Serum uric acid and disorders of glucose metabolism: the role of glycosuria

Hyperuricemia has been associated with hypertension, diabetes mellitus, and metabolic syndrome. We studied the association between hyperuricemia and glycemic status in a nonrandomized sample of primary care patients. This was a cross-sectional study of adults ≥20 years old who were members of a community-based health care program. Hyperuricemia was defined as a value >7.0 mg/dL for men and >6.0 mg/dL for women. The sample comprised 720 participants including controls (n=257) and patients who were hypertensive and euglycemic (n=118), prediabetic (n=222), or diabetic (n=123). The mean age was 42.4±12.5 years, 45% were male, and 30% were white. The prevalence of hyperuricemia increased from controls (3.9%) to euglycemic hypertension (7.6%) and prediabetic state (14.0%), with values in prediabetic patients being statistically different from controls. Overall, diabetic patients had an 11.4% prevalence of hyperuricemia, which was also statistically different from controls. Of note, diabetic subjects with glycosuria, who represented 24% of the diabetic participants, had a null prevalence of hyperuricemia, and statistically higher values for fractional excretion of uric acid, Na excretion index, and prevalence of microalbuminuria than those without glycosuria. Participants who were prediabetic or diabetic but without glycosuria had a similarly elevated prevalence of hyperuricemia. In contrast, diabetic patients with glycosuria had a null prevalence of hyperuricemia and excreted more uric acid and Na than diabetic subjects without glycosuria. The findings can be explained by enhanced proximal tubule reabsorption early in the course of dysglycemia that decreases with the ensuing glycosuria at the late stage of the disorder.

Serum uric acid and disorders of glucose metabolism: the role of glycosuria.

Hyperuricemia has been associated with hypertension, diabetes mellitus, and metabolic syndrome. We studied the association between hyperuricemia and glycemic status in a nonrandomized sample of primary care patients. This was a cross-sectional study of adults ≥ 20 years old who were members of a community-based health care program. Hyperuricemia was defined as a value >7.0 mg/dL for men and >6.0 mg/dL for women. The sample comprised 720 participants including controls (n=257) and patients who were hypertensive and euglycemic (n=118), prediabetic (n=222), or diabetic (n=123). The mean age was 42.4 ± 12.5 years, 45% were male, and 30% were white. The prevalence of hyperuricemia increased from controls (3.9%) to euglycemic hypertension (7.6%) and prediabetic state (14.0%), with values in prediabetic patients being statistically different from controls. Overall, diabetic patients had an 11.4% prevalence of hyperuricemia, which was also statistically different from controls. Of note, diabetic subjects with glycosuria, who represented 24% of the diabetic participants, had a null prevalence of hyperuricemia, and statistically higher values for fractional excretion of uric acid, Na excretion index, and prevalence of microalbuminuria than those without glycosuria. Participants who were prediabetic or diabetic but without glycosuria had a similarly elevated prevalence of hyperuricemia. In contrast, diabetic patients with glycosuria had a null prevalence of hyperuricemia and excreted more uric acid and Na than diabetic subjects without glycosuria. The findings can be explained by enhanced proximal tubule reabsorption early in the course of dysglycemia that decreases with the ensuing glycosuria at the late stage of the disorder.

Tipos de estacas e substratos na propagação vegetativa da menta (Mentha arvensis L. ) / Types of cuttings and substrates in the vegetative propagation of mint (Mentha arvensis L. )

O trabalho teve como objetivo avaliar a propagação vegetativa da menta utilizando diferentes tipos de estacas e substratos. O experimento foi conduzido no Horto de Plantas Medicinais da Unimontes, campus Janaúba - MG. O delineamento experimental utilizado foi o inteiramente casualizado, em esquema fatorial 2 x 4 (dois tipos de estacas e quatro diferentes substratos) com quatro repetições, sendo cada parcela representada por seis estacas. Foram analisadas as variáveis comprimento de parte aérea e de raízes, massa seca de parte aérea e de raízes e número total de brotações formadas por planta. Os dados foram submetidos à análise de variância e as médias comparadas pelo teste de Scott-Knott a 5% de probabilidade. A interação entre os fatores estacas e substratos não foi significativa para as variáveis estudadas, passando-se a estudar o efeito isolado de cada fator. A propagação de Mentha arvensis L. pode ser realizada tanto por estacas apicais como medianas, utilizando o substrato solo + areia + esterco bovino (2:1:1) para a produção de mudas de qualidade.

