Independência funcional, aspectos clínicos e fatores sociodemográficos em pacientes na fase aguda do Acidente Vascular Cerebral: uma análise de associação / Functional independence, clinical aspects, and sociodemographic factors in patients in the acute phase of stroke: an association analysis

RESUMO Objetivo Analisar a associação da independência funcional com aspectos clínicos de comprometimento neurológico, a localização e extensão do dano neuronal e os fatores sociodemográficos em pacientes na fase aguda do AVC. Método Estudo analítico de recorte transversal, realizado com 90 pacientes adultos e idosos acometidos por AVC isquêmico, que tiveram admissão no ambiente hospitalar nas primeiras 24 horas após o evento vascular. A coleta dos dados referentes aos aspectos clínicos e fatores sociodemográficos foi realizada pelo prontuário eletrônico e/ou entrevista para descrever o perfil dos pacientes, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale e a Medida de Independência Funcional. Resultados O comprometimento neurológico, de acordo com a National Institute of Health Stroke Scale, foi associado à funcionalidade nas primeiras 24 horas após o AVC. Além disso, a presença de hipertensão arterial, idade, trabalho inativo, tabagismo e extensão do dano neuronal estiveram associados à dependência funcional, mas não permaneceram no modelo final deste estudo. Conclusão A dependência funcional está associada à hipertensão arterial, idade, trabalho inativo, tabagismo, extensão do dano neuronal e grau de comprometimento neurológico nas primeiras 24 horas após o evento vascular. Além disso, um nível mais elevado de comprometimento neurológico foi independentemente associado a níveis aumentados de dependência funcional.

ABSTRACT Purpose To analyze the association of functional independence with clinical aspects of neurological impairment, the location and extent of neuronal damage and sociodemographic factors in patients in the acute phase of stroke. Methods Analytical cross-sectional study in 90 adult and older patients affected by ischemic stroke, admitted to the hospital within 24 hours of the vascular event. Sociodemographic factors and clinical aspects data were collected from electronic medical records and/or interviews in order to depict the patients'profile, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale, and Functional Independence Measure. Results Neurological impairment, according to the National Institute of Health Stroke Scale, was associated with functioning in the first 24 hours after the stroke. Furthermore, the presence of arterial hypertension, age, inactive work, smoking and extent of neuronal damage were associated with functional dependence, but did not remain in the final model of this study. Conclusion Functional dependence is associated with arterial hypertension, age, inactive work, smoking, extent of neuronal damage, and degree of neurological impairment in the first 24 hours after the vascular event. Furthermore, a higher level of neurological impairment was independently associated with increased levels of functional dependence.

Acute-phase protein concentration in bronchoalveolar lavage fluid from healthy horses / Proteínas de fase aguda do lavado broncoalveolar de equinos hígidos

Bronchoalveolar lavage fluid (BALF) was analyzed to obtain information on leakage of acute-phase proteins from the blood into the respiratory lumen and about local synthesis. Ceruloplasmin, transferrin, albumin, α1-antitripsin, immunoglobulin G heavy, immunoglobulin G light, immunoglobulin A, haptoglobin, acidic glycoprotein, and P23 were measured in BALF from 30 horses without inflammatory disease by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). In serum, the same proteins were identified except for α1-antitrypsin. In conclusion, this study demonstrated that polyacrylamide gel electrophoresis (SDS-PAGE) can be used for the determination of acute-phase proteins in BALF samples from horses. In healthy horses, the values are very low, but they can be compared with reference values to assist in the diagnosis of animals with respiratory diseases.(AU)

O líquido obtido através da lavagem broncoalveolar (LBA) foi analisado para obter informações sobre as proteínas da fase aguda. Ceruloplasmina, transferrina, albumina, α1-antitripsina, imunoglobulina G pesada, imunoglobulina G leve, imunoglobulina A, haptoglobina, glicoproteína ácida e P23 foram medidas nos LBA de 30 cavalos sem doença inflamatória por eletroforese em gel de poliacrilamida com dodecilsulfato de sódio (SDS-PAGE). No soro, as mesmas proteínas foram identificadas, exceto a α1-antitripsina. Em conclusão, este estudo demonstra que a eletroforese em gel de poliacrilamida (SDS-PAGE) pode ser usada para a determinação de proteínas de fase aguda em amostras de LBA em cavalos. Em cavalos saudáveis, os valores são muito baixos, no entanto, podem ser comparados e auxiliar no diagnóstico de animais com doenças respiratórias.(AU)

Edema facial como manifestación inicial atípica de arteritis de células gigantes: a propósito de un caso y revisión de la literatura / Facial edema as an atypical initial manifestation of giant cell arteritis: a case report and review of the literature

Introducción: la arteritis de células gigantes es la vasculitis de vaso grande más frecuente y se ve predominantemente en adultos ma-yores de 50 años. El diagnóstico es en base a la clínica que se compone de cefalea, polimialgia reumática, sensibilidad en relación a la arteria temporal, compromiso del estado general, entre otras cosas, más laboratorio que se evidencia reactantes de fase aguda elevados y anemia y se confirma con biopsia de arteria temporal. Métodos: reporte de un caso de una paciente con debut con cefalea y aumento de volumen facial, lo que conllevó un diagnóstico erróneo de celulitis facial. Debido a esta presentación atípica, se retrasó el diagnóstico de arteritis de la temporal y tratamiento oportuno. Resultados: la arteritis de células gigantes es una patología que posee un gran rango de presentaciones atípicas, lo que ocurre en hasta un 38% de los pacientes que poseen la enfermedad, manifestaciones que incluyen neuralgia del trigémino, infartos linguales, aneurismas aórticos, edema facial, entre otros. Conclusión: es muy relevante conocer las presentaciones atípicas de esta patología que son muy frecuentes de encontrar en los pacientes y conocerlas nos permite aumentar nuestra sospecha clínica permitiendo un diagnóstico y tratamiento oportuno, evitando consecuencias irreversibles por el retraso diagnóstico.

