ABSTRACT
Introducción: Desde hace 20 años se presenta en Centroamérica una enfermedad renal crónica que fundamentalmente afecta a hombres agricultores y no asociada a las causas tradicionales. Se caracteriza por presentar una nefritis intersticial crónica, en tanto las características ultraestructurales no se conocen con exactitud. En su origen se invoca el uso de agroquímicos y otros agentes nefrotóxicos, la deshidratación crónica, el consumo de medicamentos, entre otros factores. Objetivo: Describir las características ultraestructurales de la nefritis intersticial crónica en comunidades agrícolas. Método: Se realizó un estudio descriptivo de corte transversal. Se estudiaron muestras de biopsias renales de ocho pacientes con diagnóstico de nefritis intersticial crónica de las comunidades agrícolas. Resultados: De los ocho pacientes estudiados, dos (25 por ciento) trabajaban en labores agrícolas y cinco eran del sexo femenino (62,5 por ciento). Dos de los pacientes (25 por ciento) presentaban una enfermedad renal crónica estadio 2, y seis (75 por ciento) estadio 3. En cinco pacientes se hallaron fagolisosomas con presencia de componente lipídico entremezclado con material electrodenso en células del túbulo distal. En igual cantidad de pacientes se observaron cuerpos mieloides con zonas laminadas y núcleo central en células de túbulo proximal y de los vasos sanguíneos. Conclusiones: En pacientes de comunidades agrícolas que padecen nefritis intersticial crónica se evidencian fagolisosomas y estructuras mieloides en túbulos y vasos renales, cuyo contenido y origen se desconocen(AU)
Introduction: Chronic kidney disease mainly affecting male farmers and not associated to traditional causes has been present in Central America for twenty years. The condition is characterized by the presence of chronic interstitial nephritis, but its ultrastructural features are not fully known. Factors suggested as responsible for its occurrence include the use of agrochemicals and other nephrotoxic agents, chronic dehydration and medicine consumption. Objective: Describe the ultrastructural characteristics of chronic interstitial nephritis in farming communities. Method: A cross-sectional descriptive study was conducted of renal biopsy samples from eight patients diagnosed with chronic interstitial nephritis in farming communities. Results: Of the eight patients studied, two (25 percent) were farm workers and five (62.5percent) were female. Two of the patients (25 percent) had stage 2 and six (75 percent) stage 3 chronic kidney disease. In five patients evidence was found of phagolysosomes with lipid component mixed with electrodense material in distal tubule cells. An equal number of patients had myeloid bodies with laminated areas and central nucleus in proximal tubule and blood vessel cells. Conclusions: Evidence of phagolysosomes and myeloid structures of unknown content and origin was found in renal tubules and vessels of patients from farming communities diagnosed with chronic interstitial nephritis(AU)
Subject(s)
Humans , Female , Middle Aged , Phagosomes , Microscopy, Electron/methods , Renal Insufficiency, Chronic/pathology , Chronic Kidney Diseases of Uncertain Etiology/pathology , Epidemiology, Descriptive , Cross-Sectional StudiesABSTRACT
Modelo do estudo: Estudo observacional transversal. Objetivo: Avaliar o conhecimento dos médicos prestadores de serviço na Atenção Primária à Saúde do município de Lagarto, Sergipe, sobre o rastreamento das neoplasias colorretais. Metodologia: Estudo quantitativo e qualitativo transversal, realizado com médicos atuantes na Atenção Primária do município de Lagarto, Sergipe. Resultados: Vinte e cinco médicos (92,5%) responderam ao questionário. A maioria deles (76%) informou pos-suir conhecimento necessário para realização do rastreamento do câncer colorretal (CCR). Ao serem questionados, porém, sobre a idade para início do rastreio, apenas 60% relataram que deve ser aos 50 anos, assim como preconizado pela Organização Mundial de Saúde (OMS). Dezessete (68%) afir-maram que não há limite de idade para encerrar o rastreamento. Entre os motivos justificados para a não realização do rastreio, 50% responderam que não o faz porque o paciente não aceita; 33,33%, por não ter os exames disponíveis no sistema; e 16,66%, por não possuir conhecimento para conduta. A pesquisa de sangue oculto nas fezes (PSOF) foi escolhida por 92% dos médicos e a colonoscopia por 60% deles. Em relação à periodicidade, enquanto 72% informaram de forma assertiva que a PSOF deve ser realizada anualmente, apenas 36% relataram que a retossigmoidoscopia deve ser realizada a cada 5 anos. Conclusão: Apesar de a maioria dos médicos inseridos na Atenção Primária do município de Lagarto acreditar possuir o conhecimento necessário para realização do rastreamento do câncer colorretal, observou-se significativa inconformidade em relação às respostas sobre faixa etária alvo e métodos de rastreio quando comparadas ao que a Organização Mundial de Saúde e o Instituto Nacional do Câncer preconizam. A ausência de uma política de saúde pública de prevenção, associada à falta de programas de formação e reciclagem dos profissionais sobre prevenção de câncer colorretal, podem impactar (AU) diretamente na manutenção dos altos índices de mortalidade por esta neoplasia (AU)