The purpose of the study was to evaluate the vegetative propagation using different types of mint cuttings and substrates. The experiment was conducted in the Garden of Medicinal Plants of Unimontes, in Janaúba - MG. The experimental design was completely randomized (CRD) in 2 x 4 factorial schemes (two types of poles and four different substrates) with four replications and each plot was represented by six cuttings. The variables analyzed were the length of the shoots and roots, the dry matter of the shoots and roots and the total number of shoots per plant. The data were subject to ANOVA and the means were compared by Scott-Knott's test at 5% of probability. The interaction among stem cuttings and substrates was not significant for the variables studied, thus, the isolated effect of each factor was studied. The propagation of Mentha arvensis L. can be performed either by apical cuttings as medians, using the substrate soil + sand + manure bovine (2:1:1) for the production of quality seedlings.

[Aphallia associated to urethrorectal fistula: a case report]. / Afalia asociada a fístula recto-uretral: reporte de un caso.

Aphallia had an incidence of 1/30.000.000 newborn. This is a rare genitourinary anomaly derived from a faulty development of the genital tubercles. It usually coexists with series of other anomalies which are incompatible with normal life. This article presents a description of a 2 years old patient.

Spin-spin indirect interaction at low-energy excitation in zero-dimensional cavities.

We solve the low-energy part of the spectrum of a model that describes a circularly polarized cavity mode strongly coupled to two exciton modes, each of which is coupled to a localized spin of arbitrary magnitude. In the regime in which the excitons and the cavity modes are strongly coupled, forming polaritons, the low-energy part of the spectrum can be described by an effective spin model, which contains a magnetic field, an axial anisotropy, and an Ising interaction between the localized spins. For detunings such that the low-energy states are dominated by nearly degenerate excitonic modes, the description of the low-energy states by a simple effective Hamiltonian ceases to be valid and the effective interaction tends to vanish. Finally, we discuss a possible application to two-qubit quantum computing operations in a system of transition-metal impurities embedded in quantum dots inside a micropillar.

Ring chromosome instability evaluation in six patients with autosomal rings.

Ring chromosomes are often associated with abnormal phenotypes due to loss of genomic material and also because of ring instability at mitosis after sister chromatid exchange events. We investigated ring chromosome instability in six patients with ring chromosomes 4, 14, 15, and 18 by examining 48- and 72-h lymphocyte cultures at the first, second and subsequent cell divisions after bromodeoxyuridine incorporation. Although most cells from all patients showed only one monocentric ring chromosome, ring chromosome loss and secondary aberrations were observed both in 48- and 72-h lymphocyte cultures and in metaphase cells of the different cell generations. We found no clear-cut correlation between ring size and ring instability; we also did not find differences between apparently complete rings and rings with genetic material loss. The cytogenetic findings revealed secondary aberrations in all ring chromosome patients. We concluded that cells with ring chromosome instability can multiply and survive in vivo, and that they can influence the patient's phenotype.

Photoreactivation and dark repair in UV-treated microorganisms: effect of temperature.