Introduction: giant cell arteritis is the most frequent large vessel vasculitis and is seen predominantly in adults over 50 years. The diag-nosis is based on the clinic that is composed of headache, polymyalgia rheumatic, sensitivity near the temporal artery, compromise of the general condition, among other things, added to a laboratory that is evidenced like severe acute phase reactants and anemia and finally, is confirmed with temporal artery biopsy. Methods: a case report of a patient who debuted with headache and increased facial volume that led to a wrong diagnosis of facial cellulite. Because of this atypical presentation of the disease, the diagnostic took more time than usual and delayed the accurate diagnosis and timely treatment; this could have caused irreversible consequences. Results:giant cell arteritis has a wide range of atypical presentations; this may occur even up to 38% of patients that have this disease; manifes-tations include: trigeminal neuralgia, lingual infarct, aortic aneurysm, facial edema, and other symptoms. Conclusion: it is important to study the atypical presentations of this pathology because they are usually founded in patients. If we are informed about the atypical presentations, we can increase our clinical suspicion, and that allows us to get the right diagnosis and opportune treatment, avoiding irreversible consequences because of a late diagnosis.

Serum levels of proteins and acute-phase proteins in captive emus (Dromaius novaehllandieae) of different ages / Teores séricos de proteínas, inclusive proteínas de fase aguda, em emus (Dromaius novaehollandiae) de diferentes faixas etárias e criados em cativeiro

Protein electrophoresis is a relatively simple technique that allows separating serum protein fractions, and provides important information in the investigation and diagnosis of several diseases. This study determined the levels of acute-phase proteins in the serum of healthy, captive emus (Dromaius novaehollandiae). Animals were divided into two groups (n=11 in each) based on age, with 1-year-old and 4-year-old emus. Acute-phase proteins were separated by SDS-PAGE. Ceruloplasmin, transferrin, albumin, haptoglobin, acidic glycoprotein, IgA, and IgG were detected in the serum of all animals. Protein profiles varied significantly with age (P<0.05). Individuals in the 4-year-old emus group had higher values of ceruloplasmin, transferrin, albumin, haptoglobin, and acidic glycoprotein, compared with the group with 1-year-old animals, showing the role of age in the protein profile of this species. Reference values for acute-phase proteins in healthy emus may be useful in the evaluation of health status and in the diagnosis of diseases affecting the species.(AU)

A eletroforese de proteínas é um método relativamente simples, que permite a separação das proteínas do plasma em frações. Sua interpretação fornece informações importantes para a investigação e o diagnóstico de inúmeras doenças. O objetivo deste estudo foi o de determinar a concentração das proteínas de fase aguda no soro de emus (Dromaius novaehollandiae) hígidos e criados em cativeiro. As aves foram separadas em dois grupos: grupo 1: (n=11), aves com um ano de idade; grupo 2: (n=11), aves com quatro anos de idade. As proteínas de fase aguda foram separadas por eletroforese em gel de poliacrilamida (SDS-PAGE). Identificaram-se as proteínas ceruloplasmina, transferrina, albumina, IgG, haptoglobina, glicoproteína ácida, IgA e IgG no soro de todos os emus. Houve diferença (P<0.05) entre os traçados eletroforéticos em função da faixa etária. As aves do grupo 2 apresentaram valores superiores de ceruloplasmina, transferrina, albumina, haptoglobina e glicoproteína ácida quando comparadas às aves do grupo 1. Conclui-se que o perfil eletroforético de emus sofre alterações conforme a idade analisada. O estabelecimento de valores de referência para as proteínas de fase aguda de emus hígidos poderá auxiliar estudos futuros na avaliação da saúde assim como no diagnóstico de doenças em emus.(AU)

Relação entre adiposidade, perfil energético, proteínas inflamatórias e lesões osteoarticulares em equinos jovens sobre diferentes sistemas de criação / Relationship between adiposity, energy profile, inflammatory proteins and osteoarticular lesions in young horses on different rearing systems

Os atuais sistemas de criação de equinos estão associados às dietas ricas em carboidratos que resultam em sobre peso e acúmulo de gordura em animais ainda muito jovens. Nesses animais com sobre peso submetidos exercício físico intenso há aumento na incidência de osteoartrite juvenil e outras afecções inflamatórias. O objetivo deste estudo foi associar a adiposidade corporal e a forma de criação de potros com o perfil energético sanguíneo, as concentrações sanguíneas de proteínas inflamatórias e lesões osteoarticulares na região társica comparando animais criados em regimes intensivo ou extensivo. Foram avaliados 40 potros com 18 meses de idade da raça crioula, 23 fêmeas e 17 machos, sendo 20 animais criados exclusivamente em sistema extensivo e 20 animais criados em sistema intensivo. Foram efetuadas coletas de sangue para avaliação bioquímica e eletroforese proteica. Foram efetuadas através de ultrassonografia a mensuração da gordura na crista do pescoço, região retroperitoneal e na base da cauda. Em 17 animais do grupo intensivo e nove animais do grupo extensivo foi efetuado o estudo radiográfico da região do tarso esquerdo. Foi observado maiores níveis de colesterol total e LDL, glicemia, Amilóide A sérica (SAA), transferrina, haptoglobina, ceruloplasmina, glicoproteína ácida e uma proteína de 23Kda de peso molecular (não identificada) nos animais do grupo intensivo com relação aos do grupo extensivo. O grupo intensivo também apresentou maior depósito de gordura na região da crista do pescoço, região retroperitoneal e base da cauda. Em 100% dos animais do grupo intensivo foram observados lesões compatíveis com osteoartrite juvenil, enquanto que em apenas 23% dos animais do grupo extensivo apresentaram tais alterações. No teste exato de Fisher foi observado que os animais do grupo intensivo apresentaram 105% mais chance de desenvolver osteoartrite que os animais do grupo extensivo. Ainda, no teste de Pearson foi observada correlação positiva entre a gordura na crista do pescoço com o grau de comprometimento articular dos potros. A gordura na crista do pescoço apresentou correlação positiva com as alterações osteoarticulares, com os níveis séricos de colesterol LDL, níveis séricos de glicose, níveis de glicoproteína ácida, haptoglobina, transferrina e SAA. A SAA apresentou correlação com a espessura de gordura retroperitoneal. Conclui-se que o depósito de gordura na crista do pescoço apresenta correlação com as alterações no perfil energético, inflamatório e no comprometimento osteoarticular dos animais avaliados. Os níveis de glicose, colesterol LDL, glicoproteína ácida, haptoglobina, ceruloplasmina, transferrina e SAA estiveram correlacionados ao depósito de gordura na crista do pescoço. Potros em sistema intensivo apresentam, em relação aos criados em sistema extensivo, 105 % mais chance de apresentarem lesões articulares degenerativas crônicas compatíveis com osteoartrite juvenil.(AU)

