Manifestações neurológicas em ribeirinhos de áreas expostas ao mercúrio na Amazônia brasileira / Neurological manifestations in riverine populations from areas exposed to mercury in the Brazilian Amazon / Manifestaciones neurológicas en las comunidades ribereñas expuestas al mercurio de la Amazonia brasileña

This study evaluated current levels of mercury exposure and sensory symptoms in adults from three riverine communities in Pará State, Brazil, two of which located in the Tapajós River basin and one in the Tocantins basin. Participants in this study included 78 residents in Barreiras (Tapajós), 30 in São Luiz do Tapajós (Tapajós), and 49 in Furo do Maracujá (Tocantins). Total hair mercury concentrations were quantified by atomic absorption spectrophotometry, and neurological evaluation was conducted by routine examination. Mercury concentrations in the Tapajós communities were higher than those in the Tocantins (p < 0.01). Evaluation of neurological changes showed no significant difference between the communities in exposed areas and control areas for the changes observed by conventional neurological examination, except for gait deviation (p < 0.05). The study concludes that despite the mercury exposure levels, there was a low frequency of sensory alterations according to conventional neurological testing.

No presente estudo, foram avaliados comparativamente os níveis atuais de exposição ao mercúrio e as manifestações neurológicas em ribeirinhos residentes em comunidades situadas no Estado do Pará, Brasil. Participaram do estudo 78 ribeirinhos de Barreiras (bacia do rio Tapajós), 30 de São Luiz do Tapajós (bacia do rio Tapajós) e 49 do Furo do Maracujá (bacia do rio Tocantins). As concentrações de mercúrio total foram quantificadas, em cabelo, pela espectrofotometria de absorção atômica, e a avaliação neurológica foi realizada por meio de testes de rotina. As concentrações de mercúrio nas comunidades do Tapajós foram maiores que as do Tocantins (p < 0,01). A avaliação das alterações neurológicas não mostrou diferença significativa entre as comunidades das áreas expostas e controle para os resultados observados pelo exame neurológico convencional, exceto para desvio da marcha (p < 0,05). Concluiu-se que, apesar dos níveis de exposição ao mercúrio, houve uma baixa frequência de alterações somatossensoriais encontradas por meio de exames neurológicos convencionais.

En el presente estudio se evaluó comparativamente los niveles actuales de exposición al mercurio y sus manifestaciones neurológicas en los residentes de las comunidades ribereñas en el Estado de Pará, Brasil. Los participantes fueron 78 de las riberas limítrofes (cuenca del Tapajós), 30 en São Luís do Tapajós (cuenca del Tapajós) y 49 en Pasiflora (cuenca del río Tocantins). Las concentraciones de mercurio total en el pelo se cuantificaron por espectrofotometría de absorción atómica y la evaluación neurológica se realizó mediante el análisis de rutina. Las concentraciones de mercurio en las comunidades Tapajós fueron más altas que en Tocantins (p < 0,01). La evaluación de los trastornos neurológicos no mostró diferencias significativas entre las comunidades de las zonas expuestas, ni en el control de los resultados observados durante el examen neurológico convencional, excepto por desviaciones de la marcha (p < 0,05). Se concluyó que, si bien existen niveles de exposición al mercurio, hubo una baja frecuencia de cambios, cuyo examen neurológico fue de tipo estándar somatosensorial.

Troca valvar aórtica minimamente invasiva: uma alternativa à técnica convencional / Minimally invasive aortic valve replacement: an alternative to the conventional technique

