Avaliação do risco coronariano e sua relação com as ações de saúde em hipertensos / Evaluation of coronary risk and its relationship to health actions in hypertensive patients / Evaluación del riesgo coronario y su relación con las acciones de salud en hipertensos

Avaliou-se o risco para desenvolvimento de eventos coronarianos agudos de acordo com os critérios de Framingham e com as ações de saúde realizadas em hipertensos de uma Unidade de Saúde da Família de Vitória-ES. Estudo observacional, de corte transversal, envolvendo 330 hipertensos. A amostra considerou prevalência do agravo de 50%. Os dados foram coletados dos prontuários e as variáveis constituíram o risco coronariano, a pressão arterial, o número de consultas, de atividades educativas e de medicamentos prescritos. Foi utilizada a ANOVA para comparar as variáveis e o teste t pareado para comparação da pressão no período estudado, com nível de significância de 5%. Respectivamente, 115 (34,8%) sujeitos apresentaram baixo risco de infarto ou morte por doença coronariana nos próximos 10 anos; 67 (20,4%) apresentaram médio risco; e 148 (44,8%) apresentaram alto risco. Somente o quantitativo de medicamentos prescritos mostrou relação significante com o risco coronariano elevado.

The risk of developing acute coronary events was evaluated according to Framingham criteria and health actions performed to hypertensive patients at a Health Unit Family of Vitória-ES. This is a observational, cross-sectional study, involving 330 hypertensive. The sample considered a 50% prevalence of the disease. Data were collected from medical records and the variables were the coronary risk, blood pressure, the number of visits, educational activities and prescribed drugs. ANOVA was used to compare variables and paired t-test for comparison of pressure during the study period, with significance level of 5%. Respectively, 115 (34.8%) subjects had low risk for myocardial infarction or death from coronary heart disease in the next 10 years; 67 (20.4%) had average risk; and 148 (44.8%) had high-risk. Only the amount of prescribed medications showed significant relationship with high coronary risk.

Se evaluó el riesgo de desarrollar eventos coronarios agudos según criterios de Framingham y acciones de salud realizadas en hipertensos de una Unidad de Salud de la Familia de Vitória-ES. Estudio observacional, transversal, envolviendo la participación de 330 hipertensos. La muestra considero la prevalencia del agravo en 50%. Los datos fueron recogidos de las historias clínicas y las variables fueron el riesgo coronario, presión arterial, el número de visitas, actividades educativas y los medicamentos recetados. Fue utilizada ANOVA para comparar las variables y el teste t para la comparación de la presión durante el período de estudio, con un nivel de significación del 5%. Respectivamente, 115 (34,8%) sujetos tenían bajo riesgo de infarto de miocardio o muerte por enfermedad coronaria en los próximos 10 años; 67 (20,4%) tenían un riesgo promedio; y 148 (44,8%) tenían alto riesgo. Sólo la cantidad de medicamentos prescritos mostraron asociación significativa con el riesgo coronario alto.

Protection against rotavirus diarrhoea in mice by trypsin inhibitor.

To investigate the role of soyabean trypsin inhibitor (TI) during rotavirus (RV) diarrhoea, changes in enzyme activities of six relevant mucosal enzymes (lactase, sucrase, maltase, trehalase, glucoamylase and alkaline phosphatase) were assayed following inoculation of suckling mice with EB rotavirus (serotype 3) along with the TI and compared with the age-matched healthy control mice. The animals were divided into three groups i.e. group 1 (controls), group 2 (RV inoculated) and group 3 (RV + TI inoculated and sacrificed under light anaesthesia on 0, 1, 3, 5, 7 and 10 day post inoculation (dpi). Then intestines were excised and divided into two parts (jejunum and ileum). They were separately homogenized in 0.9% cold normal saline and activities of mucosal enzyme were measured. Alkaline phosphatase and disaccharidases were found to be decreased significantly in RV inoculated animals in both the anatomical portions of small intestine of mice. These enzyme levels were restored with the administration of TI i.e. in group 3 and became comparable to the controls in both intestinal portions. These studies suggest that activity of intestinal enzymes which are important in digestive absorptive functions of small intestine were restored with the addition of TI whengiven to infant mice showing its protective efficacy during rotavirus infection.

