Single molecule analysis of Trypanosoma brucei DNA replication dynamics.

Eukaryotic genome duplication relies on origins of replication, distributed over multiple chromosomes, to initiate DNA replication. A recent genome-wide analysis of Trypanosoma brucei, the etiological agent of sleeping sickness, localized its replication origins to the boundaries of multigenic transcription units. To better understand genomic replication in this organism, we examined replication by single molecule analysis of replicated DNA. We determined the average speed of replication forks of procyclic and bloodstream form cells and we found that T. brucei DNA replication rate is similar to rates seen in other eukaryotes. We also analyzed the replication dynamics of a central region of chromosome 1 in procyclic forms. We present evidence for replication terminating within the central part of the chromosome and thus emanating from both sides, suggesting a previously unmapped origin toward the 5' extremity of chromosome 1. Also, termination is not at a fixed location in chromosome 1, but is rather variable. Importantly, we found a replication origin located near an ORC1/CDC6 binding site that is detected after replicative stress induced by hydroxyurea treatment, suggesting it may be a dormant origin activated in response to replicative stress. Collectively, our findings support the existence of more replication origins in T. brucei than previously appreciated.

Cutaneous idiopathic hyperchromia of the orbital region (CIHOR): a histopathological study.

BACKGROUND: Dark circles under or around the eyes is a cosmetic problem for a large number of people. It is a condition of unknown etiology characterized by the darkening of the eyelids and periorbital skin. The aim of this study was to determine histopathological changes associated with cutaneous idiopathic hyperchromia of the orbital region (CIHOR). METHODS: Twenty-eight adult patients with CIHOR were consecutively selected for the study. Biopsy specimens were taken from the darkened skin of the eyelid and from the normal retroauricular skin as a control. RESULTS: Hemosiderin was absent in all cases. The increase in melanin content in the papillary dermis was slight in mild clinical cases and moderate in both the moderate and severe clinical cases of CIHOR. Mild dilation of blood vessels was observed in the papillary dermis at the different clinical levels of CIHOR severity, while in the reticular dermis, blood vessels showed moderate dilation and few melanophages were found. CONCLUSION: An increase in melanin content was the most marked histological change in specimens of darkened skin. Dilation of dermal blood vessels may contribute to the severity of CIHOR. Hemosiderin was not observed in any case. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Self-esteem and functional capacity outcomes following reduction mammaplasty.

BACKGROUND: Both physical health and psychosocial outcomes are important issues in the evaluation of medical treatment. Women with breast hypertrophy may suffer from low self-esteem and reduced functional capacity because of the size of their breasts. OBJECTIVE: The aim of this study was to evaluate the impact of reduction mammaplasty on self-esteem and functional capacity in patients with breast hypertrophy. METHODS: One hundred patients with breast hypertrophy who ranged in age from 18 to 55 years and who had undergone no previous mammary surgery were selected from the Plastic Surgery Outpatient Clinic of the Federal University of São Paulo (UNIFESP-EPM). They were randomly allocated into two groups (A and B) of 50 patients each. Patients from group A were submitted for reduction mammaplasty while those from group B were placed on the waiting list and used as a control group. At the beginning of the study, all patients were interviewed to collect clinical and demographic data and to have their self-esteem and functional capacity measured. Two Brazilian-validated versions of quality of life measurement instruments were chosen: the Rosenberg Self-Esteem Scale and Rolland-Morris (to assess functional capacity). A visual analog scale (VAS) was used to evaluate pain intensity. Six months after the beginning of the study, these instruments were again administered to both groups. RESULTS: Forty-six out of 50 patients from each group (A and B) completed the study. The mean age of group A was 31.6 years (SD, 11 yrs), and that of group B was 32.3 years (SD, 10 yrs). The mean weight of removed breast tissue from group A patients was 1052 g (SD, 188 g). A decrease on the score of Rosenberg Self-Esteem Scale of patients from group A indicated an improvement of self-esteem (P < .001). Functional capacity had improved 6 months after reduction mammaplasty (group A) as compared to the control group. Intensity of pain evaluated by the VAS in the lower back region decreased from 5.7 to 1.3. CONCLUSIONS: Reduction mammaplasty improved self-esteem and functional capacity and relieved pain in the lower back region in patients with breast hypertrophy.

Functional capacity and postural pain outcomes after reduction mammaplasty.

