Drogas imunossupressoras afetam os núcleos hipotalâmicos envolvidos na ingestão alimentar ? estudo experimental / Do the immunosuppressive drugs affect the hypothalamic nuclei involved in the regulation of food intake? an experimental study

RESUMO - RACIONAL: Drogas imunossupressoras são indispensáveis para pacientes pós-transplante, diminuindo, significativamente, os riscos de rejeição inerentes a este tipo de procedimento. No entanto, seus efeitos colaterais sobre os núcleos hipotalâmicos envolvidos na regulação da ingestão de alimentos e o efeito no excessivo ganho de peso e suas comorbidades associadas são desconhecidos. OBJETIVO: Analisar a ocorrência de alterações morfológicas dos núcleos paraventricular, área hipotalâmica lateral, dorsomedial, ventromedial e arqueado em ratos Wistar submetidos ao tratamento imunossupressor com Tacrolimus (TAC) ou Micofenolato Mofetil (MMF). MÉTODOS: Foram utilizados Ratos Wistar machos adultos distribuídos, randomicamente, em quatro grupos de acordo com o tratamento oral utilizado por 14 semanas: Controle; Sham (Placebo); Tacrolimus (TAC 1mg/kg peso) e Micofenolato Mofetil (MMF 30mg/kg peso). Ao final do tratamento, os animais foram eutanasiados e seus encéfalos fixados para o processamento histológico. Posteriormente, as lâminas foram fotodocumentadas para o desenvolvimento da análise estereológica dos corpos celulares dos neurônios dos núcleos hipotalâmicos, tendo como parâmetros a densidade neuronal e no número de neurônios. RESULTADOS: Todos os grupos estudados mostraram curva de ganho de peso ponderal durante todo o período de experimento. Não houve diferença significativa na densidade neuronal e no número de neurônios hipotalâmicos dos núcleos hipotalâmicos entre os grupos estudados. Não foram detectadas alterações morfológicas dos corpos celulares dos neurônios hipotalâmicos capazes de serem imputadas ao uso dos imunossupressores envolvidos no estudo. CONCLUSÃO: O tratamento dos animais experimentais com os imunossupressores não evidenciou alterações no número e densidade dos corpos celulares dos neurônios dos núcleos hipotalâmicos estudados.

ABSTRACT - BACKGROUND: Immunosuppressive drugs are essential for reducing the rejection risk in post-transplant patients, which is commonly associated with this procedure. However, side effects of those drugs on the hypothalamic nuclei involved in the food intake regulation, excessive weight gain, and also associated comorbidities are still unknown. PURPOSE: The purpose of this study was to analyze possible changes in the neuronal morphology and cell density in the paraventricular nuclei, lateral hypothalamic area, dorsomedial nuclei, and ventromedial and arcuate nuclei in Wistar rats submitted to immunosuppressive treatment with tacrolimus (TAC) or mycophenolate mofetil (MMF). METHODS: Adult male Wistar rats were randomly assigned to the following groups according to the oral treatment administered for 14 weeks: control, sham (placebo), TAC (1 mg/kg of weight), and MMF (30 mg/kg of weight). After treatment, the animals were sacrificed and their brains fixed for later histological staining. Subsequently, the slides were photodocumented for stereological analysis of the hypothalamic nuclei. RESULTS: All experimental groups showed a weight gain throughout the study. There was no significant difference in neuronal density/number of cells in the hypothalamic nuclei between groups. Morphological changes were not detected in the hypothalamic neurons. CONCLUSION: Treatments with immunosuppressants could not modify the morphological and cell density aspects of the hypothalamic nuclei during this supplementation period.

Low estrogen doses normalize testosterone and estradiol levels to the female range in transgender women

OBJECTIVE: The ideal dosage of cross-sex hormones remains unknown. The aim of this study was to evaluate the luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin levels after low-dose estrogen therapy with or without cyproterone acetate in transgender women. METHODS: The serum hormone and biochemical profiles of 51 transgender women were evaluated before gonadectomy. Hormone therapy consisted of conjugated equine estrogen alone or combined with cyproterone acetate. The daily dose of conjugated equine estrogen was 0.625 mg in 41 subjects and 1.25 mg in 10 subjects, and the daily dose of cyproterone acetate was 50 mg in 42 subjects and 100 mg in one subject. RESULTS: Estrogen-only therapy reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from 731.5 to 18 ng/dL, 6.3 to 1.1 U/L and 9.6 to 1.5 U/L, respectively. Estrogen plus cyproterone acetate reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from 750 to 21 ng/dL, 6.8 to 0.6 U/L and 10 to 1.0 U/L, respectively. The serum levels of luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin in the patients treated with estrogen alone and estrogen plus cyproterone acetate were not significantly different. The group receiving estrogen plus cyproterone acetate had significantly higher levels of gamma-glutamyltransferase than the group receiving estrogen alone. No significant differences in the other biochemical parameters were evident between the patients receiving estrogen alone and estrogen plus cyproterone acetate. CONCLUSION: In our sample of transgender women, lower estrogen doses than those usually prescribed for these subjects were able to adjust the testosterone and estradiol levels to the physiological female range, thus avoiding high estrogen doses and their multiple associated side effects.

