Magnetic resonance angiography and transcranial Doppler ultrasound findings in patients with a clinical diagnosis of vertebrobasilar insufficiency

OBJECTIVE: To evaluate the findings of magnetic resonance angiography (MRA) and transcranial Doppler ultrasound (TCD) in patients with a clinical diagnosis of vertebrobasilar insufficiency (VBI). METHOD: From our outpatient neurotology clinic, we selected patients (using the criteria proposed by Grad and Baloh) with a clinical diagnosis of VBI. We excluded patients with any definite cause for vestibular symptoms, a noncontrolled metabolic disease or any contraindication to MRA or TCD. The patients in the study group were sex- and age-matched with subjects who did not have vestibular symptoms (control group). Our final group of patients included 24 patients (study, n=12; control, n=12). RESULTS: The MRA results did not demonstrate significant differences in the findings between our study and control groups. TCD demonstrated that the systolic pulse velocity of the right middle cerebral artery, end diastolic velocity of the basilar artery, pulsatility index (PI) of the left middle cerebral artery, PI of the right middle cerebral artery, and PI of the basilar artery were significantly higher in the study group than in the control group, suggesting abnormalities affecting the microcirculation of patients with a clinical diagnosis of VBI compared with controls. CONCLUSION: MRA failed to reveal abnormalities in patients with a clinical diagnosis of VBI compared with controls. The PI of the basilar artery, measured using TCD, demonstrated high sensitivity (91%) and specificity (91%) for detecting clinically diagnosed VBI.

Clinical evaluation, biochemistry and genetic polymorphism analysis for the diagnosis of lactose intolerance in a population from northeastern Brazil

OBJECTIVE: This work aimed to evaluate and correlate symptoms, biochemical blood test results and single nucleotide polymorphisms for lactose intolerance diagnosis. METHOD: A cross-sectional study was conducted in Fortaleza, Ceará, Brazil, with a total of 119 patients, 54 of whom were lactose intolerant. Clinical evaluation and biochemical blood tests were conducted after lactose ingestion and blood samples were collected for genotyping evaluation. In particular, the single nucleotide polymorphisms C>T-13910 and G>A-22018 were analyzed by restriction fragment length polymorphism/polymerase chain reaction and validated by DNA sequencing. RESULTS: Lactose-intolerant patients presented with more symptoms of flatulence (81.4%), bloating (68.5%), borborygmus (59.3%) and diarrhea (46.3%) compared with non-lactose-intolerant patients (p<0.05). We observed a significant association between the presence of the alleles T-13910 and A-22018 and the lactose-tolerant phenotype (p<0.05). After evaluation of the biochemical blood test results for lactose, we found that the most effective cutoff for glucose levels obtained for lactose malabsorbers was <15 mg/dL, presenting an area under the receiver operating characteristic curve greater than 80.3%, with satisfactory values for sensitivity and specificity. CONCLUSIONS: These data corroborate the association of these single nucleotide polymorphisms (C>T-13910 and G>A-22018) with lactose tolerance in this population and suggest clinical management for patients with lactose intolerance that considers single nucleotide polymorphism detection and a change in the biochemical blood test cutoff from <25 mg/dL to <15 mg/dL.

Effects of glutamine alone or in combination with zinc and vitamin A on growth, intestinal barrier function, stress and satiety-related hormones in Brazilian shantytown children

OBJECTIVE: To determine the impact of supplemental zinc, vitamin A, and glutamine alone or in combination on growth, intestinal barrier function, stress and satiety-related hormones among Brazilian shantytown children with low median height-for-age z-scores. METHODS: A randomized, double-blind, placebo-controlled trial was conducted in children aged two months to nine years from the urban shanty compound community of Fortaleza, Brazil. Demographic and anthropometric information was assessed. The random treatment groups available for testing (a total of 120 children) were as follows: (1) glutamine alone, n = 38; (2) glutamine plus vitamin A plus zinc, n = 37; and a placebo (zinc plus vitamin A vehicle) plus glycine (isonitrogenous to glutamine) control treatment, n = 38. Leptin, adiponectin, insulin-like growth factor (IGF-1), and plasma levels of cortisol were measured with immune-enzymatic assays; urinary lactulose/mannitol and serum amino acids were measured with high-performance liquid chromatography. ClinicalTrials.gov: NCT00133406. RESULTS: Glutamine treatment significantly improved weight-for-height z-scores compared to the placebo-glycine control treatment. Either glutamine alone or all nutrients combined prevented disruption of the intestinal barrier function, as measured by the percentage of lactulose urinary excretion and the lactulose:mannitol absorption ratio. Plasma leptin was negatively correlated with plasma glutamine (p = 0.002) and arginine (p = 0.001) levels at baseline. After glutamine treatment, leptin was correlated with weight-for-age (WAZ) and weight-for-height z-scores (WHZ) (p≤0.002) at a 4-month follow-up. In addition, glutamine and all combined nutrients (glutamine, vitamin A, and zinc) improved the intestinal barrier function in these children. CONCLUSION: Taken together, these findings reveal the benefits of glutamine alone or in combination ...