BACKGROUND: Neck, shoulder, and lower back pain and reduction of functional capacity can be caused by breast hypertrophy. Reduction mammaplasty appears to improve these aspects. After a systematic review of the literature, no scientific evidence was found to confirm this hypothesis. The authors' objective was to evaluate the impact of reduction mammaplasty on pain and functional capacity of patients with mammary hypertrophy. METHODS: One hundred patients with mammary hypertrophy, between 18 and 55 years old, with no previous mammary surgery, were consecutively selected from the Plastic Surgery Outpatient Clinic of the Universidade Federal de São Paulo-Escola Paulista de Medicina and randomly allocated into two groups. Group A (n = 50) underwent mammaplasty reduction immediately, whereas group B patients (n = 50) were placed on a waiting list (control group). All patients were interviewed for clinical and demographic data and evaluated to measure pain and functional capacity. To measure shoulder, neck, and lower back pain, a visual analogue scale (0 = no pain, 10 = unbearable pain) was used. The Stanford Health Assessment Questionnaire (HAQ-20), Brazilian validated version (0 = best, 3 = worst), was applied to assess functional capacity. Pain and functional capacity were measured at baseline and 6 months after surgery. RESULTS: Forty-six of 50 patients, from both groups, completed the study. The mean (+/-SD) patient age in groups A and B was 31.6 +/- 11 and 32.3 +/- 10 years, respectively. The mean breast tissue weight was 1052 +/- 188 g. Functional capacity in group A was improved 6 months after reduction mammaplasty, compared with group B (control), in the following aspects: getting dressed, getting up, walking, maintaining personal hygiene, reaching, and grasping objects. The mean pain intensity dropped in the lower back, from 5.7 to 1.3; in the shoulders, from 6.1 to 1.1; and in the neck, from 5.2 to 0.9. CONCLUSION: Reduction mammaplasty improved functional capacity and relieved pain in the lower back, shoulders, and neck of patients with mammary hypertrophy.

Adaptação cultural e validação da versão brasileira da escala de auto-estima de Rosenberg / Translation into portuguese, cultural adaptation and validation of the Rosenberg self-esteem scale

Os autores tiveram como objetivos: Traduzir para a língua portuguesa, adaptar ao contexto cultural brasileiro e validar a escala de auto-estima de Rosenberg para uma população de pacientes que irão submeter-se à cirurgia plástica. CONCLUSÃO – A versão para a língua portuguesa da escala de auto-estima de Rosenberg (EPM/Rosenberg) apresentou bons índices de reprodutibilidade e validade no nosso meio, podendo ser usada como instrumento para medir a auto-estima de pacientes brasileiros que irão submeter-se à cirurgia plástica.

Quality of life after reduction mammaplasty.

Reduction mammaplasty is a common procedure in plastic surgery. Patients seek the operation for neck and lower back pain, and social and emotional problems. The evaluation of health results based on the patient's opinion has become an important and reliable method for the analysis of alterations resulting from treatment. To evaluate the impact of plastic surgery on the quality of life of patients with mammary hypertrophy we used the SF-36 standardised questionnaire in a prospective study of 44 patients preoperatively and three and six months postoperatively. There were significant improvements in seven of the eight aspects of the SF-36 (physical function, physical role, pain, energy, social function, emotional role, and mental health). Only general health was unchanged.

Tradução para a língua portuguesa e validação do questionário genérico de avaliação de qualidade de vida SF-36 (Brasil SF-36) / Brazilian-Portuguese version of the SF-36. A reliable and valid quality of life outcome measure

Objetivos: O objetivo deste estudo foi avaliar a tradução, adaptação cultural e propriedades de medida (reprodutibilidade e validade) do SF-36 em pacientes com artrite reumatóide. Métodos: O questionário foi traduzido e adaptado culturalmetne para a população brasileira de acordo com metodologia internacionalmente aceita. O SF-36 foi administrado por meio de entrevista a 50 pacientes (7 homens) com AR. Para avaliação da reprodutibilidade, os pacientes foram entrevistados duas vezes na primeira avaliação (entrevistadores 1 e 2) e novamente dentro de um período de 15 dias (entrevistador 1). O paciente também foi submetido a avaliação clínica e laboratorial. Também foram administrados os seguintes questionários: Nottingham Health Profile (NHP), Arthritis Impact Measurement Scales 2 (AIMS2) e HAQ. Análise descritiva foi utilizada na caracterização dos pacientes. O coeficiente de correlação de Pearson foi usado para avaliação da reprodutibilidade e validade. Resultados: Somente duas questões foram modificadas na fase de tradução e adaptação cultural. A média de idade e a de duração de doença foram de 49,2 (mais ou menos 13,28) e 8,54 (mais ou menos 6,55) anos, respectivamene. As dimensões que apresentaram as menores médias foram capacidade funcioanl (59,50), limitação por aspectos físicos (63,96) e dor (66,50). A reprodutibilidade intra e interobservadores foi estatisticamente significante (0,4426 < r < 0,8468 e 0,5542 < r < 0,8101), respectivamente. Para dimensões semelhantes, as correlações entre SF-36 e HAQ, NHP e AIMS2 foram estatisticamente significantes (p<0,01). Conclusões: A versão para a língua portuguesa do SF-36 é um parâmetro reprodutível e válido para ser utilizado na avaliação da qualidade de vida de pacientes brasileiros portadores de AR