Genetic diversity of Cryptosporidium identified in clinical samples from cities in Brazil and Argentina

The identification and characterisation of Cryptosporidiumgenotypes and subtypes are fundamental to the study of cryptosporidiosis epidemiology, aiding in prevention and control strategies. The objective was to determine the genetic diversity ofCryptosporidium in samples obtained from hospitals of Rio de Janeiro, Brazil, and Buenos Aires, Argentina. Samples were analysed by microscopy and TaqMan polymerase chain reaction (PCR) assays forCryptosporidium detection, genotyped by nested-PCR-restriction fragment length polymorphism (RFLP) analysis of the 18S rRNA gene and subtyped by DNA sequencing of the gp60 gene. Among the 89 samples from Rio de Janeiro, Cryptosporidium spp were detected in 26 by microscopy/TaqMan PCR. In samples from Buenos Aires,Cryptosporidium was diagnosed in 15 patients of the 132 studied. The TaqMan PCR and the nested-PCR-RFLP detected Cryptosporidium parvum, Cryptosporidium hominis, and co-infections of both species. In Brazilian samples, the subtypes IbA10G2 and IIcA5G3 were observed. The subtypes found in Argentinean samples were IbA10G2, IaA10G1R4, IaA11G1R4, and IeA11G3T3, and mixed subtypes of Ia and IIa families were detected in the co-infections. C. hominis was the species more frequently detected, and subtype family Ib was reported in both countries. Subtype diversity was higher in Buenos Aires than in Rio de Janeiro and two new subtypes were described for the first time.

Anorexia: "uma neurose paralela à melancolia" / Anorexia: "a neurosis parallel to melancholia" / Anorexie: "une névrose parallèle à la melancolie" / Anorexia: "una neurosis paralela a la melancolia"

Investiga-se a assertiva freudiana de que "a neurose nutricional paralela à melancolia é a anorexia". Percorreremos a obra freudiana para construir o paralelo entre essas duas afecções. O conceito de narcisismo e o mecanismo de identificação fundamentarão essa aproximação desdobrada nos seguintes pontos: a anestesia sexual, a autodepreciação e o sadismo.

The objective here is to investigate Freud's statement that "the nutritional neurosis which parallels melancholia is anorexia." We studied Freud's writings to construct an equivalence between these two affections. Narcissism and the mechanism of identification are the basis for this discussion on the concepts of sexual anesthesia, low self-esteem and sadism.

Cet article discute l'affirmation freudienne selon laquelle "la névrose alimentaire parallèle à la mélancolie est l'anorexie". Nous examinons l'œuvre freudienne pour construire une parallèle entre ces deux affections. Le concept de narcissisme et le mécanisme d'identification servent de base à cette approximation à partir de laquelle nous élaborons les points suivants: l'anesthésie sexuelle, l'autodépréciation et le sadisme.

Se investiga la afirmación freudiana de que "la anorexia es la neurosis nutricional paralela a la melancolía". Examinaremos la obra freudiana para construir el paralelismo entre esas dos afecciones. El concepto de narcisismo y el mecanismo de identificación fundamentarán esa aproximación, que se despliega en los siguientes puntos: la anestesia sexual, la autodepreciación y el sadismo.

Detection and differentiation of Cryptosporidium by real-time polymerase chain reaction in stool samples from patients in Rio de Janeiro, Brazil

This study reports the first genetic characterisation of Cryptosporidium isolates in Brazil using real-time polymerase chain reaction (RT-PCR). A total of 1,197 faecal specimens from children and 10 specimens from human immunodeficiency virus-infected patients were collected between 1999-2010 and screened using microscopy. Forty-eight Cryptosporidium oocyst-positive isolates were identified and analysed using a generic TaqMan assay targeting the 18S rRNA to detect Cryptosporidium species and two other TaqMan assays to identify Cryptosporidium hominis and Cryptosporidium parvum. The 18S rRNA assay detected Cryptosporidium species in all 48 of the stool specimens. The C. parvum TaqMan assay correctly identified five/48 stool samples, while 37/48 stool specimens were correctly amplified in the C. hominis TaqMan assay. The results obtained in this study support previous findings showing that C. hominis infections are more prevalent than C. parvum infections in Brazil and they demonstrate that the TaqMan RT-PCR procedure is a simple, fast and valuable tool for the detection and differentiation of Cryptosporidium species.