OBJETIVO: Demonstrar o uso da cirurgia minimamente invasiva para tratamento da valva aórtica e comparar seus resultados com o método tradicional. MÉTODOS: Entre 2006 e 2011, 60 pacientes foram submetidos à cirurgia na valva aórtica, após consentimento escrito, destes 40 pela técnica minimamente invasiva com acesso por minitoracotomia ântero-lateral direita (Grupo 1/G1)e 20 por esternotomia mediana (Grupo 2/G2). Comparamos os tempos operatórios e a evolução pós-operatória intra-hospitalar. RESULTADOS: Os tempos médios de circulação extracorpórea (CEC) e pinçamento aórtico no G1 foram, respectivamente, 142,7 ± 59,5 min e 88,6 ± 31,5 min e, no G2, 98,1 ± 39,1 min e 67,7 ± 26,2 min (P<0,05), uma diferença nas medianas de 39 minutos no tempo de CEC e 23 minutos no pinçamento aórtico foram observados a favor da técnica convencional. A perda sanguínea pelos drenos torácicos foi significativamente menor no grupo minimamente invasivo: 605,1 ± 679,5 ml (G1) versus 1617 ± 1390 ml (G2) (P<0,05). Os tempos médios de internamento em UTI e hospitalar foram menores em G1: 2,3 ± 1,8 dias e 5,5 ± 5,4 dias versus 5,1 ± 3,6 dias e 10 ± 5,1 dias em G2 (P<0,05), respectivamente. O uso de drogas vasoativas no pós-operatório também foi menor no grupo minimamente invasivo 12,8% em G1 versus 45% em G2. CONCLUSÃO: Troca valvar aórtica com o uso de técnicas minimamente invasivas, apesar de demonstrar maiores tempos intraoperatórios, não afeta os resultados pósoperatórios, que nesta casuística mostraram-se melhores quando comparado ao método tradicional.

OBJECTIVES: To demonstrate the use of minimally invasive surgery for aortic valve replacement and compare your results with the traditional method. METHODS: Between 2006 and 2011 sixty patients underwent surgery on aortic valve, after written consent, these 40 by minimally invasive technique with right anterior minithoracotomy access (Group 1/G1) and 20 by median sternotomy (Group 2/G2). Compare the operating times and postoperative evolution intra-hospital. RESULTS: The average times of bypass and aortic crossclamp in G1 were, respectively, 142.7 ± 59.5 min and 88.6 ± 31.5 min and, in G2, 98.1 ± 39.1 min and 67.7 ± 26.2 min (P < 0.05), a difference in medians of 39 minutes in bypass time and 23 minutes in aortic cross-clamp were observed in favour of conventional technique. The blood loss by the thoracic drains was significantly lower in the Group: minimally invasive 605.1 ± 679.5 ml (G1) versus 1617 ± 1390 ml (G2) (P < 0.05).The average time of ICU and hospital stay were shorter in G1: 2.3 ± 1.8 and 5.5 ± 5.4 days versus 5.1 ± 3.6 and 10 ± 5.1 in G2 (P < 0.05), respectively. Vasoactive drug use was also less post-operative at 12.8% in minimally invasive group G1 versus 45% in G2. CONCLUSION: Aortic valve replacement through minimally invasive techniques, although intraoperative times larger, not demonstrate affect postoperative results that this case proved best when compared to the traditional approach.

Prevalência de alterações laríngeas no ambulatório de endoscopia respiratória alta / Prevalence of laryngeal alterations in the high respiratory endoscopy service

Introdução: Atualmente, a fibrolaringoscopia flexível é considerada um método de primeira escolha no exame otorrinolaringológico, principalmente na avaliação da funcionalidade laríngea. Objetivo: O objetivo do estudo é descrever a prevalência de alterações laríngeas, observadas no serviço de endoscopia respiratória alta da Universidade, correlacionado-as com a idade e sexo dos pacientes. Método: Realizamos um estudo retrospectivo abordando prontuários de duzentos e quatorze pacientes do Ambulatório de Endoscopia Respiratória Alta atendidos num período de 18 meses. Os resultados foram avaliados no programa SPSS, versão 10.0, sendo realizadas freqüências, medidas de tendência central e desvio-padrão e teste de associação (qui-quadrado). Resultados: Dos 214 pacientes analisados, 21% (n=45) sinais sugestivos de doença do refluxo gastroesofágico (DRGE) e 7,5% (n=16) sinais sugestivos de câncer de laringe (onde 7 foram confirmados), sendo os restantes 71,5 % (n=153) considerados normais. Dos 45 pacientes que apresentaram DRGE, a freqüência foi maior no sexo feminino, predominando na faixa etária superior a 43 anos. Dos sete pacientes que tiveram câncer de laringe confirmado, todos os casos foram no sexo masculino e na faixa etária superior a 43 anos. Conclusão: O câncer de laringe foi claramente mais prevalente em homens. Com relação aos pacientes com sinais sugestivos de DRGE, não se observou diferença significativa de prevalência entre os sexos

