Retinal disorders in northern Brazilian patients treated with chloroquine assessed by multifocal ERG.

The effects of chloroquine intake on the retinal function in a Brazilian population of patients were assessed by multifocal electroretinography. Twenty-four randomly chosen eyes of patients treated with chloroquine for rheumatoid arthritis and systemic lupus erythematosus were examined using multifocal electroretinography (mfERG). Control measurements were acquired from 21 randomly chosen eyes of age-matched healthy subjects. None of the study participants had an inherited retinal disease or a Snellen visual acuity reduced to less than 20/40. In patients and control subjects, cumulative chloroquine dose, total daily dose, duration of treatment, retinal examination, visual field defects, visual acuity, and the mfERG were assessed. The average amplitudes and implicit times of the N1, P1, and P2 components of the mfERGs were measured in the central hexagon (R1) and in five rings (R2-R6). The values measured in patients and normal subjects were compared. The P1 amplitudes in R2 were significantly decreased in the patients. In addition, the amplitudes of N1 and N2 in R1 were significantly smaller in the patients. The implicit times of none of the components were significantly different between patients and controls. The response amplitude was not significantly correlated with cumulative dose and duration of intake. There was no correlation with retinal appearance, visual field, and visual acuity. In agreement with earlier data, the central mfERG amplitudes were decreased in chloroquine patients indicating functional alterations in the retina. These changes are also present in a Brazilian population suggesting that the effects of chloroquine are general and that genetic background and life circumstances probably have, if at all, only little effect.

Analysis of electromyographic muscles activity of gait in healthy subjects with and without AFO developed for patients with hemiparesis.

The aim of the present study was to analyze the electromyographic (EMG) signals of the rectus femoris (RF), vastus lateralis (VL), tibialis anterior (TA) and soleus (SO) muscles in young healthy adults with and without the use of an experimental ankle-foot-orthosis (AFO) designed for patients with hemiparesis. Twenty-eight individuals with an average age of 22 +/- 3.63 years participated in the study. An electromyograph, surface electrodes and two force plates were used. There was a non-significant increase in the TA activity with the use of the AFO (6.04 +/- 2.81) when compared to non-use (5.91 +/- 2.49) (p > 0.5); the same was true for the other muscles evaluated. There was a positive correlation (r = 0.37) between TA and SO activity (p < 0.05). The results demonstrate that the AFO did not affect the gait pattern of healthy young adults.

[The seroprevalence of HCV in patients submitted to hemodialysis and health professionals in the State of Minas Gerais, southwest of Brazil]. / Seroprevalencia del virus de la hepatitis C en pacientes en hemodiálisis y en profesionales de la salud en el Estado de Minas Gerais, región Sudeste de Brasil.

UNLABELLED: Patients with chronic renal failure(CRF) in hemodialysis(HD) programs comprise a risk group for acquisition of hepatitis C virus(HCV) infection. The objectives were to evaluate the seroprevalence of HCV in patients submitted to HD in State of Minas Gerais(MG), southwest of Brazil; to correlate this seroprevalence with the time of treatment on HD; to investigate the anti-HCV seropositivity in health professionals, to investigate the existence of a correlation between mean HCV seroprevalence and the human development index (HDI). Patients from 66 healthcare units(HU) were studied using a validated questionnaire and considering the positive values of anti-HCV(Elisa III) tests performed in these units between january and december 2003. RESULTS: the majority of patients were male (56.2%), between 41 and 60 years old. The mean seroprevalence of HCV in the 66 healthcare units was 13+/-9.5%; the three-monthly seroprevalence was below 20%, 15% and 10% in 75%, 50% and 40% of healthcare units, respectively. When the HU were grouped according to HCV seroprevalence into low(<5%), medium(5-15%) and high seroprevalence(>15%), 20% of the units have low, 42% medium and 37.5% were found to have high seroprevalence. No correlation was found between HDI and HCV seroprevalence (r=0.42; p=0.174) but in the regions in which the HDI was higher, HCV seroprevalence was also higher. There was a positive correlation between HCV seroprevalence and time on HD in 884 patients in the 4 HU (p<0.001). The seroprevalence of HCV was investigated in 387 healthcare professionals(29%) working in 14 HU. They were divided into two groups according to their time of professional activity: <10 y (G1) and >10 y (G2). In G1, there were no cases of anti-HCV seropositivity. In G2, 3 members of the staff were anti-HCV seropositive. The mean time of work of the seropositive staff in the HU was 15.6 years. The seroprevalence of HCV was 0.8% when all the healthcare professionals were taken into consideration. There was no statistically significant difference with respect to HCV seroprevalence between G1 and G2 with respect to the time of occupational exposure (p=0.27). CONCLUSION: the seroprevalence of HCV in patients on HD in MG is 13+/-9.5% and was <10% in 40% of the HU; there was no statistically significant correlation between HDI and seroprevalence of HCV in the healthcare units evaluated; there was a statistically significant correlation between HCV seroprevalence and time of treatment on HD; HCV seroprevalence in the health professionals studied was 0.8% and similar to the literature.