High carbohydrate diets are increasingly used in horse rearing systems. This can result in weight gain and fat accumulation in young horses. There is a growing incidence of juvenile osteoarthritis and other inflammatory conditions in overweight young horses that undergo intense physical exercise. The aim of this study was to associate corporal adiposity with energy profile, serum concentration of acute phase proteins and presence of osteo-articular lesion in the tarsal region of young horses raised in two different rearing systems: intensive system and extensive system. We evaluated 40 young horses 18 months old, 23 of them were females and 17 were males. Twenty horses were raised in the extensive rearing system and twenty horses were raised in intensive rearing system. Blood samples were collected for biochemical analysis and protein electrophoresis. Fat deposition on the crest of the neck, peritoneum and tailhead was measured by ultrasonography. Radiographic examination of the left tarsus was performed in 17 horses of the farm rearing system and in nine horses of the extensive rearing system. We observed higher levels of total cholesterol, LDL, glucose, serum amyloid A (SAA), transferrin, haptoglobin, acid glycoprotein and unidentified protein 23Kda in horses of the intensive system. These horses also showed higher fat deposition on the crest of the neck, peritoneum and tailhead than horses raised on extensive system. All horses on the intensive system group that underwent radiographic examination had lesions compatible with juvenile osteoarthritis while only 23% of the animals of the extensive system group showed such changes. With Fisher's exact test we observed that horses of the intensive rearing system are 105% more likely to develop osteoarthritis than horses of the extensive rearing system. With the Pearson correlation test we found a positive correlation between fat deposition on the crest of the neck and degree of articular injury. Fat deposition on the crest of the neck also showed a positive correlation with serum levels of LDL, glucose, acid glycoprotein, haptoglobin, transferrin and SAA. The SAA correlated with the thickness of retroperitoneal fat. There was a positive correlation between retroperitoneal fat deposition and presence of osteoarticular abnormalities. In conclusion, fat deposition on the crest of the neck has a correlation with energetic profile changes, cute phase proteins changes and with articular injuries. Levels of glucose, LDL cholesterol, acid glycoprotein, haptoglobin, ceruloplasmin, transferrin and SAA have a correlation with fat deposition on the crest of the neck. In addition, young horses of the intensive rearing system are 105% more likely to have chronic degenerative joint lesions compatible with juvenile osteoarthritis than horses of the extensive rearing system.(AU)

Eficacia y seguridad de supositorios de mesalazina en pacientes adultos con proctitis o proctosigmoiditis ulcerativa para las fases agudas y del mantenimiento de la remision / Efficacy and safety of mesalazine suppositories in adult patients with proctitis or ulcerative proctosigmoiditis for acute phases and maintenance of remission

INTRODUCCIÓN: Antecedentes: El presente dictamen presenta la evaluación de tecnología de la eficacia y seguridad de los supositorios de mesalazina para su uso en pacientes adultos con proctitis o proctosigmoiditis ulcerativa para las fases aguda y del mantenimiento de la remisión. Aspectos Generales: La colitis ulcerativa (CU) es la condición inflamatoria crónica más común de las enfermedades gastrointestinales. Frecuentemente se desarrolla entre los 15 y 25 años y 55 y 65 años, aunque no excluye la población fuera de estos rangos de edad. Esta enfermedad genera inflamación a nivel de la mucosa del colon, siendo variable la extensión de la inflamación y pudiendo llegar a afectar también el área del recto. Se caracteriza por fases de relapso y remisión. Tecnología Sanitaria de Interés: Mesalazina (Canasa®/Mesacron®/Pentasa®/Salofalk®/Asacol®) es un medicamento anti-inflamatorio de acción tópica compuesto químicamente por el ácido 5 aminosalicílico o 5-ASA. Tiene dos vías de administración, oral y rectal, siendo los supositorios rectales, la forma de presentación de interés de esta evaluación de tecnología. METODOLOGÍA: Estratégia de Búsqueda: Se realizó una estrategia de búsqueda sistemática de la evidencia científica con respecto a la eficacia y seguridad de supositorios de mesalazina para pacientes con proctitis o proctosigmoiditis ulcerativa en fases aguda y del mantenimiento de la remisión. Para la búsqueda primaria se revisó la información disponible por entes reguladoras y normativas como la Administración de Drogas y Alimentos (FDA), y la Dirección General de Medicamentos y Drogas (DIGEMID). Posteriormente, se buscaron guías de práctica clínica a través de los metabuscadores: Translating Research into Practice (TRIPDATABASE), The National Guideline of Clearinghouse (NGC), y Health Systems Evidence (HSE). Seguidamente, se realizó una búsqueda dentro de la información generada por grupos internacionales que realizan revisiones sistemáticas, evaluaciónes de tecnologías sanitarias y guías de práctica clínica, tales comoHealth Technology Assesment (HTA), la Biblioteca de Cochrane, el Instituto Nacional de la Salud y Excelencia en Cuidado (NICE), la Agencia Canadiense de Drogas y Tecnologías en Salud (CADTH), y el Consorcio Escocés de Medicinas (SMC). Adicionalmente se revisaron las bases National Library of Medicine (Pubmed-Medline), LILACS, EMBASE, OVID, y complementando la búsqueda con la página de ensayos clínicos www.clinicaltrials.gov, para identificar estudios primarios en elaboración o que no hayan sido publicados aún. RESULTADOS: Tras la búsqueda se encontró evidencia que sustenta la eficacia y seguridad de supositorios de mesalazina en pacientes adultos con proctitis o proctosigmoiditis ulcerativa para las fases aguda y del mantenimiento de la remisión.RESULTADOS: Tras la búsqueda se encontró evidencia que sustenta la eficacia y seguridad de supositorios de mesalazina en pacientes adultos con proctitis o proctosigmoiditis ulcerativa para las fases aguda y del mantenimiento de la remisión. Sinopsis de la Evidencia: Se encontró evidencia acerca de la eficacia y seguridad de supositorios de mesalazina en pacientes adultos con proctitis o proctosigmoiditis ulcerativa para las fases aguda y del mantenimiento de la remisión. CONCLUSIONES: La presente evaluación de tecnología evalúa la evidencia disponible a Febrero del 2016 para el uso de supositorios de mesalazina para pacientes adultos con proctitis o proctosigmoiditis para las fases agudas y del mantenimiento de la remisión. - Se ha encontrado evidencia que sustenta la eficacia y seguridad de supositorios de mesalazina, la cual está basada en dos guías de práctica clínica y dos revisiones sistemáticas de buena calidad metodológica. Cabe resaltar que esta eficacia ha sido demostrada únicamente para la población de pacientes con proctitis o proctosigmoiditis ulcerativa, mas no en otras áreas del colon en fases aguda. Sin embargo, para la fase del mantenimiento de la remisión no se ha encontrado evidencia directa que evalúe el potencial beneficio de supositorios de mesalazina. , El Instituto de Evaluación de Tecnologías en Salud e Investigación ­ IETSI, aprueba el uso de supositorios de mesalazina en pacientes adultos con proctitis o proctosigmoiditis ulcerativa para el tratamiento de fases aguda y del mantenimiento de la remisión. El presente Dictamen Preliminar tiene una vigencia de dos años a partir de la fecha de publicación.