Because of the lack of readily available information about the influence of temperature on microorganism reactivation processes subsequent to inactivation with UV radiation, a series of batch reactivation studies were performed at 5, 10, 15, 20, 25, and 30 degrees C. A special effort was made to model the reactivation process to enable the effect of the temperature variable to be quantified. Because an earlier-proposed kinetic model (K. Kashimada, N. Kamiko, K. Yamamoto, and S. Ohgaki, Water Sci. Technol. 33:261-269, 1996), a first-order saturation type, does not adequately fit the data obtained in experiments of reactivation in conditions of light and darkness, a modification of that model is proposed. The new model, which actually coincides with the classical logistic equation, incorporates two kinetic parameters: the maximum survival ratio (Sm) and the second-order reactivation rate constant (k2). In order to interpret correctly the reactivation occurring in conditions of darkness, a new term for the decay is added to the logistic equation. The new model accurately fits the data obtained in reactivation experiments, permitting the interpretation of the kinetic parameters Sm, k2, and M (for only repair in darkness), where M is mortality, a zero-order decay rate constant, and their relationship with various environmental conditions, such as microbial type, light, and temperature. The parameters Sm and k2 (and M for reactivation in conditions of darkness) show exponential dependence on the reactivating temperature, and it is possible to predict their values and hence the reactivation curve from the equations proposed in this work.

Duplication 4p and deletion 4p (Wolf-Hirschhorn syndrome) due to complementary gametes from a 3:1 segregation of a maternal balanced t(4;13)(p16;q11) translocation.

We present clinical and cytogenetic data on a family with a t(4;13)(p16;q11) translocation present in four generations. The balanced translocation resulted in one individual with monosomy 4p and one individual with trisomy 4p, due to 3:1 segregation. The male patient with trisomy 4p was fertile and transmitted the extra chromosome to his daughter.

TRAP-silver staining, a highly sensitive assay for measuring telomerase activity in tumor tissue and cell lines

Measurement of telomerase activity in clinically obtained tumor samples may provide important information for use as both a diagnostic marker and a prognostic indicator for patient outcome. In order to evaluate telomerase activity in tumor tissue without radiolabeling the product, we developed a simple telomeric repeat amplification protocol-silver-staining assay that is less time-consuming, is safe and requires minimal equipment. In addition, we determined the sensitivity of the silver-staining method by using extracts of telomerase-positive thyroid carcinoma cell lines which were serially diluted from 5,000 to 10 cells. Telomerase activity was also assayed in 19 thyroid tumors, 2 normal controls and 27 bone marrow aspirates. The results indicate that the technique permits the detection of telomerase activity from 5000 to as few as 10 cells. We propose that it could be immediately applicable in many laboratories due to the minimal amount of equipment required

TRAP-silver staining, a highly sensitive assay for measuring telomerase activity in tumor tissue and cell lines.

Measurement of telomerase activity in clinically obtained tumor samples may provide important information for use as both a diagnostic marker and a prognostic indicator for patient outcome. In order to evaluate telomerase activity in tumor tissue without radiolabeling the product, we developed a simple telomeric repeat amplification protocol-silver-staining assay that is less time-consuming, is safe and requires minimal equipment. In addition, we determined the sensitivity of the silver-staining method by using extracts of telomerase-positive thyroid carcinoma cell lines which were serially diluted from 5,000 to 10 cells. Telomerase activity was also assayed in 19 thyroid tumors, 2 normal controls and 27 bone marrow aspirates. The results indicate that the technique permits the detection of telomerase activity from 5000 to as few as 10 cells. We propose that it could be immediately applicable in many laboratories due to the minimal amount of equipment required.

Effects of ozone on evaporative water loss and thermoregulatory behavior of marine toads (Bufo marinus).