Optical coherence tomography analysis of axonal loss in band atrophy of the optic nerve.

AIMS: To measure axonal loss in patients with band atrophy of the optic nerve caused by optic chiasm compression using optical coherence tomography and to evaluate its ability in identifying this pattern of retinal nerve fibre layer (RNFL) loss. METHODS: Twenty eyes from 16 consecutive patients with band atrophy of the optic nerve and permanent temporal hemianopia due to chiasmal compression, and 20 eyes from an age and sex matched control group of 16 healthy individuals, were studied prospectively. All patients were submitted to an ophthalmic examination including perimetry and evaluation of the RNFL using optical coherence tomography. Mean RNFL thickness around the optic disc was compared between the two groups. RESULTS: The mean (SD) peripapillary RNFL thickness of eyes with band atrophy was 101.00 (9.89) microm, 62.21 (12.71) microm, 104.89 (12.60) microm, and 50.13 (16.88) microm in the superior, temporal, inferior, and nasal regions, respectively. The total RNFL mean was 79.94 (7.17) microm. In the control group, the corresponding values were 140.10 (16.06) microm, 86.50 (12.17) microm, 144.60 (15.70) microm, and 97.94 (16.02) microm. The total RNFL mean was 117.72 (9.53) microm. The measurements were significantly different between the two groups. Measurements in each of twelve 30 degrees divisions provided by the equipment also showed significantly different values between eyes with band atrophy and normal controls. CONCLUSIONS: Optical coherence tomography was able to identify axonal loss in all four quadrants as well as in each of the twelve 30 degrees segments of the disc. Thus, it seems to be a promising instrument in the diagnosis and follow up of neuro-ophthalmic conditions responsible for RNFL loss, even if predominantly in the nasal and temporal areas of the optic disc.

Prevençäo de malformações congênitas / Congenital malformations prevention

A idéia de escrever este artigo surgiu a partir da experiência didática, durante os últimos 22 anos, sobre temas referentes à embriologia geral (formaçäo do zigoto humano até o início do período embrionário) e embriologia especial (diferenciaçäo dos sistemas orgânicos), de um simpósio interno CAMU I - Unesa-2001 e, finalmente, da VIII Semana Científica da FMP, em 2002, sobre "Medicina: uma preocupaçäo com a saúde ou com a doença". Segundo a OMS (1999), o nível primário representa evitar que aconteça o modelo genético, o secundário representa evitar a recorrência das doenças entre as famílias e o terciário representa a reabilitaçäo dos problemas decorrentes destas doenças. A prevençäo das malformações congênitas, sobretudo, se faz mais essencial na saúde pública preventiva, ou seja, no nível primário, tendo como objetivo final proporcionar uma boa qualidade de vida ao portador da malformaçäo

[High blood pressure in children and adolescents: determinant factors] / Hipertensão arterial na infância e na adolescência: fatores determinantes.

OBJECTIVE: To review the state of prevalence of hypertension in childhood and the importance of its possible determinants. METHODS: Analysis of the literature concerned with eleven possible determinant factors - experimental design, internal and external validity. RESULTS AND CONCLUSIONS: Central body fat pattern seems to be a risk factor, while heart rate and tracking would be true markers of future hypertension. Social class, biological maturation, race, sodium intake and genetic factors have not yet been validated through unbiased studies.

[Perception on and registration of alcohol abuse and alcohol-related diseases at a university general hospital]. / Percepção e registro de abuso de álcool e de doenças relacionadas num hospital geral universitário.

BACKGROUND: The high frequency of alcohol related problems highlights the importance of its approach. The association of both the alcohol-abuse and alcohol related diseases has been pointed in the literature and are often the main reason for hospitalization. Physicians use different tools to detect abusive drinkers, and one of them is the CAGE-test, validated by Mayfield et al. in 1974. OBJECTIVES: To study the association between the result of the CAGE-test and the perception and registration of alcohol abuse by the medical staff and the nurses in charge of inpatients of Hospital de Clínicas de Porto Alegre, southern Brazil. MATERIAL AND METHOD: The design involved three phases. First, the application of the CAGE-test to the 385 eligible patients. Second, review of all 51 CAGE-positive patients' records as well the controlled evaluation of 51 randomized CAGE-negative patients, to seek alcoholic habits and alcohol-related diseases. Third, interview with the medical staff to find out their perception about these subjects. RESULTS: We found 51 patients CAGE-positive (prevalence = 13%). When evaluated through the registration and through a standardized interview, medical staff and nurses were not aware of more than half of CAGE-positive patients. No significant differences were found between medical staff registration and perception; the prevalence of alcohol related diseases was the same for both: 26 and 27% (p = .861). The prevalence of alcohol related diseases was higher among CAGE-positive patients (p = .0003). CONCLUSIONS: In spite of the high prevalence among our patients, alcohol abuse is not pursued by our health teams as it should be. As for the future, there is reason to envision a continuing alcoholism rapprochement.