Zinc, vitamin A, and glutamine supplementation in Brazilian shantytown children at risk for diarrhea results in sex-specific improvements in verbal learning

OBJECTIVE: To identify the impact of supplemental zinc, vitamin A, and glutamine, alone or in combination, on long-term cognitive outcomes among Brazilian shantytown children with low median height-for-age z-scores. METHODS: A randomized, double-blind, placebo-controlled trial was conducted in children aged three months to nine years old from the urban shanty compound community of Fortaleza, Brazil. Demographic and anthropometric information was assessed. The random treatment groups available for cognitive testing (total of 167 children) were: (1) placebo, n = 25; (2) glutamine, n = 23; (3) zinc, n = 18; (4) vitamin A, n = 19; (5) glutamine+zinc, n = 20; (6) glutamine+vitamin A, n = 21; (7) zinc+vitamin A, n = 23; and (8) glutamine+zinc+vitamin A, n = 18. Neuropsychological tests were administered for the cognitive domains of non-verbal intelligence and abstraction, psychomotor speed, verbal memory and recall ability, and semantic and phonetic verbal fluency. Statistical analyses were performed using SPSS, version 16.0. ClinicalTrials.gov: NCT00133406. RESULTS: Girls receiving a combination of glutamine, zinc, and vitamin A had higher mean age-adjusted verbal learning scores than girls receiving only placebo (9.5 versus 6.4, p = 0.007) and girls receiving zinc+vitamin A (9.5 versus 6.5, p = 0.006). Similar group differences were not found between male study children. CONCLUSIONS: The findings suggest that combination therapy offers a sex-specific advantage on tests of verbal learning, similar to that seen among female patients following traumatic brain injury.

Worries about memory loss and knowledge on Alzheimers disease in community-dwelling elderly from Brazil / Influências das características sociodemográficas no conhecimento sobre doença de Alzheimer numa população de idosos da cidade de Santos

Alzheimers disease (AD) is the most common cause of dementia in the elderly. Efforts to determine risk factors for the development of AD are important for risk stratification and early diagnosis. Furthermore, there are no standardized practices for memory screening. Lack of knowledge on AD, perception of memory loss as part of normal aging, and poor socioeconomic conditions may also be implicated in the current situation of dementia. Objective: To evaluate knowledge of AD in a literate population of elders and correlate these findings with sociodemographic characteristics. Methods: A descriptive survey design study enrolled 994 volunteers from September 2007 to May 2008 in the city of Santos, São Paulo, Brazil, to answer a brief questionnaire consisting of 8 simple questions about knowledge of AD and worries about memory loss. Results: Greater knowledge about AD was associated with eight or more years of education, female gender and age between 60 and 70 years. Also, 52.8% of responders (95% CI - 49.5-56.0%) answered that memory loss is part of normal aging and 77.5% (95% CI - 74.7-80.1%) had never sought a doctor to evaluate their memories. Conclusion: Our study results reinforced that the first line of preventing late diagnosis of dementia is to act in health promotion, especially by targeting subjects older than 70 years of male gender and with lower educational level. It also provided evidence that strategies to promote physician initiative in treating memory problems are also paramount.

A doença de Alzheimer (DA) é a causa mais comum de demência. Determinar os fatores de risco para o desenvolvimento da DA é importante na estratificação de risco e no diagnóstico precoce. Falta de conhecimento sobre a DA, percepção de perda de memória como parte do envelhecimento normal e más condições de socioeconômicas podem também estar implicadas. Objetivo: Avaliar o conhecimento sobre DA numa população alfabetizada de idosos e correlacionar esses achados com suas características sociodemográficas. Métodos: Este estudo descritivo envolveu 994 voluntários de Setembro de 2007 a Maio de 2008 na cidade de Santos, São Paulo, Brasil. Eles se dispuseram a responder um questionário simples composto de 8 questões sobre o conhecimento da DA e preocupações com a perda de memória. Resultados: Um maior conhecimento sobre DA foi associado à escolaridade >8 anos de estudo, ao gênero feminino e a idade entre 60 e 70 anos. Além disso, 52,8% dos respondedores (IC 95% - 49,5-56,0%) disseram que perda de memória faz parte do envelhecimento normal e 77,5% (IC 95% - 74,7-80,1%) relataram que nunca haviam procurado um médico para avaliação de memória. Conclusão: Nosso estudo reforça o fato de que a primeira linha de prevenção do diagnóstico tardio de demência é a promoção da saúde, especialmente tendo em foco indivíduos maiores de 70 anos, gênero masculino e maior escolaridade, nossa população de mais alto risco. Também traz evidências de que estratégias para promover a iniciativa dos médicos no cuidado aos problemas de memória são de grande importância.

