Suicide risk in people living with AIDS/HIV: the effect of childhood trauma is mediated by mental disorders and social vulnerability.

Suicide is an important problem in people living with HIV/AIDS (PLWHA). The importance of mental disorders and social vulnerability on suicidal behaviors is described in the literature; however, the impact of childhood traumatic events in this scenario is not clear. The aim of this study was to verify the mediation effect of mental disorder comorbidities and social vulnerability in association with childhood trauma intensity and suicide risk level. This cross-sectional study of HIV-positive outpatients was conducted in a specialized care service in the city of Pelotas in Southern Brazil. Sociodemographic data and HIV-related information were collected and the Childhood Trauma Questionnaire was applied. A total of 364 patients underwent psychiatric evaluation using MINI Plus including module C of suicide risk severity. Suicide risk was present in 39.3% of the sample. The relation between childhood traumatic events and the level of suicide risk is mediated by mental disorder comorbidities and socioeconomic vulnerability. Specific psychosocial interventions in PLWHA should consider the potential role of abusive traumatic experiences in the current mental health conditions and suicidal behaviors.

Distal radius and tibia bone microarchitecture impairment in female patients with diffuse systemic sclerosis.

Radius and tibia bone microarchitecture, analyzed through a high-resolution peripheral quantitative computed tomography, were significantly impaired in female patients with diffuse systemic sclerosis compared with healthy controls. Acroosteolysis, quality of life-grip strength, hand disability, and disease duration were significantly associated with this bone deterioration. INTRODUCTION: The effect of diffuse systemic sclerosis (dSSc) on the bone is not completely understood. The objective of this study was to analyze the volumetric bone mineral density (vBMD), microarchitecture, and biomechanical parameters at the distal radius and tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT, XtremeCT) in female patients with dSSc and identify clinical and laboratory variables associated with these parameters. METHODS: Thirty-eight women with dSSc and 76 healthy controls were submitted to HR-pQCT at the distal radius and tibia. Clinical and laboratory findings, bone mineral density(BMD), nailfold capillaroscopy (NC), total passive range of motion(ROM), and quality of life (health assessment questionnaire-HAQ) were associated with HR-pQCT (Scanco Medical AG, Brüttisellen, Switzerland) parameters. Multiple linear regression models adjusted for clinical and laboratory variables, ROM and HAQ, were performed. RESULTS: Density, microarchitecture, and biomechanical parameters at the distal radius and tibia were significantly impaired in dSSc patients compared with healthy controls (p < 0.001). Multiple linear regression models showed that lower trabecular density (Tb.vBMD) (radius R2 = 0.561, p = 0.002; and tibia R2 = 0.533, p = 0.005), and lower trabecular number (Tb.N) (tibia R2 = 0.533, p = 0.005) were significantly associated with acroosteolysis. Higher trabecular separation (Tb.Sp) was associated with disease duration and higher HAQ-grip strength (radius R2 = 0.489, p = 0.013), while cortical density (Ct.vBMD) was associated with ROM (radius R2 = 0.294, p = 0.002). CONCLUSION: Bone microarchitecture in patients with dSSc, analyzed through HR-pQCT, showed impairment of trabecular and cortical bone at distal radius and tibia. Variables associated with hand involvement (acroosteolysis, quality of life-grip strength, and ROM) and disease duration may be considered prognostic factors of this bone impairment.

Experimental Observation of Proton Bunch Modulation in a Plasma at Varying Plasma Densities.

We give direct experimental evidence for the observation of the full transverse self-modulation of a long, relativistic proton bunch propagating through a dense plasma. The bunch exits the plasma with a periodic density modulation resulting from radial wakefield effects. We show that the modulation is seeded by a relativistic ionization front created using an intense laser pulse copropagating with the proton bunch. The modulation extends over the length of the proton bunch following the seed point. By varying the plasma density over one order of magnitude, we show that the modulation frequency scales with the expected dependence on the plasma density, i.e., it is equal to the plasma frequency, as expected from theory.

Analysis of polymorphisms of TNF-α, LT-α, IL-10, IL-12 and CTLA-4 in patients with warm autoimmune haemolytic anaemia.