Ozone (O(3)) is a strong pulmonary irritant and causes a suite of respiratory tract inflammatory responses in humans and other mammals. In addition to lung injury, rodents exposed to O(3) exhibit a pronounced decrease in core body temperature at rest, which may offer a protective effect against O(3) damage. The effects of O(3) on other vertebrates have not been studied. Compared to individuals exposed to air (N=34), Bufo marinus toads exposed to O(3) (N=32) for 4 h lost 3.78 g body mass (adjusted mean from analysis of covariance, body mass mean+/-SD, 90.1+/-21.90 g). We tested the thermoregulatory responses of 22 toads in a thermal gradient 1, 24, and 48 h after 4-h exposure to air (N=11) or 0.8 ppm O(3) (N=11). Individual toad thermal preferences were also significantly repeatable across all trials (intraclass correlation=0.66, P <0.001). We did not observe a direct effect of O(3) exposure on the preferred body temperatures (PBT) of toads. However, O(3) exposure did have an indirect effect on selected temperatures. Ozone-exposed toads with higher evaporative water loss rates, in turn, also selected lower PBT, voluntary minimum, and voluntary maximum temperatures 24 h post-exposure. Ozone exposure may thus alter both water balance and thermal preferences in anuran amphibians.

Association of reactive nitrogen species metabolites, myeloperoxidase, and airway inflammation in lung transplants.

BACKGROUND: We have previously reported that patients who had single or double lung transplants had higher concentrations than controls of nitrite and nitrate, which are metabolites of reactive nitrogen species (RNS), in bronchoalveolar lavage fluid (BALF) and serum. METHODS: This study investigates implications of RNS metabolites as markers of airway inflammation in a distinct group of lung transplant patients (n = 40). All patients underwent spirometry, routine surveillance transbronchial lung biopsies, and bronchoalveolar lavage as required by clinical protocol. Four normal controls also had bronchoscopy for measurement of BALF nitrite (NO2-) and nitrate (NO3-). BALF NO2- and NO3-, myeloperoxidase (MPO), protein, and urea were assayed. Total nitrite (NO2- plus enzymatically reduced NO3-) and urea were measured in serum. RESULTS: BALF RNS metabolites were mainly NO3-. Forced expiratory volume in 1 s (FEV1) obtained near bronchoscopy was compared with best postoperative FEV1. Total nitrite in transplant patients' BALF and serum were 3.8 +/- 0.2 and 49 +/- 5 microM, respectively. Total nitrite in controls' BALF and serum were 2.2 +/- 0.7 and 19 +/- 2 microM, respectively (P < 0.05 compared with transplant values). Serum total nitrite correlated (Pearson product moment) with percentage of neutrophils in BALF (R = 0.650, P < 0.0001), MPO (R = 0.431, P = 0.0055), change in FEV1 from baseline (deltaFEV1) (R = -0348, P = 0.0298), and days after transplantation (R = 0.345, P = 0.0294). None of the associated variables, airway inflanmmation (quantified as a score, "B"), deltaFEV1, serum, or BALF total nitrite, were explained by infection. Univariate analysis of airway inflammation in patients showed that it was associated with BALF neutrophils, deltaFEV1, and serum total nitrite. CONCLUSIONS: Serum nitrite appears to reflect the degree of airway inflammation in this lung-transplant study group.

Protein nitration, metabolites of reactive nitrogen species, and inflammation in lung allografts.

This study investigated nitration and chlorination of epithelial lining fluid (ELF) proteins in patients (n = 29) who had undergone lung allotransplantation. We assayed lung lavage nitrotyrosine (NT) and chlorotyrosine (CT) by HPLC. We measured NT, nitrate (NO(3)(-)), and nitrate (NO(2)(-)) in bronchoalveolar lavage fluid (BALF) and total nitrite (NO(2)(-) + NO(3)(-)) in serum of another group of lung transplant patients (n = 82). In the first group (n = 29), percent nitration of tyrosines (Tyr) (NT/total Tyr x 100) in BALF proteins was: patients, 0.01 (0.00-0.12)%; median (25th-75th% confidence interval), and control subjects 0.01 (0.00-0.02)%. CT (CT/ total Tyr x 100) occurred only in the patients' BALF: 0.01 (0. 00- 0.02)%. In the second group (n = 82), nitrotyrosine (NT) was detected by ELISA in the BALF of patients: 9 (0-41) pmol/mg pro and control subjects: 28 (26-33). Total nitrite (NO(2)(-) + NO(3)(-)) in BALF of the patients: 3.3 (1.9-5.1) microM significantly exceeded that in control subjects: 1.3 (0.8-1.3) microM; p = 0.0133. Serum nitrite also was significantly higher in patients: 37 (26-55) microM than control subjects: 19 (17-20) microM; p = 0.0037. Airway inflammation in transbronchial biopsies (B score) correlated with NT in BALF (p = 0.0369). Lung transplants have increased airway concentrations of reactive nitrogen species (RNS) metabolites. NT, a marker of peroxynitrite (ONOO(-)), is related to the degree of airway inflammation in lung transplants.