Prevalência de dermatoses em idosos residentes em instituição de longa permanência / Prevalence of dermatoses in residents of institutions for the elderly

OBJETIVOS: Determinar a prevalência das afecções dermatológicas em 75 idosos residentes em instituição de longa permanência na cidade de Santos-SP, e confrontar os achados com revisão da literatura. MÉTODOS: Setenta e cinco idosos foram submetidos a exame dermatológico. Com os dados obtidos calculou-se a prevalência, o número médio por paciente e a freqüência de dermatoses. Foi ainda analisado a distribuição nos subgrupos sexo, raça, faixa etária e nos subgrupos principais de dermatoses. RESULTADOS: O número total de dermatoses diagnosticadas foi 280, o número médio por paciente foi 3,73 e o número total de tipos de dermatoses foi 32. A prevalência das principais dermatoses encontradas foi: melanose solar (53,3 por cento), queratose seborréica (46,6 por cento), onicomicose (37,3 por cento), nevo rubi (33,3 por cento), púrpura senil (29,3 por cento), xerose (14,6 por cento), escabiose (12,0 por cento) e neoplasia maligna (1,3 por cento). A distribuição das dermatoses foi 70 por cento (IC95 por cento: 59 por cento a 81 por cento) maior no sexo feminino do que no masculino. CONCLUSÃO: Apesar da pequena casuística, os dados obtidos são compatíveis com os poucos relatos disponíveis na literatura. Este estudo de prevalência definiu a distribuição de dermatoses em uma fração da população de idosos. Entretanto, os dados agregados de casuísticas subseqüentes podem permitir tornar os dados mais precisos, cuja relevância é indiscutível na orientação de medidas de saúde individual e coletiva.

OBJECTIVE: To determine the prevalence of dermatoses in 75 elderly residents in an institution of long permanence in the city of Santos, and to compare findings with those in literature. METHODS: Seventy five healthy elderly persons were submitted to a dermatological exam. The prevalence, the average number per elderly person and the frequency of dermatoses were calculated from the data collected. An analysis was then made of the distribution in the subgroups of, gender, race, age bracket as well as of dermatosis in the main sub-groups. RESULTS: The total number of diagnoses of dermatosis was 280 with an average number of 3. 73/ per elderly person and 32 different types of dermatosis: were found. The prevalence of the dermatosis most often found was respectively: melanosis (53.3 percent), seborrheic keratosis (46.6 percent), onychomycosis (37.3 percent), nevus (33.3 percent), senile purpura (29.3 percent), xerosis (14.6 percent), scabies (12.0 percent) and malignant neoplasm (1.3 percent). The distribution of dermatosis was 70 percent (CI95 percent: 59 percent to 81 percent) higher in the female population than in the male. CONCLUSION: Notwithstanding the small number of cases, these data are compatible with the few reports available in literature. This study of prevalence defined the distribution of dermatosis in a fraction of the elderly population. However the aggregate data of subsequent casuistries may provide the more precise information whose relevance is undeniable in the orientation of individual and collective future health measures.

A importância de um programa de assistência multidisciplinar no controle de pressão arterial no idoso hipertenso / The importance of a multidisciplinary assistance program in the control of blood pressure in hypertensive elderly patients

Objetivo: Verificar se o fato de ser inserido em um programa de assistência geriátrica multidisciplinar contribui para um melhor controle da pressão arterial. Métodos: Estudo transversal. Local: um centro terciário de ensino de um Hospital de São Paulo, Brasil. Participantes:110 pacientes hipertensos com mais de 60 anos. Medidas: apressão arterial de idosos foi verificada em um serviço denominado“grupo de referência”. Posteriormente foi feito o controle da pressão arterial do mesmo grupo de idosos depois de serem inseridos no programa multidisciplinar de exercícios. Resultados: Encontrou-se uma diferença significativa entre o “grupo de referência” e o “grupomultidisciplinar” em relação à proporção de pacientes que estavamem controle da pressão arterial (p = 0,021). No “grupo de referência”,24,7% dos pacientes tiveram pressão arterial controlada e no “grupomultidisciplinar”, essa proporção foi de 41,1%. Conclusão: O fato de ser inserido em um grupo geriátrico com assistência multidisciplinar para exercícios mostrou um significativo controle da pressão arterial no idoso hipertenso.