Percepçäo e registro de abuso de álcool e de doenças relacionadas num hospital geral universitário / Perception and registration of alcohol abuse and alcohol related diseases by nurses and medical staff of an university general hospital

Objetivo. Avaliar a associaçao entre o resultado do teste CAGE aplicado em pacientes internados num hospital geral universitário (Hospital de Clínicas de Porto ALegre - HCPA) e a percepçao e registro de abuso de álcool e de doenças relacionadas pelas equipes de saúde. Pacientes e Métodos. O delineamento envolveu três fases: a) aplicaçao do teste CAGE aos 385 pacientes adultos e adolescentes internados considerados elegíveis para o estudo; b) revisao dos prontuários dos pacientes CAGE-positivo e de um número igual de pacientes CAGE-negativo, estratificados por área de internaçao e sorteados, para identificar hábitos alcoólicos e a presença de doenças relacionadas ao uso de álcool; c) entevista com os membros das equipes médicas responsáveis para avaliar sua percepçao sobre o hábito alcoólico em seu paciente. As diferenças encontradas foram analisadas através do teste Qui-quadrado e do teste t de Student, com significância estatística em nível de 5 por cento bicaudal. Resultados. Foram encontrados 51 pacientes CAGE-positivo (13 por cento). A equipe médica registrou abuso de álcool no prontuário de 51 por cento dos pacientes CAGE-positivo e 10 por cento dos CAGE-negativo, e a equipe de enfermagem fez este registro no prontuário de 31 por cento dos pacientes CAGE-positivo e 8 por cento dos CAGE-negativo (p=.724). Nao houve diferença entre o registro e a percepçao da equipe médica (p=.184). A prevalência de doenças relacionadas ao abuso de álcool foi 27 por cento quando se examinou os prontuários médicos e 26 por cento quando se entrevistou a equipe médica (p=.861), sendo maior entre os pacientes CAGE-poistivo (43 por cento) do que entre os CAGE-negativo (10 por cento) (p=.0003). Conclusoes. O abuso de bebidas alcoólicas e a presença de doenças associadas ao mesmo sao condiçoes prevalentes nos pacientes admitidos ao HCPA. Entretanto, mais de metade dos casos nao foram detectados pela equipe de saúde, havendo correspondência entre os registros de prontuário e a entrevista.

Maintenance of prolactin (PRL) binding sites in rat liver cells in suspension culture: effect of PRL and of inhibitors of various cellular functions.

An in vitro method to study the regulation of PRL receptors has been established using adult rat liver cells cultured in a continuous suspension in L-15 medium. PRL binding averaged 28.2 +/- 1.8% of the added labeled hormone per 10(6) cells in freshly isolated liver cells prepared from female rats treated with 17 beta-estradiol. When these cells were incubated at 37 C, binding rapidly declined by 50% at 10 h and 90% at 48 h. This rapid decline could be counteracted by the inclusion of ovine PRL (50 nM), which maintained initial PRL receptor levels up to 48 h of culture. Higher concentrations of PRL (2.5 microM) induced a rapid down-regulation, apparent at 2 and 10 h of culture. Cycloheximide (50 micrograms/ml) induced a slight diminution of control PRL receptor levels and partially reversed the effect of 50 nM PRL. Approximately 60% of the PRL receptors were resistant to the effect of cycloheximide. On the other hand, actinomycin D (10 micrograms/ml) had no effect on PRL receptor levels in control and only a very slight effect in PRL-treated cells. Dinitrophenol, which blocks metabolic oxidation, also partially reversed the effect of 50 nM PRL although it was without any significant effect on control levels. Chloroquine (100 microM) and colchicine (1 microM) failed to alter PRL binding either in the absence or presence of 50 nM PRL. Our results suggest that the existence of regulatory factors occurring in vivo, which are absent in the culture medium, could be responsible for the decline in PRL receptor levels in the control hepatocytes. PRL itself could be one of these factors. On the other hand, and in agreement with the putative actions of the drugs utilized, the mechanism of the PRL-induced maintenance of receptor levels appears to lie in part with an effect on receptor synthesis at the translational (ribsomal) level but to be independent of the internalization or of lysosomal degradation.