[Persistent diarrhea] / Diarréia persistente.

INTRODUCTION: Persistent diarrhea has high impact on infantile morbidity and mortality rates in developing countries. Several studies have shown that 3 to 20% of acute diarrheal episodes in children under 5 years of age become persistent. DEFINITION: Persistent diarrhea is defined as an episode that lasts more than 14 days. ETIOLOGY: The most important agents isolated in persistent diarrhea are: Enteropathogenic E. coli (EPEC), Salmonella, Enteroaggregative E. coli (EAEC), Klebisiella and Cryptosporidium. CLINICAL ASPECTS: In general, the clinical characteristics of patients with persistent diarrhea do not change with the pathogenic agent. Persistent diarrhea seems to represent the final result of a several insults a infant suffers that predisposes to a more severe episode of diarrhea due to a combination of host factors and high rates of enviromental contamination. Therefore, efforts should be made to promptly treat all episodes of diarrhea with apropriate follow-up. THERAPY: The aim of the treatment is to restore hydroelectrolytic deficits and to replace losses until the diarrheal ceases. It is possible in the majority of the cases, using oral rehydration therapy and erly an appropriate type of diet. PREVENTION: It is imperative that management strategies also focus on preventive aspects. The most effective diarrheal prevention strategy in young infants worldwide is promotion of exclusive breast feeding.

[Lethality in hospitalized infants with acute diarrhea: risk factors associated with death]. / Letalidade em crianças hospitalizadas com diarréia aguda--fatores de risco associados ao óbito.

OBJECTIVES: Acute diarrhea is a very frequent disease in developing countries and is the first cause of death in infants under 2 years of age. This study was designed to evaluate the clinical and epidemiological factors associated to the death of 17 out of 511 infants hospitalized owing to severe acute diarrhea, between January 1989 and December 1995. PATIENTS AND METHODS: The patients were divided into two groups according to their clinical evolution: Group I--Death and Group II--Survival. The following parameters were evaluated: birth weight, sex, age, duration of diarrhea (days) prior to admission, nutritional status, hydration, presence of an enteropathogenic agent in the stools, food intolerance and duration of hospitalization. RESULTS: The analyzed factors have shown a significant association with death for the following variables: age, relative risk (RR) = 4.0 for infants less than 6 months of age, identification of an enteropathogenic Escherichia coli (EPEC) strain in the stools (RR = 3.3), severe malnutrition at admission to the hospital (RR = 4.5), Occurrence of food intolerance during hospitalization (RR = 2.7). Some enteropathogenic agent was identified in the stools of 253 (54.9%) infants, among the 461 (90.2%) studied. Group I revealed the presence of an enteropathogenic agent in 75% of the cases. The most frequent agents identified in Group I was: EPEC (56.3%) and Shigella (12.5%), while in Group II EPEC was identified in 26.5% of the patients. CONCLUSIONS: The association of some factors such as age less than 6 months, severe malnutrition, food intolerance and the identification of EPEC strains in the stool culture are indicators of high risk of death in infants hospitalized due to severe acute diarrhea.