Intestinal cholesterol synthesis and mobilisation to blood in sucrose-feeding and alcohol-intake.

Small intestines synthesize cholesterol to a greater extent than liver. Between starch-fed and sucrose-fed rats, using (14C) glucose, it was found that the synthesis of cholesterol by the jejunum of small intestines was greater in the sucrose-fed group than starch-fed group. By a novel experimental technique and using (14C) glucose, it was found that the contribution towards buffer representing lymph was greater in the sucrose-fed group (13.3%) than the controls (11%). Hypercholesterolemia on sucrose feeding may be at least partly due to contribution by the small intestines. Regarding alcohol, using (14C) glucose it was found that total synthesis of cholesterol by the small intestines was decreased in alcohol-fed rats. There was no difference in the cholesterol retained by the intestinal tissue between the controls and alcohol-fed animals while, the secretion towards buffer (lymph) was 9% as against 11. This indicates that there is contribution of cholesterol to blood from small intestines in alcohol-intake also but due to overall decrease in the intestinal synthesis of cholesterol, contribution of intestines to hypercholesterolemia may not be substantial as in the case of sucrose feeding. This is because in sucrose-feeding there is increased cholesterol synthesis.

Anticuerpos monoclonales en la evaluación de enzimas del ribete estriado yeyunal de lactantes con diarrea persistente / Monoclonal antibodies in the assessment of the jejunal striatum border enzymes in infants with longstanding diarrhea

En las biopsias de mucosa yeyunal de 10 pacientes con diarrea persistente se estudió expresión de las enzimas lactasa, sacarasa-isomaltasa, maltasa y aminopeptidasa, del ribete estriado, mediante anticuerpos monoclonales y los resultados se contrastaron con los síntomas y signos clínicos, morfológicos (microscopía de luz), actividad disacaridásica (Dahlqvist) y la expresión de lactasa por un método histoquímico. Se obtuvo expresión de aminopeptidasa en criptas y vellosidades, mediante los anticuerpos correspondientes. La expresión por anticuerpos histoquímica y actividad enzimática (Dahlqvist) fueron concordantes para la expresión de lactasa en las vellosidades, mientras en las criptas se registró positividad sólo en 2 casos. En las vellosidades los anticuerpos monoclonales tendieron a producir más reacciones positivas para sacarasa-isomaltasa en los casos con menos daño morfológico, excepto en uno de deficiencia primaria; en las criptas el resultado fue positivo en todos, menos dos pacientes, en los que tampoco hubo positividad en las vellosidades. Los anticuerpos monoclonales pueden aportar información útil para entender mejor los mecanismos de daño y reparación de las enzimas del ribete estriado y estimar el pronóstico de la lesión

Pattern of disaccharidases in chronic diarrhoea and malabsorption

Disaccharide-splitting enzymes were analyzed in the jejunal mucosae of 48 patients suffering from chronic diarrhoea and/or malabsorption, and the results were compared to those of 11 controls. Four [36.4%] of the controls were found to have partial lactase deficiency with a mean ratio of sucrase to lactase activity of 54.8 [SEM +/- 60.06] Significant reduction in the disaccharidases [lactase, sucrase, maltase, and isomaltase] were observed in patients with celiac disease and primary intestinal lymphoma; other groups exhibited variable affection in all disaccharidasas. High incidence of hypolactasia in these patients is the net results of both genetic influence on lactase activity and as a consequence to mucosal injury. It is suggested that further studies should be carried out using intestinal biopsy and direct enzyme assay in a large number of healthy adults

Jejunal disaccharidases in protein energy malnutrition and recovery.

The jejunal disaccharidases, sucrase, maltase and lactase, were determined in jejunal biopsies obtained from 43 malnourished children and 10 controls. In the study group, 63% were girls and 93% had severe malnutrition. Lactase activity was significantly reduced in third and fourth degree malnutrition (p < 0.05 and p < 0.005, respectively), but maltase activity was significantly reduced only in the fourth degree malnutrition (p < 0.01). After recovery, maltase and sucrase activities showed a marginally significant increase (p = 0.06), where lactase showed no significant increase (p > 0.05). We conclude that jejunal disaccharidase activity decreases significantly with increasing severity of malnutrition, lactase being the most severely affected and the last to recover.