Efficacy of pamidronate in pediatric osteosarcoma patients with low bone mineral density

PURPOSE: Most surviving pediatric osteosarcoma patients experience osteoporosis, bone pain, and pathologic fracture during and after therapy. The aim of this study was to evaluate the efficacy and side effects of pamidronate therapy in these patients. METHODS: Nine osteosarcoma patients (12.8±1.6 years of age; 5 boys and 4 girls) who had a history of nontraumatic fracture or severe pain after completing chemotherapy were included. Intravenous pamidronate (1.5 mg/kg) was given every 6 weeks for 4 to 6 cycles. Bone mineral density (BMD) of the lumbar spine was measured by dual-energy x-ray absorptiometry. Clinical outcomes including acute side effects were also evaluated. RESULTS: After pamidronate treatments, all patients experienced decreased pain. Seven of 9 patients could walk without a crutch. The BMD of lumbar spine was increased by 0.108±0.062 mg/cm2 after 8.4±1.0 months (n=8, P=0.017) and the mean z-score improved from -2.14±0.94 to -1.76±0.95 (P=0.161). Six patients (67%) had an acute-phase reaction, and 2 patients had symptomatic hypocalcemia. CONCLUSION: Pamidronate appears to be safe and effective for the treatment of osteosarcoma in children with low BMD and bone pain.

Teste rápido para detecção da Proteína C-Reativa (FASTest® CRP canino) como auxílio diagnóstico de piometra em cadelas / Fast test for C-reactive Protein detection (FASTest® CRP canine) as an aid for the diagnosis of pyometra in bitches

A piometra é uma enfermidade comum em cadelas, caracterizada pela inflamação do útero com acúmulo de exsudato purulento. A avaliação ultrassonográfica abdominal é um dos principais exames utilizados para o diagnóstico da doença e o tratamento de eleição é a ovário-histerectomia (OSH). A proteína C reativa (PCR) é uma proteína de fase aguda que apresenta concentração sérica aumentada na ocorrência de processos inflamatórios. O objetivo deste trabalho foi avaliar a eficácia do teste rápido para detecção da PCR sérica (FASTest® CRP canino), como auxiliar no diagnóstico de piometra em cadelas com suspeita da doença ao exame ultrassonográfico. Das 25 cadelas com imagem ultrassonográfica sugestiva de piometra incluídas no estudo, apenas 12 (48,0%) tiveram o diagnóstico confirmado por exame histopatológico uterino realizado após a OSH. Em todas as pacientes com o diagnóstico de piometra confirmado pelo exame histológico a PCR foi positiva. O FASTest® CRP apresentou valor preditivo positivo de 92,3%, valor preditivo negativo e sensibilidade de 100,0% e 92,3% de especificidade. Logo, a acurácia do FASTest® CRP canino para diagnóstico de piometra em cadelas com suspeita ao exame ultrassonográfico foi de 96,0%. Conclui-se que o teste rápido para detecção da PCR sérica pode ser utilizado como exame auxiliar para o diagnóstico de piometra em cadelas...

Pyometra is a common disease in bitches characterized by an inflamed uterus filled with pus. Abdominal ultrasonographic evaluation is one of the most requested exam used to diagnose the disease, whereas ovariohysterectomy is the most commonly chosen treatment. C-reactive protein (CRP) is an acute phase protein whose serum concentration increases in inflammatory processes. The goal of this study was to evaluate the effectiveness of the rapid test for detecting serum CRP (FASTest® canine CRP) in the diagnosis of pyometra in bitches with suspicion of the disease by ultrasonography. From 25 bitches with ultrasonographic image suggestive of pyometra included in this study, only 12 (48.0%) has the diagnosis confirmed by histopathological examination of the uterus after ovariohysterectomy. In all patients diagnosed with pyometra, confirmed by histology, the CRP was positive. The FASTest® CRP showed a positive predictive value of 92.3 %, negative predictive value and sensitivity of 100.0% and 92.3% of specificity. Therefore, the accuracy of FASTest® CRP for diagnosis of pyometra in bitches with suspicion by ultrasonography was 96.0%. It was concluded that the rapid test for detecting serum CRP can be used as an aid to diagnose pyometra in bitches...

Acute systemic response to intraperitoneal implantation of polypropylene mesh/chitosan-based film composite in pigs

PURPOSE:To assess the systemic response of pigs to the intraperitoneal implantation of polypropylene mesh associated with chitosan-based film with a degree of deacetylation of 95%.METHODS:Blood samples were collected 24 hours before, and two and seven days after surgery. Systemic reactions were evaluated based on white blood cell count, C-reactive protein, and total serum protein, albumin and globulin levels.RESULTS:The systemic response was proportional to the composite response induced by polypropylene mesh, and the tissue inflammatory response was higher in the PP group (p=0.0033).CONCLUSION:The polypropylene mesh/chitosan-based film composite did not elicit a systemic response in pigs.