Letalidade em crianças hospitalizadas com diarréia aguda fatores de risco associados ao óbito / Lethality in hospitalized infants with acute diarrhea: risk factors associated to death

Objetivo. Diarréia aguda é enfermidade freqüente em países subdesenvolvidos. Este estudo teve a finalidade de avaliar os fatores clínicos e epidemiológicos associados ao óbito em 17 crianças, dentre 511 hospitalizadas com diarréia aguda na Fundaçao Hospital Italo Brasileiro Umberto I, entre janeiro de 1989 e dezembro de 1995. Pacientes e Métodos. Os pacientes foram divididos em 2 grupos: óbito e sobrevida, de acordo com a evoluçao clínica ao término da internaçao. Os parâmetros avaliados foram: peso de nascimento, sexo, idade, procedência, tempo de duraçao da diarréia anterior à admissao, estado nutricional, estado de hidrataçao, agente enteropatogênico identificado nas fezes, tolerância alimentar e tempo de duraçao da internaçao. Resultados. Os fatores que mostraram associaçao significativa com óbito foram: idade, com risco relativo (RR)=4 para crianças com idade inferior a 6 meses; presença de Escherichia coli enteropatogênica clássica (EPEC) nas fezes (RR=3,3), desnutriçao protéico-calórica de III grau à internaçao (RR=4,5) e a ocorrência de intolerância alimentares no decorrer da internaçao (RR=2,7). Algum agente etiológico foi identificado nas fezes de 253 (54,9 por cento) crianças, dentre as 461 (90,2 por cento) pesquisas realizadas. Dentro do grupo óbito, a positividade da pesquisa etiológica foi de 75 por cento. O agente mais freqüentemente isolado no grupo óbito foi EPEC (56,3 por cento), seguido de Shigella (12,5 por cento). Os sorogrupos de EPEC (26,5 por cento) também foram os mais freqüentemente isolados no grupo sobrevida. Conclusoes. Idade inferior ou igual a seis meses, presença de EPEC nas fezes, desnutriçao protéico-calórica de III grau e intolerância alimentar sao fatores que estao interrelacionados na determinaçao de maior risco de morte nas crianças hospitalizadas com diarréia aguda. Septcemia e broncopneumonia apresentaram-se como importantes causas prováveis de óbito nas crianças hospitalizadas com diarréia aguda.

Y-chromosome identification by PCR and gonadal histopathology in Turner's syndrome without overt Y-mosaicism.

OBJECTIVE: The frequency of gonadoblastoma is high in patients with Turner's syndrome bearing cells with Y or partial Y-chromosome. About 60% of patients with Turner's syndrome have a 45,X karyotype. In 30% of them a Y-sequence is disclosed by DNA analysis. To identify patients at risk of developing gonadoblastoma, a PCR based assay with SRY, ZFY and DYZ3 specific primers was carried out to detect different Y-sequences in the DNA of peripheral lymphocytes from patients with Turner's syndrome. DESIGN AND PATIENTS: Peripheral blood karyotypes from 36 patients with Turner's syndrome were studied. Patients with proven Y-chromosomal material were excluded. Genomic DNA was extracted from peripheral blood. SRY and ZFY genes and DYZ3 repetion of Y-chromosome were amplified by PCR. Patients with clinical signs of hyperandrogenism or with positive Y-sequences by PCR underwent gonadectomy. The gonadal tissues were examined for Y-sequences using PCR, morphology and immunohistochemical study. MEASUREMENTS: Turner's syndrome and signs of hyperandrogenism were evaluated both clinically and through laboratory tests. Haematoxylin and eosin staining was employed in gonadal morphology studies. The presence of testosterone was detected by immunohistochemistry using a monoclonal antibody. RESULTS: Two patients who had Y-positive blood samples and three hyperandrogenic (2 hirsutes, 1 virilized) Y-negatives underwent gonadectomy. PCR was carried out on their gonadal tissue. The tissue from the two patients without hyperandrogenism was Y-positive. The gonadal tissue from the three hyperandrogenics was Y-negative. Gonadal morphology disclosed hilus cell hyperplasia in the 3 hyperandrogenic Y-negatives and in one Y-positive patient; stromal luteoma and hyperthecosis in the virilized patient, cystadenofibroma in one hirsute patient and gonadoblastoma in one Y-positive. Testosterone was detected immunohistochemically in the hilus cell hyperplasia, stromal luteoma and hyperthecosis found in the hyperandrogenic patients. CONCLUSIONS: The molecular study was sensitive and useful in the evaluation of patients at risk of developing gonadoblastoma. Other nontumour, gonadotrophin-dependent and Y-independent mechanisms which deserve the same medical approach may be involved in the genesis of hyperandrogenic signs in Turner's syndrome.