Introduction: Currently, the flexible fibrolaryngoscopy is considered to be a first choice method in the otorhinolaryngological exam, mainly in the laryngeal functioning evaluation. Objective: The objective of the study is to describe the prevalence of laryngeal alterations; observed in the high respiratory endoscopy service of the University, by matching them with the patients' age and sex. Method: We carried out a retrospective study by approaching records of two hundred and fourteen patients of the High Respiratory Endoscopy Service attended in a period of 18 months. The results were evaluated in the SPSS program, version 10.0, and we carried out frequencies evaluation, central tendency and standard deviation measurements and association test (chi-square). Results: Out of the 214 patients analyzed, 21% (n=45) of suggestive signs of Gastroesophageal reflux disease (GERD) and 7.5% (n=16) of suggestive signs of larynx cancer (from which 7 were confirmed) and the other ones of 71.5% (n=153) considered to be normal. Out of 45 patients who presented GERD, the frequency was higher in the female sex, and the prevailing age range was higher than 43 years. Out of the seven patients who had larynx cancer confirmed all cases were in the male sex and age range older than 43 years. Conclusion: The larynx cancer was clearly more prevalent in men. As to the patients with suggestive signs of GERD, there was no significant difference of prevalence between sexes.

DNA methylation analysis of the tumor suppressor gene CDKN2B in Brazilian leukemia patients

The aim of this work was to evaluate the methylation profile of the p15 (CDKN2B) gene in Brazilian patients with leukemia and to correlate the CDKN2B gene expression with the percentage of methylated CpG dinucleotides in its promoter region. Thirty-one samples from six patients with acute lymphocytic leukemia (ALL), four with chronic myeloid leukemia (CML), and 21 with acute myeloid leukemia (AML) were evaluated by MSP (Methylation-Specific PCR). The CDKN2B gene was found to be methylated in four (67 percent) of the six ALL samples and in 16 (76 percent) of the 21 AML samples, but in none of the four CML samples analyzed. We observed a correlation between the CDKN2B mRNA expression (RT-PCR) and the percentage of methylated CpG dinucleotides. Therefore, this study in Brazilian patients confirms that the CDKN2B gene is methylated in the majority of leukemia patients.

Prevalence of hereditary risk factors for thrombophilia in Belém, Brazilian Amazon

Different risk factors for venous thromboembolism (VTE) have been identified, including hereditary abnormalities in the mechanisms of coagulation and fibrinolysis. We investigated five genetic polymorphisms (FVL G1691A, FII G20210A, MTHFR C677T, TAFI A152G and TAFI T1053C) associated with VTE in individuals from the city of Belém in the Brazilian Amazon who had no history of VTE. No significant difference was found between the observed and expected genotype frequencies for the loci analyzed. We found high frequencies of MTHFR C677T (33.9 percent) and TAFI T1053C (74 percent) and low frequencies of FVL (1.6 percent), FII G20210A (0.8 percent) and TAFI A152G (0.8 percent). The FVL G1691A, FII G20210A and MTHFR C677T frequencies were similar to those for European populations and populations of European descent living in the city of Ribeirão Preto in the Brazilian state of São Paulo. The frequency of the two TAFI mutations in the Belém individuals was not significantly different from that described for individuals from Ribeirão Preto. We suggest that the risks for VTE in the population of Belém are of the same magnitude as that observed in European populations and in populations with an expressive European contribution.

Heterogeneous ethnic distribution of the factor V leiden mutation

Inherited resistance to activated protein C caused by the factor V Leiden (FVL) mutation is the most common genetic cause of venous thrombosis yet described, being found in 20-60 per cent of patients with venous thrombophilia. A relationship between the FVL mutation and an increased predisposition to arterial thrombosis in young women was recently reported. We assessed the prevalence of the FVL mutation in 440 individuals (880 chromosomes) belonging to four different ethnic groups: Caucasians, African Blacks, Asians and Amerindians. PCR amplification followed by MnlI digestion was employed to define the genotype. The FVL mutation was found in a heterozygous state in four out of 152 Whites (2.6 per cent), one out of 151 Amerindians (0.6 per cent), and was absent among 97 African Blacks and 40 Asians. Our results confirm that FVL has a heterogeneous distribution in different human populations, a fact that may contribute to geographic and ethnic differences in the prevalence of thrombotic diseases. In addition, these data may be helpful in decisions regarding the usefulness of screening for the FVL mutation in subjects at risk for thrombosis.