Nível de conhecimento dos alunos do curso de Odontologia da Univali sobre o uso profilático e terapêutico do flúor / The Univali Dental students' knowledge level about the prophylactic and therapeutic use of fluoride

Introdução: O conhecimento sobre os produtos fluoretados permitediscernir as condições que tornam o flúor um elemento benéfico outóxico. Objetivo: Buscou-se verificar o conhecimento dos alunos do 7.ºao 9.º período do curso de Odontologia da Universidade do Vale do Itajaí(Univali), no 1.º semestre de 2008, sobre o uso profilático e terapêuticodo flúor. Material e métodos: Realizou-se um estudo descritivo,transversal, mediante levantamento de dados por meio de questionáriosemiestruturado, abordando o conhecimento dos acadêmicos sobremétodos de aplicação, recomendações e concentrações de flúor contido nos produtos da sua prática clínica diária, bem como níveis de flúora que seus pacientes já se encontram expostos. Resultados: Dosacadêmicos entrevistados, 82,75% conhecem a dose provavelmentetóxica (DPT) aguda, e 43,68%, a dose crônica. A fluorose dental foicitada por 71,26% como a manifestação clínica na forma crônica.A aplicação tópica de flúor profissional (ATFP) é feita por 90,80%dos acadêmicos, e 85,05% reconhecem na quantidade de dentifríciofluoretado colocado na escova um fator relevante para intoxicaçãocrônica. Todos os estudantes desconhecem a concentração de flúorutilizada na água de abastecimento de Itajaí e 77,01% entendem queo principal modo de atuação do flúor é tópico e primário. Conclusão:Apesar da grande quantidade de informações sobre flúor repassadasno decorrer da matriz curricular, uma expressiva parte dos alunosainda não sabe empregá-lo em sua prática clínica e não tem domíniosobre a toxicidade, as concentrações, as indicações e os usos corretospara poder ministrá-lo a cada paciente.

Introduction: The knowledge about fluoridated products enablesthe perception of conditions that make fluoride a toxic or beneficialelement. Objective: To verify the knowledge about the prophylacticand therapeutic use of fluoride among students in the 7th, 8th and9th semester of the Dentistry Course at the Vale do Itajaí University(Univali) in the first semester of 2008. Material and methods: It wasa transversal descriptive study that gathered primary data through asemi-structured questionnaire, approaching the students? knowledgeabout the fluoride application methods, the recommendations andthe fluoride concentrations of products used in the clinical routine, aswell as the fluoride levels to which the patients are already exposed to.Results: 82.75% of the interviewed students know the acute probabletoxic dose (PTD) and 43.68% of them know the chronic toxic dose.Dental fluorosis was mentioned as a chronic clinical manifestationby 71.26% of the students. Professional topical fluoride application(PTFA) is used by 90.80% of the students and 85.05% of them recognizethat the amount of fluoride toothpaste used in brushing is a relevantfactor for chronic intoxication. None student was aware of the fluorideconcentration used in Itajaí community water supply, and 77.01% of thestudents comprehend that the main mode of action of fluoride is topicaland primary. Conclusion: Despite the large amount of informationabout fluoride received by students during the curricular program,most of them do not know how to use it in their clinical practice andare not aware of toxicity, concentrations, indications and correct usesfor each patient.

Manifestações otorrinolaringológicas e esofágicas da epidermólise bolhosa / Otorhinolaryngological and esophageal manifestations of epidermolysis bullosa