INTRODUCTION: Autoimmune haemolytic anaemia (AIHA) is defined as the increased destruction of red blood cells (RBCs) in the presence of anti-RBC autoantibodies and/or complement. Its pathogenesis is multifactorial and includes changes in mechanisms of cytokine production and functionality. A number of recent studies have implicated cytokines polymorphisms in the pathogenesis of autoimmune diseases. The aim of this study was to determine the frequency of polymorphisms of tumour necrosis factor alpha (TNF-α), lymphotoxin-α (LT-α), interleukin 10 (IL-10), interleukin 12 (IL-12) and cytotoxic T-lymphocyte antigen-4 (CTLA-4) in patients with AIHA in comparison with healthy individuals. METHODS: The study population consisted of 17 patients with AIHA and 40 healthy controls. The polymorphisms for TNF-α-308, LT-α +252, IL-10 -592, IL-12 +1188 and CTLA-4 +49 were examined by polymerase chain reaction followed by specific restriction enzyme digestion. RESULTS: There was no significant difference in the phenotypic distributions of polymorphisms of the TNF-α, IL-10, IL-12 and CTLA-4 between the patients and controls. Compared with healthy controls, patients with AIHA had a significant higher frequency of LT-α (+252) AG phenotype (41%vs. 13%; P = 0.032). CONCLUSION: In this study, no significant differences on the frequency of TNF-α, IL-10, IL-12 and CTLA-4 polymorphisms between patients with AIHA and controls was found, suggesting that the targeted polymorphisms do not influence on the emergence and evolution of the disease. However, the LT-α +252 polymorphism might have an effect for AIHAI development, suggesting that further studies are necessary to clear up this question.

Digestibilidade aparente de rações contendo complexo enzimático para tilápia-do-nilo / Apparent digestibility of diets containing enzyme supplement for Nile tilapia

Avaliou-se a digestibilidade aparente de cinco rações isoproteicas e isoenergéticas contendo 0; 0,1; 0,2; 0,3 e 0,4g do complexo enzimático Bioenzimaplus (lipase, protease e carboidrase)/kg de ração na alimentação da tilápia-do-nilo. Foram utilizados 100 peixes distribuídos em cinco aquários de alimentação e cinco aquários de coleta de fezes. Os cinco tratamentos foram arranjados em delineamento inteiramente ao acaso com cinco repetições. Houve efeito linear de tratamento sobre a digestibilidade aparente (CDa) para proteína bruta e extrato etéreo. O CDa da proteína bruta e do extrato etéreo variaram de 81,60 por cento a 84,93 por cento e de 74,19 por cento a 82,69 por cento, respectivamente. Para carboidrato e energia bruta, o maior nível de suplementação resultou em maior CDa, 57,85 por cento e 63,78 por cento, respectivamente( P<0,05). Não foi observada diferença entre tratamentos no CDa da matéria seca, apresentando valores de 49,47 por cento a 58,55 por cento. A inclusão de complexo enzimático - lipase, protease e carboidrase - em dietas para tilápia-do-nilo melhorou a digestibilidade da proteína, do extrato etéreo, do carboidrato e da energia das rações.

Apparent digestibility (ADC) of five isoproteic and isoenergetic diets containing 0, 0.1, 0.2, 0.3, and 0.4g/kg of enzymatic complex Bioenzimaplus (lipase, protease, and carbohydrase) for Nile tilapia was evaluated. A hundred fish were randomly assigned in five feeding aquaria, and five collecting feces ones. Treatments were composed by five enzymatic complex levels arranged in a completely randomized design in five repetitions. Significant differences (P<0.05) were observed with the inclusion of enzymatic complex in the diets for ADC of crude protein and fat (linear effect). ADC of crude protein and fat varied from 81.60 percent to 84.94 percent and 74.19 percent to 85.69 percent, respectively. The highest enzyme supplementation level showed better digestibility values for carbohydrate and gross energy (57.85 percent and 63.78 percent, respectively). No difference was observed for ADC of dry matter showing values between 49.47 percent and 58.55 percent. The use of enzymes in Nile tilapia diets improved the digestibilities of protein, fat, carbohydrate, and gross energy digestibility.

A very strict guideline reduces the number of erythrocyte transfusions in preterm infants.

BACKGROUND AND OBJECTIVES: Benefits of adopting restrictive guidelines for erythrocyte transfusions are still controversial. The objective of this study was to verify if a very strict guideline could reduce erythrocyte transfusions in preterm infants without adverse outcomes. MATERIALS AND METHODS: Two prospective cohorts of neonates with gestational age < 37 weeks and birth weight < 1500 g were studied. Neonates born in Period 1 were submitted to a strict guideline for erythrocyte transfusions. In Period 2, a new stricter protocol was introduced. Infants of both periods were compared regarding number of transfusions and clinical outcome. RESULTS: The median number of transfusions decreased from 2 (1 to 14) in Period 1 to 1 (1-9), P = 0.001, in Period 2. The linear regression multivariate analysis showed that the implementation of the stricter guideline was associated with a reduction in the number of transfusions received by patients by 0.55 (95% confidence interval: -0.08; -1.02) units/patients. Number of apnea episodes, weight at 28 days of life and days of hospital stay were similar in both periods. Intra-hospital death was lower in Period 2. CONCLUSION: A very strict guideline reduced the number of erythrocyte transfusions in preterm infants, without threatening their clinical course.