Escala EPM-ROM Pediátrica: uma escala reduzida para avaliação da amplitude de movimento articular de pacientes com artrite reumatóide juvenil / Pediatric EPM-ROM scale: a reduced scale to be used in the daily juvenile rheumatoid arthritis practice and in clinical trials

Objetivo: Desenvolver um instrumento específico para a avaliação da amplitude de movimento articular de crianças e adolescentes com artrite reumatóide juvenil (ARJ) e avaliar as suas propriedades de medida. Casuística e métodos: os 10 movimentos da escala Escola Paulista de medicina - Range of Motion (EPM-ROM) Pediátrica originaram-se de 25 movimentos iniciais. A seleção foi baseada em dois critérios: 1 )consenso entre três reumatologistas pediátricos, um fisioterapêuta e um terapeuta ocupacional e 2 )resultados e um estudo piloto envolvendo pacientes com ARJ. A nota obtida em cada movimento articular variou de zero (movimento total) a três (limitação grave) e os ângulos de corte para os movimentos foram obtidos, de modo geral, de acordo com a falta de capacidade em realizar algumas atividades comuns do dia a dia. Foram avaliadas a reprodutibilidade intra-observador (teste-reteste) e a interobservadores. A validade construída foi estudada através da correlação dos valores de alguns parâmetros clínicos rotineiramente utilizados em pacientes com ARJ com as notas da escala EPM-ROM Pediátrica. Resultados: A escala foi aplicada em 34 pacientes com ARJ (11 com tipo de início sistêmico, 11 poliarticular e 12 pauciarticular). A nota obtida (média) foi de 0,57 (0 a 2,05). A reprodutibilidade foi satisfatória. Os coeficientes de correlação de Pearson obtidos entre as notas da escala e os valores dos outros parâmetros (childhood Health Assessment Questionaire, classe funcional do American College of Rheumatology e número de articulações acometidos) variaram entre 0,55 e 0,65 (p<0,05). Conclusão: A escala EPM-ROM Pediátrica é um instrumento válido e reprodutível e é útil na avaliação de pacientes com ARJ

Adaptação ao contexto cultural brasileiro e validação do "Caregiver Burden scale" / Adaptation and validation of the caregiver burden scale to Brazilian cultural milieu

Objetivo: Traduzir para a língua portuguesa, adaptar culturalmente e validar para o Brasil um instrumento para medir o impacto subjetivo das doenças crônicas na vida dos cuidadores: Caregiver Burden Scale (CB scale). Material e métodos: o CB scale foi traduzido e adaptado ao contexto brasileiro seguindo normas propostas pela literatura pertinente. O questionário adaptado foi aplicado em 30 cuidadores de pacientes com doenças reumáticas, em três momentos diferentes, para determinar a reprodutibilidade. A validade de construção foi testada por correlações com variáveis clínicas e de qualidade de vida de 62 cuidadores e 62 pacientes com artrite reumatóide. Resultados: Todas as 22 questões do CB scale foram consideradas aplicáveis no contexto cultural brasileiro e modificações foram feitas em quatro questões. Os coeficientes de reprodutibilidade intra e interobservador foram 0,87 e 0,92, respectivamente. A validade do instrumento foi comprovada por meio de correlações com outras variáveis dos cuidadores. Conclusões: A versão em português do CB scale mostrou ser um instrumento válido e reproduzível

Estudo do fator von Willebrand em pacientes com esclerose sistêmica / Evaluation of serum von Willebrand factor in systemic sclerosis

Objetivo: Avaliar o papel do fator de von Willebrand (vWf:Ag) como possível marcador sorológico de atividade ou gravidade na esclerodermia sistêmica. Métodos: Determinaçao do vWf:Ag pela técnica de ELISA em 26 portadores de esclerodermia sistêmica que preenchiam os critérios do Colégio Americano de Reumatologia e sua correlaçao com vários parâmetros clínicos e laboratoriais. Especial atençao foi dada a parâmetros de extensao (forma limitada x difusa, número de sistemas envolvidos) e gravidade (escore clínico de gravidade, velocidade de progressao) da doença. Foi utilizado grupo-controle com 46 indivíduos saos,doadores de sangue. A significância estatística foi determinada pelo teste do qui-quadrado ou pelo exato de Fisher. Resultados: O vWf:Ag estava significativamente aumentado nos pacientes esclerodérmicos, quando comparado a controles normais (p<0,01). Nao houve diferença estatisticamente significante entre pacientes em atividade quando comparados àqueles em remissao (p=0,07) ou quando comparamos: extensao (difusa x limitada, p=0,33) ou gravidade (grave x moderada, p=0,65) da doença. Também nao encontramos correlaçao entre aumento vWf:Ag e qualquer outra alteraçao clínica ou laboratorial, em especial as clássicas provas de atividade inflamatórias (p=0,62). Conclusoes: O aumento do vWf:Ag encontrado na ES parece se dever à lesao vascular presente nesta doença e nao a uma simples reaçao de fase aguda. O reduzido número de nossa amostra e a nao disponibilidade de gold standard confiável podem ser sido em parte responsáveis pela falha em estabelecer um papel marcador de atividade para o vWf:Ag. Mais estudos, com ampliaçao do número de casos, fazem-se necessários