Reação de fase aguda e sua relação com o desempenho de cavalos em competição de longa distância / Acute phase reaction and its relationship with performance horses competing long distance

O exercício físico é um dos estímulos fisiológicos mais estressantes que um animal pode sofrer e, dependendo de sua intensidade, sugere-se que possa gerar uma reação mediada por proteínas de fase aguda (PFA). O objetivo deste estudo foi caracterizar a reação de fase aguda e sua relação com o desempenho de cavalos submetidos a uma competição de longa distância. O experimento foi desenvolvido durante a Marcha de Resistência anual promovida pela Associação Brasileira de Criadores de Cavalos Crioulos (ABCCC), composta por um percurso de 750km percorrido durante 15 dias. Foram avaliados 23 equinos, os quais foram divididos em dois grupos, sendo o grupo 1 composto pelos 10 primeiros colocados na competição e o grupo 2 formado pelos 13 animais que concluíram a competição em colocações inferiores ou foram desclassificados antes de terminar a prova. Efetuaram-se coletas sanguíneas em repouso (dia 0) e no último dia de competição, e foi realizado o teste de eletroforese em gel de poliacrilamida contendo dodecil sulfato de sódio (SDS-PAGE) para identificar as proteínas (albumina, haptoglobina, ceruloplasmina, transferrina, imunoglobulina G, imunoglobulina A, glicoproteína ácida e proteína de peso molecular de 23kDa). Os resultados demonstraram que o exercício físico imposto influenciou de forma significativa (P<0,0001) as concentrações séricas de haptoglobina, ceruloplasmina, imunoglobulina A, glicoproteína ácida e proteína de peso molecular de 23kDa. Quando comparados os resultados dos grupos estudados, observou-se que a concentração de haptoglobina após a competição foi superior no grupo de animais com baixo desempenho (grupo 2). Conclui-se que a competição de longa duração é capaz de gerar reação de fase aguda e que o monitoramento da concentração de haptoglobina pode ser um sinalizador de processo inflamatório e baixo desempenho.(AU)

Exercise is one of the most stressful physiologic stimuli that an animal might suffer, depending on its intensity it may generate a reaction mediated by acute phase proteins (APP). The aim of this study was to characterize the acute phase reaction and its relation to performance horses subjected to long distance competition. The experiment was conducted during the annual March of Resistance promoted by the Brazilian Association of Crioulo Horse Breeders (ABCCC), composed of a 750km route traveled during 15 days. 23 horses which were divided in two groups, one group composed by the 10 best placed horses and the second group consisting of 13 animals that have completed the competition in other positions or were disqualified before concluding the race were evaluated. All horses at the beginning of the competition (day 0) and on the last day of competition were subjected to collection of blood and SDS-polyacrylamide gel (SDS-PAGE) electrophoresis was used to measure APPs concentrations (albumin, ceruloplasmin, transferrin, haptoglobin, acid glycoprotein, immunoglobulin G, immunoglobulin A and a protein with molecular weight of 23 kDa). By the evaluation of the results, it was observed that exercise had a highly significant influence (P<0.0001) in the serum concentrations of the ceruloplasmin, haptoglobin, acid glycoprotein, immunoglobulin A and protein with molecular weight of 23kDa. When comparing the results of the study groups it was observed that the concentration of haptoglobin after the competition was higher in the group of animals with low performance (group 2). We conclude that the long term competition is able to generate acute phase reaction and monitoring the concentration of haptoglobin may be an indicator of inflammation and low performance.(AU)

Novas perspectivas para o papel de amilóide sérica A (SAA) na obesidade e resistência à insulina / New insights into the role of serum amyloid A (SAA) on obesity and insulin resistance

Chronic low-grade endotoxemia is an important player in obesity and insulin resistance associated to a high-fat diet (HFD). On the other hand, although it is known that intense endotoxemia and infection reduce appetite and induce intense catabolism, leading to weight loss during the acute inflammatory phase, the late effects of an intense endotoxemia were previously unexplored. Here we report that, besides the concurrent effects, multiple and intense endotoxemia causes long lasting biochemical alterations in the adipose tissue that intensify the harmful effects of a HFD. Mice submitted to multiple and severe endotoxemia had increased the adipose tissue expression of TLR-4, CD14 and SAA3, remaining altered after one week in recovery. When associated to a HFD, mice previously submitted to acute endotoxemia showed a more severe weight gain and impaired insulin sensitivity. Adopting the HFD as an obesogenic stimulus, we evaluated the participation of the protein serum amyloid A (SAA) in obesity development. Using a SAA-targeted antisense oligonucleotide, we observed that the depletion of SAA prevented metabolic alterations, endotoxin elevation, weight gain and insulin resistance in a diet-induced obesity protocol. Inadequate sleep is another important factor to be considered in the obesity epidemic. We found that sleep restriction (SR) causes biochemical and morphological alterations in mice adipose tissue. The levels of serum resistin and the adipose tissue mRNA expression of resistin, TNF-α and IL-6 were increased after SR. When associated to a HFD, mice previously submitted to SR gained more weight with increased macrophage infiltration in the epididymal adipose tissue, and insulin resistance. SAA is also part of the initial biochemical alterations caused by SR. It was observed that the expression of SAA in liver and adipose tissue is upregulated, with return to baseline when sleep is restored. Furthermore, 48 hours of total sleep restriction in healthy human volunteers also caused a serum elevation in SAA concentrations. Considering that SAA induces cell proliferation, we suggest that situations with an increase in SAA production and the consecutive preadipocyte proliferation would prime the adipose tissue to further adipocyte differentiation and hypertrophy. Furthermore, we suggest that SAA alter LPS signaling, possibly inhibiting its clearance. The mechanism associating inflammation and obesity is complex and encompass a diversity of factors; the inflammatory protein SAA may be one of them. In conclusion, our data describes the relationship between SAA, acute inflammation, sleep restriction and obesity