Muscle delta13C change in Nile tilapia (Oreochromis niloticus) fingerlings fed on C3-or C4-cycle plants grain-based diets.

The effects of grain-based diets from C3 or C4-cycle plants on muscle delta(13)C change process in Nile tilapia (Oreochromis niloticus) fingerlings were investigated. Two groups of sex reversal males Nile tilapia fingerlings were fed with isoproteic (32.0% DP) and isocaloric (3200 kcal DE/kg) diets, differing from each other by their delta(13)C. Muscle samples were collected and the carbon isotopic composition was measured. For C4 diet, the formula for the muscle delta(13)C change related to the intake time of a new diet was delta(13)C=-14.88-9.21e(-0.0209t) and the half-life (T) of the muscle carbon was 33.2 days. For C3 diet, the formula was delta(13)C=-25.43+8.59e(-0.0533t) with T=13 days. The C3 diet was considered more appropriate based on its palatability and consequent larger food intake than the C4 diet, resulting in an increased muscle delta(13)C change rate. However, for future studies, would be necessary to mix both the C3 and C4 feedstuffs to formulate diets nutritionally appropriated, with contrasting stable isotopes signatures. Tissue delta(13)C change rate is therefore indicated as a promising tool to better understand the biotic and abiotic factors that influence nutrients utilization from the diet and animal growth.

Muscle delta13C change in Nile tilapia (Oreochromis niloticus): effects of growth and carbon turnover.

The contribution of growth and turnover to the muscle delta(13)C change process was investigated using mathematical models which associate delta(13)C change to time of intake of a new diet or increase in body mass. Two groups of Nile tilapia (Oreochromis niloticus) were fed on diets based on C3 (delta(13)C=-25.64+/-0.06 per thousand) or C4 (delta(13)C=-16.01+/-0.06 per thousand) photosynthetic cycle plants to standardize the muscle delta(13)C. After establishing the carbon isotopic equilibrium, fish (mean mass 24.12+/-6.79 g) then received the other treatment diet until a new carbon isotopic equilibrium could be established, characterizing T1 (C3-C4) and T2 (C4-C3) treatments. No significant differences were observed in fish productive performance. Good fits were obtained for the models that associated the delta(13)C change to time, resulting in carbon half-life values of 23.33 days for T1 and 25.96 days for T2. Based on values found for the muscle delta(13)C change rate from growth (0.0263 day(-1) and 0.0254 day(-1)) and turnover (0.0034 day(-1) and 0.0013 day(-1)), our results indicate that most of the delta(13)C change could be attributed to growth. The application of model that associated the delta(13)C change to body mass increase seems to produce results with no apparent biological explanation. The delta(13)C change rate could directly reflect the daily ration and growth rate, and consequently the isotopic change rates of carbon and other tissue elements can be properly used to assess different factors that may interfere in nutrient utilization and growth.

Teenage pregnancy: use of drugs in the third trimester and prevalence of psyquiatric disorders

Objetivo: Determinar, em adolescentes de baixa renda, a prevalência de transtornos psiquiátricos durante a gravidez, a prevalência de uso de cocaína e maconha no terceiro trimestre de gestação e descrever suas características sociodemográficas. Método: Mil adolescentes grávidas foram avaliadas por meio do Composite International Diagnostic Interview e de um questionário sociodemográfico e socioeconômico no centro obstétrico de um hospital público de São Paulo. Dessas, foi colhida amostra para análise de fios de cabelo. Resultados: Das mil pacientes entrevistadas, 53,6% tem baixa renda , 60,2% abandonaram a escola, 90,4% estão desempregadas e 92,5% são financeiramente dependentes, 6% usaram drogas durante o terceiro trimestre da gravidez (maconha: 4%, cocáina1,7%, ambos: 0,3%) e 27,6% tiveram ao menos um transtorno psiquiátrico. Os diagnósticos mais frequentes foram: depressão(12,9%), transtornos de estresse pós-traumático(10,0%) e ansiedade (5,6%). Discussão: Famílias desestruturadas, evasão escolar, desemprego e baixa capacitação profissional são fatores que contribuem para a manutenção desta situação socioeconômica desfavorável, cenário no qual são elementos importantes a alta prevalência de uso de cocaína e maconha no 3º trimestre de gravidez e de transtornos psiquiátricos.(AU)