Fator von Willebrand e de doenças reumáticas: marcador de lesao vascular ou reagente de fase aguda? / Von Willebrand factor and rheumatic diseases: marker of endothelial injury or acute phase protein?

Objetivo: Verificar o significado da dosagem plasmática do antígeno do fator von Willebrand (vWf:Ag) em doenças reumáticas como marcador de lesao vascular e como reagente de fase aguda. Material e métodos: Determinaçao do vWf:Ag, pela técnica de ELISA, em portadores de LES (31 pacientes) e AR (26 pacientes) e sua correlaçao com vários parâmetros clínicos e laboratoriais. Foi utilizado grupo-controle com 46 indivíduos saos, doadores de sangue. A significância estatística foi determinada pelo teste do qui quadrado ou pelo exato de Fisher. Resultados: Os títulos de vWf:Ag mostraram-se significantemente alterados apenas nos pacientes com LES em atividade (p<0,001). Nos pacientes com AR sem vasculopatia, nao houve aumento estatisticamente significante, mesmo naqueles em franca atividade. Nao houve correlaçao significante entre os títulos de vWf:Ag e outros parâmetros clínicos e laboratoriais, em especial com a velocidade de hemossedimentaçao (VHS). Conclusao: Os autores concluem que o vWf:Ag pode se constituir em marcador plasmático útil de lesao vascular e nao parece comportar-se como mero reagente da fase aguda

Critical appraisal of the pattern of antinuclear antibodies (ANA) testing requested over a six month period at the Escola Paulista de Medicina (EPM, Säo Paulo

In order to evaluate the pattern of ANA testing solicitation, 506 patients with ANA testing requested from July 1st. 1988 to December, had their charts reviewed. These patients, randomly selected, were regularly attending the outpatient clinic at the "Escola Paulista de Medicina" (EPM). 289 patients were followed up at the Rheumatology Division (group A) and 217 patients at other clincial divisions at EPM (group B). The disease that most frequently motivated the request for ANA test were: group A - SLE (22.5 per cents), RA (18.1 per cents), undefined arthropathies (6.2 per cents), PSS and CREST (5.9 per cents) and Raynaud phenomena (5.5 per cents); and group B - rheumatic diseases (24.4 per cents), nephropathies (17.1 per cents), neuropathies (16.6 per cents), dermopathies (7.8 per cents), hemopathies (4.6 per cents), pneumopathies (4.2 per cents) and ophtalmopathies (3.7 per cents). The positivity of ANA test in groups A and B was 32.9 per cents and 17.5 per cents respectively. 92 SLE patients were clinically diagnosed. The positivity of Ana and anti-dsDNA tests in this group was respectively 85.1 per cents and 26.6 per cents. The sensitivity and specificity of 1982 ARA revised criteria were 94.7 per cents and 99 per cents respectively. The likelihood ratio (LR) of a positive or a negative test was established for this population. LR of a positive test was 6.5 while for a negative test it was 0.17. The ANA test, although lacking specificity, has been commonly requested by different specialities in order to practically rule-out the diagnosis of some connective rheumatic diseases. Immunofluorescence technique (IF) using antibodies conjugated with fluorchromes was first described by Coons et al. in 1941 (4). This method has been used as an important diagnostic tool in routine laboratory tests ever since. Anew technique using indirect immunofluorescence for detection of antinuclear antibodies (ANA) was developed by Friou in 1957 (5). This method has been gaing importance since then, due to the presence of antoantibodies in a variety of neoplastic, infectious, autoimmune and, particularly, connective tissue diseases. In 1960, the study of Anderson (1) led to the description of a new set of autoantibodies, which recognized extractable nuclear and citoplasmatic antigens in a great percentage of cases, but were not detected by indirect IF. Nowadays, these autoantibodies can be identified by immunodifusion, immunoenzymatic, radioimmune or immunoblot techniques...