Endotoxemia crônica de baixo grau tem um importante papel na obesidade e resistência à insulina associada a uma ração hiperlipídica. Por outro lado, embora se saiba que a endotoxemia intensa e infecção reduzam o apetite e induzam a um intenso catabolismo, conduzindo a perda de peso durante a fase aguda da inflamação, os efeitos tardios da endotoxemia intensa nunca foram explorados. Aqui mostramos que, além dos efeitos correntes, a endotoxemia aguda provoca alterações bioquímicas prolongadas no tecido adiposo que intensificam os efeitos deletérios de uma ração hiperlipídica. Camundongos submetidos à endotoxemia aguda apresentaram aumento na expressão de TLR-4, CD14 e SAA3 no tecido adiposo, permanecendo alteradas após uma semana em recuperação. Quando associado a uma ração hiperlipídica, os camundongos previamente submetidos à endotoxemia aguda mostraram um ganho de peso mais pronunciado e uma maior resistência à insulina. Adotando a ração hiperlipídica como um estímulo obesogênico, foi avaliada a participação da proteína amilóide sérica A (SAA) no desenvolvimento da obesidade. Usando um oligonucleotídeo antisense anti-SAA, observamos que a depleção da SAA previne as alterações metabólicas, elevação de endotoxina, ganho de peso e resistência à insulina associadas a ração rica em gordura. O sono inadequado é outro fator importante a ser considerado na epidemia de obesidade. Descobrimos que a restrição do sono (SR) provoca alterações bioquímicas e morfológicas no tecido adiposo de camundongos. A concentração de resistina no soro e a expressão de mRNA no tecido adiposo de resistina, TNF-α e IL- 6 foram aumentadas após SR. Quando associado a uma ração hiperlipídica, os camundongos submetidos previamente à SR ganharam mais massa com aumento da infiltração de macrófagos no tecido adiposo epididimal, e resistência à insulina. SAA também faz parte das alterações bioquímicas iniciais provocadas pelo SR. Observou-se que a expressão de SAA no fígado e tecido adiposo é regulada positivamente, com retorno ao basal quando o sono é restaurado. Além disso, 48 horas de restrição de sono total em voluntários humanos saudáveis também causou uma elevação nas concentrações séricas de SAA. Considerando que SAA induz proliferação, sugerimos que situações onde ocorra aumento na produção de SAA e a consecutiva proliferação celular, o tecido adiposo se tornaria predisposto a futura diferenciação e hipertrofia. Além disso, sugerimos que SAA altera a sinalização de LPS, possivelmente inibindo sua depuração. O mecanismo de associação entre a inflamação e a obesidade é complexo e inclui uma diversidade de fatores; a proteína inflamatória SAA pode ser um deles. Em conclusão, nossos dados descrevem a relação entre SAA, inflamação aguda, restrição do sono e obesidade

Comparison of short-term outcomes and acute inflammatory response between laparoscopy-assisted and totally laparoscopic distal gastrectomy for early gastric cancer

PURPOSE: Laparoscopic gastrectomy is widely used to treat early gastric cancer. The advantages of totally laparoscopic distal gastrectomy (TLDG) are unproven, and some concerns remain regarding the early surgical outcomes due to its technical difficulty. We compared the early surgical outcomes and acute inflammatory response between patients undergoing TLDG and laparoscopy-assisted distal gastrectomy (LADG) for treatment of early gastric cancer. METHODS: We performed a retrospective study on 212 consecutive patients who underwent laparoscopic distal gastrectomy for gastric cancer between January 2008 and June 2014. A total of 179 LADG cases and 33 TLDG cases were included. After age, sex, body mass index, and American Society of Anesthesiologists physical status score were matched using propensity score matching (PSM), we compared the short-term surgical outcomes between the LADG and TLDG groups. RESULTS: The TLDG group had a shorter hospital stay (9.5 days vs. 11.0 days, P = 0.046) and less blood loss (116.6 mL vs. 141.5 mL, P = 0.031) than those in the LADG group. There were no differences in the preoperative WBC count and CRP level and the other clinical data between the two groups after PSM. Postoperative WBC count, serum CRP level, and decrease rate of WBC count in the TLDG group were significantly lower than those in the LADG group. CONCLUSION: The short-term outcomes of TLDG revealed better than that of LADG in this study. Therefore, TLDG is one of the safe and feasible procedure for the treatment of early gastric cancer.

Low transformation growth factor-β1 production and collagen synthesis correlate with the lack of hepatic periportal fibrosis development in undernourished mice infected with Schistosoma mansoni

Undernourished mice infected (UI) submitted to low and long-lasting infections by Schistosoma mansoni are unable to develop the hepatic periportal fibrosis that is equivalent to Symmers’ fibrosis in humans. In this report, the effects of the host’s nutritional status on parasite (worm load, egg viability and maturation) and host (growth curves, biology, collagen synthesis and characteristics of the immunological response) were studied and these are considered as interdependent factors influencing the amount and distribution of fibrous tissue in hepatic periovular granulomas and portal spaces. The nutritional status of the host influenced the low body weight and low parasite burden detected in UI mice as well as the number, viability and maturation of released eggs. The reduced oviposition and increased number of degenerated or dead eggs were associated with low protein synthesis detected in deficient hosts, which likely induced the observed decrease in transformation growth factor (TGF)-β1 and liver collagen. Despite the reduced number of mature eggs in UI mice, the activation of TGF-β1 and hepatic stellate cells occurred regardless of the unviability of most miracidia, due to stimulation by fibrogenic proteins and eggshell glycoproteins. However, changes in the repair mechanisms influenced by the nutritional status in deficient animals may account for the decreased liver collagen detected in the present study.

