Fibrilação atrial no idoso: uma abordagem prática / Atrial fibrillation in the elderly: a practical approach

A incidência da fibrilação atrial aumenta com a idade, bem como as complicaçöes decorrentes dela própria e de seu tratamento, isto é, a anticoagulação. A principal complicação é a embolia cerebral, aumentada no idoso. Infelizamente, a incidência de complicaçöes hemorrágicas graves devido aos anticoagulantes está também aumentada e o ácido acetilsalicílico não se mostrou muito eficaz nessa faixa etária. A disfunção diastólica e as cardiopatias usualmente concomitantes tornam o idoso particularmente sensível às alteraçöes hemodinâmicas impostas pela fibrilação atrial, não sendo raras a dispnéia, as palpitaçöes constantes, a insufuciência cardíaca e as síncopes. Sendo assim, os autores propöem uma ênfase maior na tentativa de restauração e manutenção do ritmo sinusal nessa população, a fim de evitar a ocorrência de embolias sistêmicas sem o risco de hemorragias, além de proporcionar melhora mais eficaz da sintomatologia.

Induced tolerance and chimaerism in human fetuses using coelocentesis: a medical opportunity to avert genetic disease?

Coelocentesis offers a new opportunity for gaining access to the coelomic cavity of human embryos from 28 days post-fertilization (42 days menstrual age). With this technique, cells can be extracted from the cavity for the genetic typing of embryos in early pregnancy. Coelocentesis may also offer a unique opportunity of inducing tolerance to foreign grafts and chimaerism in these human embryos by replacing donor cells into the coelomic cavity. This cavity appears to be closely associated with the fetal haemopoietic system. The optimal age to inject stem cells designed to produce chimaerism may be at 5-6 weeks embryonic age, and these grafted cells may induce tolerance later in gestation. Two successive coelocenteses would be needed, the first to extract fetal cells to type the fetus, and a second within a few days to inject the donor cells into the coelomic cavity. Alternatively, non-invasive methods of diagnosis such as lower uterine pole extramembranous sampling of fetal trophoblast, or the extraction of fetal cells from maternal blood, could be combined with coelocentesis. If tolerance and chimaerism can be established, repeated tissue grafts could be carried out during fetal life and after birth, so that disorders caused by single or multiple gene defects in the haemopoietic system and other organs may be corrected.

White blood cell count in healthy Sierra Leoneans.

The lack of standard local values for use as reference values has been a problem facing our haematological units in Sierra Leone for a long time. As a preliminary step towards the establishment of standard local values, one hundred and sixty apparently healthy Sierra Leoneans between the ages of 10 years to 50 years and above living in Freetown were investigated for the determination of total and differential white blood cells counts. The total white cell count was done by using the neubeur counting chamber whilst the differential white cell count was done from a thin blood smear stained with leishman's stain. A mean white blood cell count of 5.0 x 10(9)/L was obtained for the study group with a range of 2.4-12.0 x 10(9)/L. The study did not show any significant difference in white blood cell count between males and females. A mean differential neutrophil count of 56% was obtained for the study group and a mean differential lymphocyte count of 37% were obtained for the study group. The leucopenia obtained for the study group is thought to be due to the neutropenia and is probably thought to be a genetically determined characteristic of the indigenous Africans.

[Radiofrequency ablation of incessant supraventricular tachycardia due to anomalous pathway of retrograde decremental conduction]. / Ablação por radiofreqüência de taquicardia supraventricular incessante por via anômala de condução retrögrada decremental.

Woman, 46 years-old with incessant supraventricular tachycardia and tachycardiomyopathy. The diagnosis of a concealed retrograde long conduction time accessory pathway was obtained with the delay of the next atrial activation by delivering a ventricular premature beat during His bundle refratoriness. During electrophysiologic investigation the earliest atrial activation was found to be within the coronary sinus ostium. Two 25 watts applications of radiofrequency were followed by the interruption of the incessant supraventricular tachycardia. The patient has remained symptom free without recurrence for 60 days. Radiofrequency was effective for the treatment of this tachycardia.

Dental survey in Nigeria. Part 4. Prevalence and severity of periodontal diseases.

Six hundred and seventy-three school children from the age of 3 to 20 living in the urban and the rural areas of Nigeria were examined by the Joint Dental Epidemiological Survey in 1986. The survey was funded by the Grant-in-Aid from the Japanese Ministry of Education, Science and Culture, and was conducted by both the Japanese survey team and the staff from the University of Ife, Ile-Ife, Nigeria. The periodontal state of the children was evaluated according to the Community Periodontal Index for Treatment Needs (CPITN) by WHO (1). The prevalence of periodontal diseases was found to be 84.2% within the sample with a high occurrence of gingivitis and heavy deposits of calculus. However, there was little evidence of damage to the periodontal tissues. This can be attributed to the nature of their diet. The results suggested that there would be an increasing need for well-planned and organized public educational programs for the Nigerian children to promote better oral hygiene coupled with parental involvement in the prevention at home.

Dental survey in Nigeria. Part 2. Biting force of Nigerian.

The biting force of 855 Nigerian children and adults from the age of 3 to 60 was recorded in the Joint Dental Epidemiological Survey in Nigeria in 1981. The biting force of the Nigerian rural group (245 males and 178 females) was significantly greater than those of the Nigerian urban group (227 males and 203 females) and the Japanese males and females.

Light and electron histochemistry of phosphoamidase with p-chloranilidophosphonic acid and with cyclophosphamide (endoxan).

The original metal-salt technique of Gomori (1948a) employing p-chloranilidophosphonic acid as a substrate for the demonstration of the activity of phosphoamidase has been used with varying success by a number of investigators for light microscopy. Cyclophosphamide (endoxan) which is a cytotoxic drug known to activate phosphoamidase and other lysosomal enzymes in neoplasm (Grillo, 1971) is proposed as another substrate for the enzyme for both light and electron microscopy.

Cellular changes in tissues of newborn mice infected with Mokola virus: ultrastructural and biochemical changes.

Cellular and biochemical changes which occurred in the tissues of newborn mice infected with Mokola virus, a rabies-related virus (rhabdovirus group), were described. The virus was transmitted along the peripheral nerves and appeared in various tissues of the body, but did not replicate in any except the nervous system, where it manifested its gross effects. While Mokola virus increased the synthesis of glycogen and total protein in infected brain, liver, lung, spleen and heart, it reduced the activity of monoamine oxidase in the brain. Virus multiplication occurred in the normal rough endoplasmic reticulum. During virus reproduction the membranes of the endoplasmic reticulum, Golgi complex and mitochondria were destroyed and replaced by a viral matrix. Virus maturation also occurred within the rough endoplasmic reticulum.

Statement of objectives of medical education

Gives examples of National and Institutional objectives for medical education in Malawi