Study model: Cross-sectional study. Objective: Evaluating the knowledge of the medical service providers in the Primary Health Care in the city of Lagarto, Sergipe, on the screening of colorec-tal neoplasias. Methodology: A quantitative and qualitative cross-sectional study carried out with physicians working in Primary Care in the city of Lagarto, Sergipe. Results: Twenty-five physicians (92.5%) answered the questionnaire. Most of them (76%) reported having the necessary knowledge to perform colorectal cancer screening (CRC). When questioned, however, about the age to start screening, only 60% reported that it should be at the age of 50, as recommended by the World Health Organization (WHO). Seventeen (68%) stated that there is no age limit to terminate the screening. Among the reasons for not performing the screening, 50% answered that it is not performed because the patient does not accept; 33.33%, for not having the exams available in the system; and 16.66%, because they did not have knowledge of the procedure. Fecal occult blood screening (PSOF) was chosen by 92% of physicians and by colonoscopy for 60% of them. Regarding periodicity, while 72% of them reported assertively that PSOF should be performed annually, only 36% reported that recto-sigmoidoscopy should be performed every five years. Conclusion: Although most of the physicians enrolled in Primary Care in the municipality of Lagarto believe that they possess the necessary knowl-edge to perform the colorectal cancer screening, there was a significant nonconformance regarding the responses on target age group and screening mwethods when compared to what the World Health Organization and the National Cancer Institute advocate. The absence of preventive public health policy, coupled with the lack of training and retraining programs for professionals on the prevention of colorectal cancer, may directly affect the maintenance of high mortality rates due to this neoplasm (AU)
Subject(s)
Humans , Male , Female , Physicians , Primary Health Care , Colorectal Neoplasms , Health Knowledge, Attitudes, Practice , Mass ScreeningABSTRACT
Objectives: To compare levels of a marker of lipid peroxidation (thiobarbituric acid reactive substances, TBARS) and brain-derived neurotrophic factor (BDNF) in umbilical cord blood (UCB) between newborns exposed to crack/cocaine in utero (exposed newborns [EN], n=57) and non-exposed newborns (NEN, n=99), as well as in maternal peripheral blood at delivery. Methods: This was a cross-sectional study. Potential confounders, including perinatal parameters, psychopathology, and use of other substances, were assessed. Results: After adjusting for potential confounders, adjusted mean BDNF was significantly higher in EN (3.86 ng/mL, 95% confidence interval [95%CI] 2.29-5.43) than in NEN (0.85 ng/mL, 95%CI 0.47-1.23; p < 0.001; Cohen effect size: 1.12), and significantly lower in crack/cocaine mothers than in control mothers (4.03 ng/mL, 95%CI 2.87-5.18 vs. 6.67 ng/mL, 95%CI 5.60-7.74; p = 0.006). The adjusted mean TBARS level was significantly lower in EN (63.97 µM MDA, 95%CI 39.43-88.50) than NEN (177.04 µM MDA, 95%CI 140.93-213.14; p < 0.001; effect size = 0.84), with no difference between mother groups (p = 0.86). Conclusions: The changes in TBARS levels observed in EN suggest that fetuses exposed to cocaine mobilize endogenous antioxidant routes since very early stages of development. The increase in BDNF levels in EN might indicate changes in fetal development, whereas the changes in BDNF levels in mothers provide evidence of the complex metabolic processes involved in drug use during pregnancy.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adolescent , Adult , Middle Aged , Young Adult , Crack Cocaine/pharmacology , Thiobarbituric Acid Reactive Substances/analysis , Brain-Derived Neurotrophic Factor/blood , Fetal Blood/chemistry , Oxidation-Reduction/drug effects , Cross-Sectional Studies , Cocaine-Related Disorders/blood , Postpartum Period/bloodABSTRACT
INTRODUÇÃO: No Brasil, o uso de crack permanece um desafio à saúde pública devido à facilidade de aquisição da droga e sua elevada capacidade de induzir dependência. A exposição intrauterina (EIU) à cocaína está associada a alterações neurocomportamentais durante a infância e adolescência. Em estudo prévio do nosso grupo, achou-se menor nível de estresse oxidativo (EO) em recém-nascidos (RN) com EIU. Uma possível explicação pode ser a Cocaine and Amphetamine Regulated Transcript (CART), um antioxidante endógeno presente desde o período embrionário e ativado por maiores níveis de dopamina. OBJETIVO: Verificar a correlação entre os níveis de CART no sangue de cordão umbilical (SCU) e sangue periférico de 57 gestantes com exposição ao crack. MÉTODOS: Trata-se de um estudo transversal, com amostragem consecutiva, em que o desfecho primário foi a correlação entre os níveis de CART no SCU e sangue periférico materno no pós-parto imediato. Dados gestacionais e perinatais foram sistematicamente coletados. RESULTADOS: Houve correlação significativa entre os níveis de CART no sangue de cordão umbilical e sangue periférico materno (rs= 0,350 e p<0,05). CONCLUSÕES: Estes achados demonstram que os níveis de CART no sangue materno e no SCU se correlacionam. Todavia, não se pode afirmar de quem é a produção, ou se é produzida por ambos. O presente trabalho pode ajudar a elucidar os caminhos neurobiológicos responsáveis pelas alterações de neurodesenvolvimento, contribuindo para a ampliação das possibilidades de intervenções precoces.