Myenteric plexus is differentially affected by infection with distinct Trypanosoma cruzi strains in Beagle dogs

Chagasic megaoesophagus and megacolon are characterised by motor abnormalities related to enteric nervous system lesions and their development seems to be related to geographic distribution of distinct Trypanosoma cruzi subpopulations. Beagle dogs were infected with Y or Berenice-78 (Be-78) T. cruzi strains and necropsied during the acute or chronic phase of experimental disease for post mortem histopathological evaluation of the oesophagus and colon. Both strains infected the oesophagus and colon and caused an inflammatory response during the acute phase. In the chronic phase, inflammatory process was observed exclusively in the Be-78 infected animals, possibly due to a parasitism persistent only in this group. Myenteric denervation occurred during the acute phase of infection for both strains, but persisted chronically only in Be-78 infected animals. Glial cell involvement occurred earlier in animals infected with the Y strain, while animals infected with the Be-78 strain showed reduced glial fibrillary acidic protein immunoreactive area of enteric glial cells in the chronic phase. These results suggest that although both strains cause lesions in the digestive tract, the Y strain is associated with early control of the lesion, while the Be-78 strain results in progressive gut lesions in this model.

relationships among acute phase response proteins, cytokines, and enzymes during ovine experimental endotoxemia

The acute phase response is beneficial to the animal in restoring homeostasis, and measuring the circulating acute phase proteins, cytokines, and enzymes can be used to evaluate the innate immune system's responses to invader agents such as bacterial lipopolysaccharide. Measurement of these parameters has shown to be useful as diagnostic and prognostic markers in animal endotoxemia. The aim of the present experimental study was expression of the acute phase response following the induction of endotoxemia by Escherichia coli serotype O55:B5 in sheep and the relationships among the acute phase response parameters during endotoxemia and their changing patterns. Five clinically healthy 1-year-old Iranian fattailed ewes [25 +/- 1.5 kg, bodyweight] were randomly selected and lipopolysaccharide from Escherichia coli serotype O55:B5 was infused at 20 micro g/kg intravenously to each animal. Fluid therapy was performed in all ewes over 120 minutes after lipopolysaccharide injection and continued for 180 minutes. Blood samples were collected from all ewes prior and 1, 2, 3, 4, 5, 6, and 24 hours after lipopolysaccharide injection and sera were separated. Serum concentrations of haptoglobin, serum amyloid A, tumor necrosis factor-alpha, interferon-gamma, superoxide dismutase, and glutathione peroxidase were assayed. The rapid and significant elevation of haptoglobin, serum amyloid A, tumor necrosis factor-alpha, and interferon-gamma were seen after endotoxemia induction. Serum concentrations of superoxide dismutase and glutathione peroxidase were significantly decreased after intravenous lipopolysaccharide infusion. The results of the present experimental study showed that haptoglobin, serum amyloid A, tumor necrosis factor-alpha, and interferon-gamma at all hours studied after endotoxemia induction were positively correlated together. These parameters were negatively correlated with superoxide dismutase and glutathione peroxidase at all hours after lipopolysaccharide infusion. The results of the present experiment can provide evidence for associations among acute phase proteins, cytokines, and enzymes and their changes during endotoxemia in sheep

Borderline tuberculoid leprosy and type 1 leprosy reaction in a hepatitis C patient during treatment with interferon and ribavirin / Hanseniase boderline tuberculoide e reacao hansenica do tipo 1 em paciente com hepatite C durante tratamento com interferon e ribavirina

Hepatitis C is an inflammatory disease of the liver caused by a single-stranded RNA virus belonging to the Hepacivirus genus in the Flaviviridae family, called the hepatitis C virus. After initial infection, 70% to 85% of the patients develop chronic hepatitis C with hepatic fibrosis. In addition to specific liver changes, various extrahepatic manifestations have been associated with the hepatitis C virus infection or with medications used to treat the condition. We report the case of a patient with chronic hepatitis C who presented with the signs and symptoms of borderline tuberculoid leprosy and type 1 reaction four months after the start of treatment with a pegylated interferon/ribavirin combination.

A hepatite C é uma doença inflamatória fígado causada por um vírus RNA de fita simples, pertencente ao gênero Hepacivirus e à família Flaviviridae, denominado de vírus da hepatite C. Após infecção inicial 70 a 85% dos pacientes infectados evoluem para hepatite C crônica, com fibrose progressiva. Além das alterações hepáticas específicas, várias manifestações extra-hepáticas têm sido relacionadas à infecção pelo vírus da hepatite C ou às medicações utilizadas no seu tratamento. Nesse trabalho, apresenta-se caso de paciente portador de hepatite C crônica, que manifestou um quadro hanseníase boderline tuberculóide e reação hansênica do tipo I, quatro meses após início do tratamento com interferon peguilado associado à ribavirina.

Elevaciones extremas de la velocidad de eritrosedimentación en pacientes internados en un hospital de mediana complejidad de la ciudad de Rosario / Extreme elevations of erythrocyte sedimentation rate in hospitalized patients at a medium complexity hospital in Rosario city, Argentina

Introducción: una elevación extrema de la velocidad de eritrosedimentación (VES) es considerada cuando su valor es mayor o igual a 100 mm/hora y se asociaría con un bajo porcentaje de falsos positivos como indicador de enfermedad. Objetivos: conocer la frecuencia de aparición de elevaciones extremas de la VES y la frecuencia de las distintas enfermedades con las que este hallazgo se asocia en pacientes adultos que ingresan al servicio de clínica médica de un hospital de mediana complejidad. Pacientes y Método: se realizó un estudio descriptivo, observacional, de corte transversal, en el Hospital Juan Bautista Alberdi de la ciudad de Rosario, que incluyó a todos los pacientes que ingresaron al servicio de Clínica Médica entre el 01/03/2008 y el 30/04/2009 y que presentaron dentro de las 24 horas del ingreso una VES mayor o igual a 100mm/hora. Resultados: durante el período estudiado ingresaron 802 pacientes, de los cuales 39 (4,86%) presentaron una elevación extrema de la VES. La VES promedio fue de 117+-14,85 mm/hora, la relación hombre/mujer de 1.05/1 y la edad promedio 48.3+-16.3 años. Las causas asociadas con la elevación extrema de la VES fueron: infección (70.45%), enfermedad renal (9.09%), neoplasias (6.82%), enfermedades autoinmunes/otras inflamatorias no infecciosas (4.55%), causas misceláneas (4.55%) y sin diagnóstico (4.55%). Conclusión: la elevación extrema de la VES es un hallazgo relativamente frecuente que se constató casi en el 5% de los pacientes que ingresaron al servicio de Clinica Médica en el período de estudio, siendo su principal causa las enfermedades infecciosas.

