included dysthymia (17.6 percent), risk of suicide (16.4 percent), and major depressive episode (8.6 percent). Women had higher risk of mental disorders than men (RC = 2.77; confidence interval [CI] 95 percent: 1.42-5.41). Widowed, divorced and single patients had higher risk than married patients (RC = 5.507; CI 95 percent: 1.348-22.551). Patients on treatment for less than two years had higher risk (RC = 2.075; CI 95 percent: 1.026-4.197). Those with Kt/V below 0.9 were at higher risk than those with a higher Kt/V (RC = 3.955; CI 95 percent: 1.069-11.012). CONCLUSIONS: The prevalence of psychiatric disorders in patients on dialysis was high (37.3 percent). Affective disorders were the most common ones. Women and patients with Kt/V below 0.9 were at increased risk. The risk was lower in patients at dialysis program for longer than two years and in married patients.

Histologic carcinoma of the prostate in autopsies: frequency, origin, extension, grading and terminology / Carcinoma histológico da próstata em autópsias: freqüência, origem, extensão, graduação e nomenclatura

Objetivo: Estudar o carcinoma incidentalmente encontrado em autópsias. Material e métodos: As próstatas de autópsias de 150 homens com mais de 40 anos de idade foram dissecadas em zonas de transição e periférica. No exame microscópico dos cortes, observou-se a presença ou não de adenocarcinoma, a extensão da neoplasia, avaliando-se o número de fragmentos que a apresentavam e a graduação histológica, utilizando-se o sistema Gleason. Resultados: A freqüência foi de 36,66 porcento, sendo significativamente maior em pacientes mais idosos e não havendo predileção quanto à cor. Do total de 55 carcinomas encontrados, 56,36 porcento localizaram-se em ambas as regiões estudadas (zonas de transição e periférica), 25,45 porcento somente na zona de transição e 18,18 porcento somente na zona periférica. Todas as neoplasias localizadas apenas na zona de transição ou na zona periférica foram pouco extensas e de baixo grau histológico. Quando presente em ambas as regiões, o carcinoma era pouco extenso e de baixo grau na zona de transição, porém extenso e de alto grau na zona periférica. Em 14,54 porcento, 80 porcento e 5,45 porcento dos carcinomas, a contagem final no sistema Gleason foi 2 - 4, 5 - 6 e 7, respectivamente. A contagem final 2 - 4 foi significativamente mais freqüente em pacientes mais jovens e a contagem final 7 em pacientes mais idosos. Conclusões: Há evidências morfológicas de um comportamento menos agressivo quando o carcinoma se localiza exclusivamente na zona de transição. A contagem final 2 - 4 foi significativamente mais freqüente em pacientes mais jovens, e a contagem final 7 em pacientes mais idosos.

Histerossalpingografia e imunofluorescência indireta pra clamídia no dignóstico do fator tubo-peritoneal em pacientes inférteis / Hysterosalpingography and chlamydia trachomatis antibody titers in diagnosis tubal disease in infertility patients

Foi realizado um estudo retrospectivo que avaliou a imunofluorescência indireta para clamídia e a histerossalpingografia (HSG), em relaçao à laparoscopia, no diagnóstico de infertilidade de causa tubo-peritoneal em pacientes inférteis. Foram selecionados 93 casos que realizaram HSG, imunofluorescência indireta para clamídia ou laparoscopia em nosso Serviço. Dezessete pacientes possuíam dados de HSG e laparoscopia, e 13 de imunofluorescência indireta para clamídia e laparoscopia. Na comparaçao, a HSG apresentou: sensibilidade de 100 por cento, especificidade de 18 por cento, valor preditivo positivo de 40 por cento e valor preditivo negativo de 100 por cento. A imunofluorescência indireta para clamídia apressentou resultados inferiores à HSG com uma sensibilidade de 60 por cento, especificidade de 38 por cento, valor preditivo positivo de 38 por cento e valor preditivo negativo de 60 por cento. As diferenças nao foram estatisticamente significativas, para o teste exato de Fisher com a<0,05. A HSG parece ser superior à imunofluorescência indireta para clamídia na avaliaçao de fator tubo-peritoneal. No entanto, nenhum dos exames contém as características ideais de exame de triagem. Ambos possuem seu papel na investigaçao inicial e, em associaçao, sao capazes de realizar melhor rastreamento de pacientes inférteis que devem ser submetidos a laparoscopia para a pesquisa de fator anatômico, do que isoladamente.