Epidermólise bolhosa (EB) é um conjunto de afecções bolhosas, de caráter hereditário, com diferentes quadros clínicos e diferentes modos de transmissão genética. Os indivíduos evoluem com bolhas na pele e mucosas, que surgem espontaneamente ou após mínimos traumatismos. OBJETIVO: Descrever as manifestações otorrinolaringológicas, as complicações esofágicas relacionadas à EB e a experiência na conduta de pacientes com estenose esofágica decorrente da EB. CASUÍSTICA E MÉTODO: Estudo descritivo de 60 pacientes com EB, atendidos de 1999 a 2006, no serviço de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço do Hospital X, centro de referência para EB. RESULTADOS: Dos 60 pacientes com idade média de 14,5 anos, 28 (46,6 por cento) eram mulheres e 32 (53,4 por cento) homens. Oito (13,4 por cento) tinham o diagnóstico de EB simples, 51 (85 por cento) EB distrófica e um (1,6 por cento) caso de EB adquirida. Lábios, boca, língua e pavilhão auricular foram os locais mais acometidos (32 pacientes - 53,3 por cento). Disfagia foi encontrada em 28 pacientes (46,6 por cento). Após dilatação do esôfago todos apresentaram remissão do sintoma. CONCLUSÃO: EB é uma doença rara e os pacientes devem ser encaminhados para tratamento em centros de referência. Portanto, é fundamental que os médicos envolvidos com os cuidados de pacientes com EB conheçam as condutas necessárias para melhorar a qualidade do tratamento sem prejuízos adicionais.

Epidermolysis bullosa (EB) is a group of skin diseases with different clinical manifestations and varied inheritance patterns. Blisters may appear spontaneously or following minimal trauma to the skin or mucosa. AIM: this paper aims to describe the otorhinolaryngological manifestations and esophageal complications related to EB, and the experience in treating patients with esophageal stenosis secondary to this disease. MATERIALS AND METHOD: this descriptive study enrolled 60 patients with EB seen from June 1999 to December 2006 at the Head and Neck Surgery Service of X Hospital, a reference center for EB. RESULTS: the patients' mean age was 14.5 years. Twenty-eight (46.6 percent) were females and 32 (53.4 percent) were males. Eight (13.4 percent) were diagnosed with epidermolysis bullosa simplex, while 51 (85 percent) had epidermolysis bullosa dystrophica; one (1.6 percent) patient had one acquired EB. Lips, mouth, tongue and ears were the most frequently involved sites (32 patients - 53.3 percent). Dysphagia was found in 28 patients (46.6 percent). After esophageal dilatation the symptoms subsided. CONCLUSION: EB is a rare disease and patients must be sent for treatment at reference centers. Physicians treating patients for EB must be aware of the measures required to improve the quality of the treatment provided without putting the patients in harm's way.

A 10-year experience with the Amatsu tracheoesophageal shunt

Introduction: Since 1991, we have done the tracheoesophageal shunt as described by Amatsu in candidates to a total laryngectomy. Our goal is to provide the patients a better speech rehabilitation that that obtained by the non-surgical techniques, and by doing so, lessen the oncological treatment impact on the patient's quality of life. Aim: This work revises the experience of our institution with the procedure during a 10 years period. Study design: Clinical retrospective. Material and method: We had 54 patients submitted to the procedure, 3 women e 51 men, with ages from 30 to 78 years old and a mean age of 59 years. All had scamous cell carcinoma, 10 from the piriform sinus, 2 from retrocricoide area, 6 from the supraglottis, 1 from the subglottis, 16 from the glottis and 19 were transglottic. According to the AJC staging system, 3 were stage II, 17 were stage III, 24 were stage IV and 10 were not staged. Previous radiotherapy as initial treatment had been done in 18 patients. During the laryngectomy, 33 patients had some type of neck dissection and in 15 of these patients the neck dissection was done bilaterally. A myocutaneous pectoralis major flap was needed in 5 cases and a deltopectoralis flap was used in one case. Postoperative radiotherapy was used in 20 patients. Local infections occurred in 36 percent of the cases, and all had a good outcome. One patient died in the early postoperative period. Results: Speech rehabilitation by the technique was successful in 70 percent of the cases. Aspiration occurred in 10 patients and, in 2 of these, the shunt had to be surgically closed. Conclusion: In conclusion, due to its low cost, good results with few complications, the Amatsu tracheoesophageal shunt continues in our service as the main technique for speech rehabilitation after laryngectomy

Study of humoral immune response in mammals immunized with Plasmodium falciparum antigenic preparations

Six Plasmodium falciparum protein fractions, isolated under reducing conditions, were used to immunize mice, rabbits and the squirrel monkey Saimiri sciureus. Five or seven subcutaneous injections of each antigenic preparation, in conjunction with Freund's complete or incomplete adjuvants, were administered. This led to the development of specific antibodies detected by IFAT, ELISA or immunobloting which inhibited merozoite reinvasion in in vitro P. falciparum cultures. This activity seems to be associated with rhoptry proteins contained in fractions Pf F2 and Pf F4