Intoduction: an extreme elevation of erythrocyte sedimentation rate (ESR) is considered when its value is greater than or equal to 100 mm/hour, and it is associated with a low false positive rate as a sickness index. Objectives: to determine the frequency of extreme elevations of the ESR, and to determine the frequency of various diseases with which this finding is associated in adult patients who admitted to a medium complexity hostipal. Patients and Methods: it is a descriptive, observational, cross-sectional study which included all patients who were admitted to the Juan Bautista Alberdi Hospital between March 01, 2008 and April 30, 2009 and who presented within 24 hours of admission an ESR greater than or equal to 100 mm/hour. Results: during the study period 802 patients were admitted, of which 39 (4.86%) had an extreme elevation of the ESR. The average ESR was 117+-14.85 mm/hour, the male/female ratio 1.05/1 and the average age 48.3+-16.3 years. Causes associated with extreme elevation of the ESR included: infection (70.45%), renal disease (9.09%), neoplasms (6.82%), autoinmune diseases /other non-infectious inflammatory diseases (4.55%), miscellaneous causes (4.55%) and no diagnosis (4.55%). Conclusion: extreme elevation of the ESR is a relatively common finding; it was found in almost 5% of patients admitted to the hospital, and its main cause was an infectious disease.

Doença inflamatória pélvica aguda: ensaio iconográfico com enfoque em achados de tomografia computadorizada e ressonância magnética / Acute pelvic inflammatory disease: pictorial essay focused on computed tomography and magnetic resonance imaging findings

O objetivo deste trabalho é descrever os principais achados em tomografia computadorizada e ressonância magnética em pacientes com dor abdominal aguda decorrente de doença inflamatória pélvica. Dois radiologistas em consenso selecionaram e analisaram exames de tomografia computadorizada e ressonância magnética, realizados entre janeiro de 2010 e dezembro de 2011, de pacientes com quadro comprovado de doença inflamatória pélvica levando a um quadro de abdome agudo. Os principais achados foram coleções líquidas intracavitárias, realce anômalo na escavação pélvica e densificação dos planos adiposos anexiais. A doença inflamatória pélvica é uma das principais causas de dor abdominal em mulheres em idade reprodutiva e tem sido progressivamente diagnosticada mediante uso da tomografia computadorizada e ressonância magnética, que complementam o papel da ultrassonografia. É crucial que os radiologistas se familiarizem com os principais aspectos diagnósticos em imagem seccional desta causa comum de abdome agudo.

The present study was aimed at describing key computed tomography and magnetic resonance imaging findings in patients with acute abdominal pain derived from pelvic inflammatory disease. Two radiologists consensually selected and analyzed computed tomography and magnetic resonance imaging studies performed between January 2010 and December 2011 in patients with proven pelvic inflammatory disease leading to presentation of acute abdomen. Main findings included presence of intracavitary fluid collections, anomalous enhancement of the pelvic excavation and densification of adnexal fat planes. Pelvic inflammatory disease is one of the leading causes of abdominal pain in women of childbearing age and it has been increasingly been diagnosed by means of computed tomography and magnetic resonance imaging supplementing the role of ultrasonography. It is crucial that radiologists become familiar with the main sectional imaging findings in the diagnosis of this common cause of acute abdomen.

Endocrinal disturbances and systemic inflammation in chronic obstructive pulmonary disease [COPD]

COPD is no longer considered to affect only the lungs and airways but also the rest of the body. The systemic manifestations of COPD include a number of endocrine disorders such as those involving the pituitary, thyroid, gonads, adrenals and pancreas. The aim of this work is to detect the endocrinal and inflammatory changes in COPD patients during stability of the disease and the effect of acute exacerbation on these changes. Twenty acute exacerbated COPD [AECOPD] male patients with acute respiratory failure [ARF] were included in this study as a patient group and a control group which included 10 healthy age-matched males with normal pulmonary functions and without any of the exclusion criteria. For patients enrolled in this study, measurement of serum levels of sex hormones [total testosterone, luteinizing hormone [LH] and follicle-stimulating hormone [FSH]], insulin like growth factor-1 [IGF-1] and C-reactive protein [CRP] were done on admission and 1 month after hospital discharge. For healthy group, the previous measurements were done once only. There were statistically significant decrease in serum testosterone and IGF-1 levels in patients after stabilization than those in the control group with more decrease of their levels during exacerbation and the difference between their levels in patients during exacerbation and after stabilization was statistically highly significant. As regards serum LH and FSH, there were statistically highly significant increase in their levels in COPD patients during exacerbation than those in the control group but there were non-significant differences in these hormones levels between the patients after stabilization and the control group. As regards serum CRP, there was highly significant increase in its serum level in patients in both exacerbation and after stabilization than that in the control group. The level of CRP in patients during exacerbation was higher than that after stabilization and the difference was statistically highly significant. As regards disease severity, there were statistically highly significant decrease in testosterone level in severe to very severe COPD patient group than that in mild to moderate one. There was also statistically significant decrease in serum IGF-1 level in severe to very severe COPD patient group than that in mild to moderate one. There was statistically highly significant increase in serum CRP level in severe to very severe COPD patient group than that in mild to moderate one. On the other hand, there was statistically non-significant increase in serum LH and FSH levels in severe to very severe CPOD patient group than those in mild to moderate one. There were statistically highly significant positive correlations between serum testosterone levels and both FEV[1%] predicted and PaCo[2]. There were also statistically highly significant positive correlations between serum IGF-1 levels and both FEV[1%] predicted and PaCo[2]and also between serum CRP levels and PaCo[2] in patients during exacerbation. Also during exacerbation, there was statistically highly significant negative correlation between serum CRP levels and FEV[1%] predicted. COPD leads to alterations in serum levels of sex hormones [testosterone, LH and FSH], IGF-1 and CRP. There was decrease in testosterone hormone levels of male stable COPD patients and this decrease was more evident, with compensatory increase in LH and FSH hormones levels, during exacerbation period when hypoxemia is more significant. CRP level is increased even in stable COPD and this rise is magnified with increased disease severity. IGF-1 decreased in stable COPD patients with more decrease in its level during acute exacerbation