INTRODUCTION: The use of crack cocaine remains a public health challenge in Brazil, due to easy drug acquisition and its high ability to induce dependence. Intrauterine exposure (IUE) to crack cocaine is associated with neurobehavioral changes during childhood and adolescence. In a previous study of our group, lower levels of oxidative stress (OS) were found in newborns with IUE. One possible explanation may be the Cocaine and Amphetamine Regulator Transcript (CART), an endogenous antioxidant present since the embryonic period activated by higher levels of dopamine. OBJECTIVE: The aim of this study is to investigate the correlation of CART levels between umbilical cord blood (UCB) and peripheral blood samples of 57 pregnant women exposed to crack. METHODS: This is a cross-sectional study with a consecutive sampling, in which the primary outcome was the correlation between CART levels in UCB and peripheral blood of their mothers in immediate postpartum. Gestational and perinatal data were systematically collected. Spearman correlation test was performed after checking the pattern of distribution, being considered a 0.05 significance level. RESULTS: There was a significant correlation between CART levels in umbilical cord blood and peripheral blood (rs = 0.350 and p <0.05). CONCLUSIONS: These findings suggest a correlation between CART levels at UCB and mother's blood. However, it remains unclear whether it is produced by the mother, the fetus, or both. This study may help to elucidate the neurobiological pathways responsible for neurodevelopmental changes, providing a rationale for early interventions.
Subject(s)
Crack Cocaine , Fetal Blood , Oxidative Stress , PregnancyABSTRACT
As neoplasias neuroendócrinas são tumores raros, cuja prevalência varia de 0,7 a 4,48 casos em 100 mil habitantes. Menos de um quinto dos pacientes tem a síndrome carcinoide, que pode ser marcada por flushing, diarreia, dor abdominal, alterações cardíacas, pulmonares e pelagra. A dosagem do ácido 5-hidroxi-indolacético urinário e da cromogranina A sérica, exames de imagem e o estudo anatomopatológico da lesão auxiliam no diagnóstico. Neste estudo, relata-se o caso de paciente do sexo masculino, 47 anos, que apresentava diarreia intermitente com evolução de 5 anos e, 2 anos após, dor abdominal e empachamento, bem como percepção de flushing em face, tronco e partes proximais de membros superiores, inicialmente episódico e que, posteriormente, tornou-se fixo, com momentos de exacerbação. Marcadores ácido 5-hidroxi-indolacético urinário e cromogranina A foram positivos. Exame de imagem e estudo anatomopatológico/imuno-histoquímica de lesões focais hepáticas demonstraram tratar-se de tumor neuroendócrino. A cintilografia com octreotide marcado demonstrou lesões hepáticas já conhecidas. Trata-se, portanto, de um tumor neuroendócrino associado à síndrome carcinoide. Foi proposto tratamento com análogo de somatostatina. A síndrome carcinoide é uma manifestação rara dos tumores neuroendócrinos, mas sua identificação precoce é de suma importância para que possa ser oferecido tratamento com intuito curativo e melhor qualidade de vida.
Neuroendocrine tumors are rare. Their prevalence ranges from 0.7 to 4.48 cases per 100,000 inhabitants. Less than 1/5 of the patients have carcinoid syndrome, which can be marked by flushing, diarrhea, abdominal pain, cardiac and pulmonary disorders, pellagra. The measurement of urinary 5-hydroxyindoleacetic acid, the serum chromogranin A, imaging studies, and pathological study of the lesion support the diagnosis. In this study we report the case of a 47-year-old male patient, with five years of intermittent diarrhea and three years of abdominal pain and bloating, as well as perception of flushing in the face, trunk and proximal portions of the upper limbs, initially episodic but that became fixed with moments of exacerbation. The 5-hydroxy-indoleacetic acid and chromogranin A markers were positive. Imaging studies and the histopathological study/immunohistochemistry of the focal hepatic lesions demonstrated that these lesions were neuroendocrine tumors. The marked octreotide scintigraphy showed known liver lesions. It is, therefore, a neuroendocrine tumor associated with carcinoid syndrome. Treatment with a somatostatin analog was proposed. Carcinoid syndrome is a rare manifestation of neuroendocrine tumors, but its early detection is of paramount importance, so that clinicians can offer treatment with curative intent and better quality of life.