Prevención de la neumonía del adulto adquirida en la comunidad / Prevention of community-acquired pneumonia in adults

Polysaccharide 23 valent pneumococcal vaccine commercially available from 1983 includes 23 serotypes of Streptococcus pneumoniae, representing near 90% of strains involved in invasive pneumococcal disease in immune competent adults. Vaccine confers protection against invasive pneumococcal disease. Immunization is recommended in adults over 65 years old, in patients affected by chronic diseases (cardiopathies, COPD, nephropathies, diabetes mellitus, hepatic cirrhosis, chronic breakage in brain-blood barrier, functional or anatomical asplenia, alcoholism), in immunocompromised hosts, including HIV infection, chemotherapy treatment and hematological malignancies. Influenza vaccine is prepared with particulated antigens, including two influenza A strains and one influenza B strain, selected according to influenza epidemiological worldwide surveillance the year before. On account of continuous antigenic changes (drifts), it is necessary to modify the vaccine antigen's composition yearly. Cost/effectiveness evaluation has confirmed the efficacy of influenza vaccine in reducing morbidity and mortality associated to influenza epidemic and health economical resources involved in patient care. Besides, clinical trials have confirmed that immunization reduces the risk of acquiring pneumonia, of hospitalization and death in elderly people during the influenza epidemic, when vaccine antigenic composition is similar to the circulating strains. Vaccination is recommended annually in healthy adults over 65 years old, in patients with chronic diseases (cardiopathies, COPD, nephropathies, diabetes mellitus, hepatic cirrhosis, chronic breakage of blood-brain barrier, functional or anatomical asplenia, alcoholism). It is also recommended in women who will be in the second or third trimester of pregnancy during the influenza season, in immunocompromised hosts, in institutionalized patients (geriatrics)...

La vacuna anti neumocóccica polivalente disponible desde 1983 incluye 23 serotipos de Streptococcus pneumoniae, que representan cerca de 90% de las cepas que ocasionan enfermedad neumocóccica invasora en adultos inmunocom-petentes. La vacuna confiere protección contra la enfermedad neumocóccica invasora. Se recomienda vacunar a los adultos sanos sobre 65 años de edad, portadores de enfermedades crónicas (cardiopatías, EPOC, nefropatías, diabetes mellitus, cirrosis hepática, pérdida crónica de LCR, asplenia funcional o anatómica, alcoholismo), inmunocom-prometidos incluyendo los infectados por VIH, quimioterapia y neoplasias hematológicas. La vacuna anti influenza se prepara con antígenos particulados, e incluye dos tipos antigénicos de virus influenza A y una de influenza B, seleccionados de acuerdo al perfil epidemiológico que arroja la vigilancia mundial de influenza en el año anterior. Debido al cambio antigénico que se produce cada año, es necesario modificar la composición de la vacuna. Los estudios de costo-efectividad han confirmado la eficacia de la vacuna anti influenza en reducir la morbimortalidad asociada a la epidemia de influenza y los gastos de salud involucrados en el manejo de los enfermos. Además, los estudios clínicos han confirmado que la vacunación reduce el riesgo de neumonía, hospitalización y muerte en la población senescente durante la epidemia de influenza, cuando la cepa de la vacuna es similar a la presente en la comunidad. Se recomienda vacunar anualmente a los adultos sanos sobre 65 años de edad, portadores de enfermedades crónicas (cardiopatías, EPOC, nefropatías, diabetes mellitus, cirrosis hepática, pérdida crónica de LCR, asplenia funcional o anatómica, alcoholismo), mujeres embarazadas con más de 3 meses de gestación al momento de aparecer la epidemia, inmunocomprometidos, pacientes institucionalizados (geriátricos, residentes en casas de reposo), trabajadores de la salud, viajeros a áreas geográficas de epidemia

Effect of swimming session duration and repetition on metabolic markers in rats.