Acute diarrhea and malnutrition: lethality risk in hospitalized infants.

OBJECTIVES: Acute diarrhea is a very frequent disease in developing countries and is the first cause of death in infants under two years of age. This study was designed to evaluate the clinical and epidemiological factors associated to the death of 17 out of 511 infants hospitalized due to severe acute diarrhea between January 1989 and December 1995. PATIENTS AND METHODS: The patients were divided into two groups according to their clinical evolution: Group I--Death and Group II--Survival. The following parameters were evaluated: birth weight, gender, age, duration of diarrhea (days) prior to admission, nutritional status, hydration, presence of an enteropathogenic agent in the stools, food intolerance and duration of hospitalization. RESULTS: The analyzed factors have shown a significant association with death for the following variables: age, relative factor of death (RFD)=4.0 for infants less than six months of age, identification of an enteropathogenic Escherichia coli (EPEC) strain in the stools (RFD=3.3), severe malnutrition at admission to the hospital (RFD=4.5), occurrence of food intolerance during hospitalization (RFD=2.7). Some enteropathogenic agent was identified in the stools of 253 infants (54.9%), among the 461 (90.2%) studied. Group I revealed the presence of an enteropathogenic agent in 75% of the cases. The most frequent agents identified in Group I were: EPEC (56.3%) and Shigella (12.5%), while in Group II EPEC was identified in 26.5% of the patients. CONCLUSIONS: The association of some factors, such as age less than six months, severe malnutrition, food intolerance and the identification of EPEC strains in the stool culture, indicate a high risk of death in infants hospitalized due to severe acute diarrhea.

[Mortality in breast-fed infants with persistent diarrhea: risk factors associated with death]. / Letalidade em lactentes com diarréia persistente: fatores de risco associados ao óbito.

OBJECTS: Persistent diarrhea is a frequent disease in developing countries. In this research, we studied 21 patients that passed away among 189 that were hospitalized with persistent diarrhea at the "Hospital Italo Brasileiro Umberto I Foundation", from January of 1985 until December of 1992. PATIENTS AND METHODS: The patients were distributed into two groups: survival and dead, in accord of the clinical evolution at the end of the internment. The analyzed parameters were: birth weight, sex, age, provenance, diarrhea period before the admission, nutritional status, hydration status, coprologic results, occurrence of food intolerance, internment period and the age of ending breast-feeding. RESULTS: The parameters that showed significantly association with the death were: age, with relative risk = 3 for children with age below 6 months old; provenance, with relative risk = 3.4 for patients who were arrived from other hospitals; third grade dehydration at the admission (relative risk = 2.9); enteropathogenic Escherichia coli (EPEC) isolated in feces (relative risk = 3.3), and use of total parenteral nutrition. The etiologic research was positive in 57.1% of the cases. The enteropathogen more frequently isolated in dead group, was EPEC (42.9%), followed by Shigella (9.5%) and Salmonella (5.9%). From the isolated EPEC (35/189), 26 (74.3%) were belonged to the OIII sorogroup (6/26). From these children, 23.1% died. From the 35 patients with EPEC isolated in feces, 25 were below 6 months old, and from these one, eight died. The relative risk to die for lactents with less than 6 months old and EPEC in feces was equal 3.2. Sepsis was considered the most important cause of death for hospitalized lactents with persistent diarrhea.