Subject(s)
Humans , Male , Middle Aged , Malignant Carcinoid Syndrome/diagnosis , Malignant Carcinoid Syndrome/pathology , Neuroendocrine Tumors/diagnosis , Diarrhea , Erythema , Hydroxyindoleacetic AcidABSTRACT
Introduction Prenatal cocaine exposure (PCE) is associated with neurobehavioral problems during childhood and adolescence. Early activation of the inflammatory response may contribute to such changes. Our aim was to compare inflammatory markers (IL-6 and IL-10) both in umbilical cord blood and in maternal peripheral blood at delivery between newborns with history of crack/cocaine exposure in utero and non-exposed newborns. Methods In this cross-sectional study, 57 newborns with a history of crack/cocaine exposure in utero (EN) and 99 non-exposed newborns (NEN) were compared for IL-6 and IL-10 levels. Sociodemographic and perinatal data, maternal psychopathology, consumption of nicotine and other substances were systematically collected in cases and controls. Results After adjusting for potential confounders, mean IL-6 was significantly higher in EN than in NEN (10,208.54, 95% confidence interval [95%CI] 1,328.54-19,088.55 vs. 2,323.03, 95%CI 1,484.64-3,161.21; p = 0.007; generalized linear model [GLM]). Mean IL-10 was also significantly higher in EN than in NEN (432.22, 95%CI 51.44-812.88 vs. 75.52, 95%CI 5.64-145.39, p = 0.014; GLM). Adjusted postpartum measures of IL-6 were significantly higher in mothers with a history of crack/cocaine use (25,160.05, 95%CI 10,958.15-39,361.99 vs. 8,902.14, 95%CI 5,774.97-12,029.32; p = 0.007; GLM), with no significant differences for IL-10. There was no correlation between maternal and neonatal cytokine levels (Spearman test, p ≥ 0.28 for all measures). Conclusions IL-6 and IL-10 might be early biomarkers of PCE in newborns. These findings could help to elucidate neurobiological pathways underlying neurodevelopmental changes and broaden the range of possibilities for early intervention.
Introdução A exposição pré-natal à cocaína está associada a problemas neurocomportamentais durante a infância e adolescência. A ativação precoce da resposta inflamatória pode contribuir para tais alterações. Nosso objetivo foi comparar marcadores inflamatórios (IL-6 e IL-10) no sangue do cordão umbilical e no sangue periférico materno na hora do parto, entre recém-nascidos expostos ao crack intraútero e recém-nascidos não expostos. Métodos Neste estudo transversal, 57 recém-nascidos expostos ao crack intraútero (RNE) e 99 recém-nascidos não expostos (RNNE) foram comparados quanto aos níveis de IL-6 e IL-10. Dados sociodemográficos e perinatais, psicopatologia materna, consumo de nicotina e outras substâncias foram sistematicamente coletados em casos e controles. Resultados Após o ajuste para potenciais confundidores, a média de IL-6 foi significativamente maior nos RNE em comparação aos RNNE [10.208,54, intervalo de confiança (IC95%) 1.328,54-19.088,55 versus2.323,03, IC95% 1.484,64-3.161,21; p = 0,007; modelo linear generalizado (MLG)]. A média ajustada de IL-10 foi significativamente maior nos RNE do que nos RNNE (432,2189, IC95% 51,44-812,88 versus 75,52, IC95% 5,64-145,39, p = 0,014; MLG). Medidas pós-parto ajustadas de IL-6 foram significativamente maiores nas mães que usaram de crack/cocaína (25.160,05, IC95% 10.958,15-39.361,99 versus 8.902,14, IC95% 5.774,97-12.029,32; p = 0,007; MLG), sem diferenças significativas para IL-10. Não houve correlação entre níveis maternos e neonatais de citocinas (teste de Spearman, p ≥ 0,28 para todas as medidas). Conclusões IL-6 e IL-10 podem ser biomarcadores precoces da exposição pré-natal a cocaína em recém-nascidos. Esses resultados podem ajudar a elucidar as vias neurobiológicas subjacentes a alterações do desenvolvimento e aumentar a gama de possibilidades para intervenção precoce.