The aim of this study was to investigate the profile of metabolites in male rats subjected to 50-60 min of swimming on three protocols: group A, a single 50 min swimming session; group B, one session a day for three days (5 min on day 1, 15 min on day 2 and 30 min on day 3); and group C, one session a day for 5 days, with increasing duration from 5 min on day 1, 15, 30, 45 and 60 min on consecutive days. The interval between sessions was 24 h. Measurements were made after the last swimming session. Controls did not swim. The glycogen content of liver and gastrocnemius and soleus muscle was depleted in the three groups that swam, but blood glucose concentration was significantly increased only in group B. Serum lactate concentrations were greater than the controls in groups A and B. There were significant increases in serum free fatty acid concentrations in all groups that swam. The increases in plasma free fatty acids may have resulted from lipolysis stimulated by endogenous catecholamines in groups A and C, since basal lipolysis measured in vitro was unchanged by swimming. The large increase in basal lipolysis in group B may have contributed to the rise in plasma free fatty acids. Adipocytes from rats in groups A and B were supersensitive to epinephrine, whereas those from group C were not. We conclude that the metabolic alterations were less pronounced after the last of five swimming sessions over 5 days than after a single session, even though session duration and the contribution of the physical component were similar. Glucose mobilization, but probably not utilization, was similar in the three groups that swam. The mechanisms of lipid mobilization from adipose tissue differed, depending on the stress paradigm. The metabolic changes in groups A and B indicated that three daily swimming sessions were insufficient to cause adaptation. The results contrast with previous findings for foot-shock stress, which leads to sensitization rather than adaptation in response to repeated stimuli.

Coexistence of reef organisms in the Abrolhos Archipelago, Brazil.

The first study on coexistence of reef benthic organisms in Brazilian coral reefs was done in three localities of the Abrolhos Archipelago. Organisms were recorded in concentric circle samples (10 and 20 cm in diameter) randomly laid on transects. Type and frequency of "coexistence events" between pairs of organisms were determined. Most frequent organisms (massive and branched coralline algae, Favia gravida, and Agaricia agaricites) also had many significant positive coexistence events. These results might be related to the abundances of these organisms. The most frequent coral (Siderastrea stellata), however, exhibited only a few significant coexistence events (9% of 32 tests). Since the great majority of events were positive, and since there was high variation in the species/groups involved in significant events in different localities, benthic communities of Abrolhos Archipelago may well be structured primarily by abiotic rather than biotic factors.

Randomised double-blind study comparing tropisetron alone and in combination with dexamethasone in the prevention of acute and delayed cisplatin-induced emesis.

In a randomised, double-blind and parallel-design multicentre study, 282 chemotherapy-naive cancer patients received tropisetron 5 mg intravenously (i.v.) before high-dose cisplatin on day 1, and oral tropisetron 5 mg daily on days 2-6, in combination with either placebo (n = 143) or dexamethasone (n = 135), given i.v. on day 1 and orally on days 2-6. Complete protection from acute vomiting/nausea was achieved in 76.3%/79.3% of patients receiving the combination and in 55.2%/61.5% of those receiving tropisetron alone. Complete protection on days 2-6 from delayed vomiting/nausea was obtained in 60%/60% and 39.2%/40.6%, respectively. Tropisetron in combination with dexamethasone is safe and more effective than tropisetron alone in the prevention of both acute and delayed cisplatin-induced emesis.

Utilizacao de aorta homologa conservada como protese bronquica. / Use of preserved homologous aorta as bronchial prosthesis

Oito caes foram submetidos a toracotomia esquerda e um segmento da aorta homologa conservada em glicerina foi interposto no bronquio do lobo inferior. Os animais foram seguidos por periodo de ate 180 dias, sendo estudados pela broncografia e as pecas cirurgicas enviadas a estudo histologico apos o sacrificio. A protese bronquica apresentou-se pervia em 3 casos.O estudo histologico demonstrou que a obstrucao da protese se deu devido a deficiencia de aporte sanguineo as paredes do enxerto, que sofreram reabsorcao com o evoluir e, consequencia, a sua resistencia diminuiu, o que levou ao colabamento das paredes do enxerto

Implante heterologo de dura-mater na traqueia. Estudo experimental. / Heterologous implantation of dura mater in the trachea. Experimental study

Os autores apresentam os resultados de um estudo experimental sobre a interposicao de retalhos de dura-mater humana em traqueia de caes. Foram utilizados 22 animais, divididos em tres series, de acordo com o tempo de evolucao do implante, que variou de 1 a 4 meses e meio. O comportamento do implante foi avaliado sob os parametros clinicos e anatomopatologicos. Nao foram observadas alteracoes clinicas em nenhum dos animais e, com relacao aos estudos anatomopatologicos, houve aparente integracao da dura-mater com a traqueia