Biochemical analysis of jejunal brush border membrane of golden hamster: pathogenic modulations due to ancylostomiasis.

The common hookworm (Ancylostoma ceylanicum) infection of humans was studied in golden hamsters model system. Significant biochemical modulations were observed in hamster jejunal brush border membrane (BBM), the primary site of infection. Analysis of BBM at the peak of infection (3-weeks) revealed a marked decrease in the activities of sucrase, lactase and maltase, while activities of alkaline phosphatase, (Ca2+ + Mg2+)-ATPase and gamma-glutamyl transpeptidase were increased. Kinetic studies conducted with maltase, a superficially localised enzyme of jejunal BBM, revealed loss of enzyme active site during the infection. Among other constituents, the levels of cholesterol and triglycerides were significantly decreased with slight increase in phospholipid content in the infected animals. The hookworm infection also caused a decline in total hexose content indicating an altered membrane glycocalyx. Conversely, there was significant enhancement of hydroxyproline and sialic acid contents. SDS-PAGE analysis showed an enhancement in both low and high molecular weight proteins in jejunal BBM preparations of the infected group. Gel electrophoresis of glycoproteins further revealed the appearance of two additional peaks in the low molecular weight region and concomitant disappearance of a peak in the high molecular weight region. These results strongly support the view that the hookworm infection causes severe damage not to the site of attachment alone but also to the entire cell lining of the jejunum and therefore could influence overall digestion and absorption.

Intestinal glucoamylase & other disaccharidases in children with protracted diarrhoea.

Brush border lactase, sucrase and glucoamylase activities were assessed in jejunal mucosal biopsy specimens from 34 children (median age 11 months; range 1.5-38) having protracted diarrhoea with failure to thrive and 8 well nourished children with normal jejunal mucosal histology (median age 10.2 months; range 2-37). All enzymes showed progressive decrease in activity which was directly in relation to increasing degree of mucosal injury (P less than 0.002). Lactase was significantly reduced even in patients with protracted diarrhoea and normal mucosa (P less than 0.05). Glucoamylase and sucrase were significantly reduced only in the presence of mucosal injury (P less than 0.01). Our data suggest that most children with protracted diarrhoea may not tolerate lactose containing feeds and may need lactose-free diets preferably based on starch. A small number of children with protracted diarrhoea, who have severe mucosal injury may not be able to handle even starch and may require diets based on short chain glucose polymers. The findings of this study, need to be corroborated with well-controlled metabolic balance studies.

Atividade dissacaridásica intestinal da esquistossomose mansônica: estudo evolutivo em camundongos com diferentes cargas de infestaçäo / Intestinal activity of disaccharides in schistosomiasis mansoni: study of the course in mice with different loads of infestation

A esquistossomose mansônica compromete vários órgäos, sendo o intestino e o fígado os mais agredidos. Com a intençäo de verificar o comprometimento do intestino delgado, dependente da intensidade e do tempo de infecçäo pelo Schistosoma mansoni, analisou-se a atividade das dissacaridases - lactase, sacarase e maltase - em 112 camundongos, distribuídos em 3 grupos: grupo I - controle, grupo II - infestado com 30 cercárias, grupo III - infestado com 60 cercárias. Observou-se uma diminuiçäo da atividade lactásica, sacarásica e maltásica do intestino delgado, decorrente da infestaçäo esquistossomótica, do tempo de infestaçäo e da alteraçäo entre ambos. O íleo é o segmento que demonstrou maior sensibilidade a esquistossomose, tendo uma diminuiçäo das suas dissacaridases a partir da fase inicial de infestaçäo. Opostamente, o jejuno só mais tardiamente mostra essas alteraçöes, exceto em relaçäo a lactase. Detectou-se um aumento da atividade dissacaridásica, inclusive para a lactase, em todos os grupos, com a evoluçäo etária dos animais, quantitativamente menor nos infestados. Cargas de 30 e 60 cercárias devem ser consideradas do mesmo porte, pois produziram reduçäo semelhante na atividade dissacaridásica