Association of vitamin A and zinc status with altered intestinal permeability: analyses of cohort data from northeastern Brazil.

To examine the association of intestinal barrier function with vitamin A deficiency and whether supplementation of micronutrients improves intestinal function and/or linear growth, height-for-age z-score (HAZ), concentrations of serum retinol and zinc, and intestinal permeability were determined in a cross-sectional sample of 75 children in northeastern Brazil. Effects of vitamin A and supplementation of zinc on intestinal permeability and growth were also determined comparing results before and after treatment in 20 children and age-matched controls. Lactulose:mannitol (L/M) permeability ratios inversely correlated with serum retinol concentrations (r = -0.55, p < 0.0005). Increased L/M permeability ratios with reduced concentrations of serum retinol were predominantly attributable to lower absorption of mannitol (r = 0.28, p = 0.02). L/M permeability ratios (p = 0.001) and HAZ scores (p = 0.007) improved with supplementation. It is concluded that impaired intestinal barrier function and linear growth shortfalls improve following supplementation of vitamin A and zinc in this setting.

Common infectious diseases and skin test anergy in children from an urban slum in Northeast Brazil

BACKGROUND: Acute respiratory infection (ARI), diarrheal disease (DD) and infective dermatitis (ID) are important causes of morbidity in children under five, in Northeast Brazil. Objectives: (a) to evaluate the morbidity of ARI, DD and ID; and (b) to determine their association with cellular immunity in poor urban children from Fortaleza, Brazil. MATERIALS AND METHODS: A prospective cohort study. At enrollment, multipuncture skin-tests (Multitest CMI) were performed and interpreted according to standard procedures. Children were followed for infectious diseases by weekly home visits. RESULTS: Seventy-one children aged 6 to 21 months were recruited in an ongoing cohort of newborns. A mean of 39 (6 to 63) home visits per child were made, which detected 184.5 symptomatic days per child-year of observation. ARI was present in 62 percent of the days of illness (6,378 out of 10,221), DD in 23 percent (2,296 days), ID in 6 percent (597) and other infections in 4 percent (373). Episodes per child-year were: 10 for ARI, 7 for DD and 1 for ID. Twelve (17 percent) out of 71 children were anergic. The incidences of ARI, DD and ID were similar in responsive versus anergic children. The mean duration of ID in anergy was 8.5 days, while it was 4.3 in the responsive group (P=0.007). Anergy was independent of age, sex and nutritional status. CONCLUSIONS: A high incidence of ARI and DD was found in these poor urban children. Skin-test responsiveness was not related to malnutrition, nor to morbidity due to ARI and DD, however anergic children had a longer duration of infective dermatitis.

Consenso brasileiro de osteoporose 2002 / Brazilian consensus on osteoporosis 2002

Objetivo: estabelecer diretrizes para o diagnóstico precoce, prevenção e tratamento da osteoporose. Métodos: representantes das diferentes especialidades que estudam e trabalham com os diferentes aspectos da osteoporose participaram deste consenso, no qual estabeleceram estas diretrizes baseados em uma revisão sistemática da literatura buscando evidências científicas consistentes. Os trabalhos foram selecionados pela sua metodologia, desenho, medidas adequadas e validade dos resultados contemplando procedimentos diagnósticos, preventivos e terapêuticos. Resultados: Após extensa discussão os participantes produziram um texto básico sujeito a correções posteriores, e revisões até a aprovação final

Critérios clínico-radiológicos para o diagnóstico das bronquiectasias: comunicaçäo pessoal / Clinico-radiological criteria for bronchiectasis diagnosis: personal report

Objetiva-se a revisäo de 60 casos de bronquiectasias, diagnosticadas, tratadas e acompanhadas no Hospital Universitário da UFPB, no período de 1978 a 1982, sob a ótica clínica, radiológica, funcional e 20 deles, anátomo-patologicamente. As características sintomatológicas mais exuberantes säo abordadas, principalmente, a hipersecreçäo brônquica matinal. Enfoca-se uma discussäo das prováveis causas dessa entidade clínica e identificam as outras doenças que podem simular essa síndrome. O tratamento proposto na maioria dos casos é conservador, preservando-se a cirurgía aos casos complicados por infecçöes recorrentes, pulmöes destruídos ou crises hemópticas incoercíveis. Ilustra-se o tema em pauta com apresentaçäo de 1 caso