Freqüência de utilização e razoes de exclusão da terapia trombolítica no infarto agudo do miocárdio em Salvador-Bahia / Frequency of utilization and reasons for exclusion from thrombolytic therapy in patients with acute myocardial infarction in Salvador-Bahia

PURPOSE: To determine the rate of utilization and reasons for exclusion from thrombolytic therapy in acute myocardial infarction (AMI) in the setting of Intensive Care Unit (ICU) Salvador-BA. METHODS: Retrospective cohort study recording patients admitted with suspected AMI in six ICU in Salvador-BA between January/93 and December/94 were reviewed. RESULTS: Three hundred and eighty-eight of confirmed cases of AMI were analysed, 165 (42.0) were admitted at public hospitals and 225 (58.0) at private hospitals. Thrombolytic therapy was indicated in 143 (36.8) patients. The thrombolysis was more frequently performed in men (PR = 1.96 IC 95 1.39-2.77), in patients less than 60 years of age (PR = 4.46 CI 95 2.17-9.19) and in those with Killip class I (PR = 2.62 CI 95 1.60-4.31). The major reasons for excluding from thrombolytic therapy were late arrival, old age and lack of ST elevation. Thirty three percent of patients were excluded for more than one reasons. Multivariate analysis showed that female gender was associated with a reduced indication for thrombolytic therapy, independent of the clinical findings on admission. CONCLUSION: The frequency of the use and reasons for excluding patients from thrombolytic therapy in AMI in Salvador-BA were similar to those of other clinical studies. The recent recommendations of the Thrombolysis Brazilian Consensus will enhance the utilization of this therapy, as it expands its utilization to elderly patients and to those who arrive late to the hospital.

Memory deficits after recovery of transient forebrain ischemia in rats: a preliminary report

Transient forebrain ischemia causes delayed cell death of vulnerable neuronal populations, in rodents, primates and man, mainly in the pyramidal CA1 sector of the hippocampus. Lesions involving hippocampal formation are of great interest due to its recognized importance in information processing. In a series of experiments, we investigated the performance of rats after recovery of an ischemic episode, in two avoidance tasks and in one appetitive task with a spatial component. Wistar rats were subjected to transient forebrain ischemia (ISC) through electrocauterization of vertebral arteries and 20 min occlusion of common carotids. One group was tested 21 to 28 days after ISC, and another 7 months after the episode, along with agematched controls. Ischemic animals tested in the early phase of recovery showed impairment of both inhibitory and active avoidance tasks, as well as the water-finding task. However, ischemic rats tested after long-term recovery exhibited avoidance deficits in the active, but not in the inhibitory task, and presented higher latencies of water-finding. Considering that the pattern of cognitive impairment after short and long recovery periods is different, we suggest that neuronal circuitry involved in the tasks studied may be influenced by the probable reorganization of hippocampal synapses after recovery from an ischemic episode.

Acropatia úlcero-mutilante familiar: enfermidade de Thévenard / Ulcerave mutilating acropathy: Thévenard's disease

Säo considerados aspectos clínicos vasculares e neurológicos da chamada Acropatia úlcero Mutilante ou enfermidade de Thévenard. A nosologia da enfermidade näo é, geralmente, bem conhecida e pode ser confundida com outras osteoartropatias e alteraçöes trópicas dos pés. A experiência demonstrada confirma a origem hereditária do mal com caráter dominante e preponderância no homem. Há predisposiçäo abiotrófica, mais ou menos óbvia nos casos familiares e mesmo naqueles considerados esporádicos, que afeta os gânglios lombosacros e raízes posteriores. As lesöes tróficas säo comentadas em seus aspectos vasculares. Säo considerados o diagnóstico vascular e neurológico de certeza antes de estabelecer-se critérios terapêuticos. O tratamento é clínico ou pertence à cirurgia vascular e ortopédica. Novos conceitos fisiopatológicos e terapêuticos säo entäo comentados

Mielolipoma da glândula adrenal; aspectos no ultra-som e na tomografia computadorizada / Myelolepoma of the adrenal gland; aspects in ultrasound and computed tomography

O mielolipoma é um tumor adrenal benigno e raro, formado por gordura e tecido hematopoético. Descrevemos 4 casos descobertos por ultrasom e tomografia computadorizada, enfatizando seu aspecto nesses métodos, em correlaçäo com a literatura. Em 3 casos o tumor tinha configuraçäo típica com predomínio de gordura e o diagnóstico foi dado pela TC em associaçäo com a US. No quarto caso o tumor apresentava densidade diferente, com valores de atenuaçäo à TC maiores que as usuais nessa patologia devido à presença de maior quantidade de tecido hematopoético e menor de gordura. A biópsia aspirativa foi inconclusiva e o diagnóstico feito cirurgicamente