Regulation of gonadotrophin function in hemidecorticate rats.

The present review focuses on some aspects of the regulation of gonadotrophin (LH and FSH) and prolactin secretion in rats submitted to hemidecortication (HD). The removal of rhinencephalic and cortical structures induces the following changes: Irregular and erratic estrous cycle; Increase in LH and FSH secretion in the afternoon of proestrus and after uni- or bilateral castration; When hormonal replacement therapy was administered to castrated female rats, the controls needed larger doses of estradiol benzoate (E2) to reduce LH levels than the HD animals, which suggests an increase in the sensitivity of the hypothalamus-hypophysis axis to gonadal steroid negative feedback. When HD was performed during the neonatal period (1-3 days old), an earlier onset of puberty and sexual maturation was observed in both female and male HD rats than in controls. During the puberal evolution the HD male rats showed elevation in plasma testosterone levels, an increase in the testicular response to hCG and also in the number of testicular binding sites to LH and FSH at 38-43 days (before the onset of puberty) and to prolactin (after 60 days). The results suggest that after removal of cortical and subcortical structures (HD), with predominant inhibitory influences, the hypothalamus-hypophysis becomes more sensitive to the LH and FSH releasing mechanisms.

Interaction of prolactin (PRL) binding sites with PRL receptor antibodies in rat liver cells in suspension culture: effect of inhibitors of cellular functions.

We have recently demonstrated that prolactin is able to maintain the level of in receptors in cultured rat hepatocytes. This effect could be modulated by various inhibitors of cellular functions. We report here that an antibody developed against a partially purified prolactin receptor preparation can mimic this effect of the hormone (although to a lesser extent) and that drugs can modulate it in a similar manner. In particular, cycloheximide (50 micrograms/mL), which reduced basal receptor levels by approximately 40%, totally reversed the maintenance induced by the antireceptor serum. Actinomycin D (10 micrograms/mL), another protein synthesis inhibitor (at the transcriptional level), had no effect of basal receptor concentration, but counteracted by about one-half the antiserum-induced maintenance. This effect of actinomycin D is much clearer here than the effect previously observed on prolactin-induced receptor levels in rat liver cells in culture. The effect of dinitrophenol (1 mM) on basal levels was of limited amplitude but maintenance was again partly reversed by this drug. In accordance with previous results obtained with prolactin, chloroquine (100 microM) and colchicine (1 microM) failed to alter prolactin binding either in the absence or presence of 5% antireceptor serum. The effect of the antiserum indicates that prolactin itself is not required beyond the membrane for its effect on receptor regulation to be attained. These results also confirm our previous results with prolactin maintenance of prolactin receptor levels in rat liver cells in culture, that the mechanism of receptor maintenance appears to be due in part to a stimulation of receptor synthesis but to be independent of the internalization or of lysosomal degradation.

The importance of osmolality fall and ultrafiltration rate on hemodialysis side effects. Influence of intravenous mannitol.

The decreases in serum osmolality as well as the rate of ultrafiltration during hemodialysis and the influence of each upon the side effects of this treatment were studied in 13 chronic stable dialysis patients. Mannitol (9 mosm/kg water) was infused in two out of four dialyses, in a double blind fashion. A solution of 5% glucose in water was used as control. 1 week after the treatment, there was no residual mannitol in the patients' serum (p less than 0.0005). The decrease in osmolality during dialysis was lower when the patients received treatment with mannitol than with placebo: 14.7 versus 25.0 mosm/kg water (p less than 0.001). The symptoms during dialysis were much less severe when the patients received mannitol (p less than 0.05). Analyzed separately, ultrafiltration rate had no effect on severity of symptoms during dialysis (p greater than 0.1). Decrease in serum osmolality during dialysis seems to be the most important factor in the genesis of dialysis symptoms in chronic stable dialysis patients and are counteracted by the infusion of an osmotically active substance such as mannitol, 1 g/kg/dialysis; this results in a slight increase in body weight between dialyses, and cannot be used routinely because of slow accumulation.

Hypotension during acetate and bicarbonate dialysis in patients with acute renal failure.

Bicarbonate dialysate is claimed to be superior to acetate for both chronic and acute hemodialysis. We compared acetate and bicarbonate dialysates in 30 acute renal failure patients during 120 dialyses. 4 patients were diabetic and 2 had liver failure. Patients were dialyzed alternating acetate and bicarbonate dialysate in a double-blind cross-over manner; each patient was his own control. BUN, creatinine, Na+, K+, osmolality, delta osmolality, % ultrafiltration, arterial blood gases, pre, post and lowest dialysis mean arterial blood pressure, dialysis with hypotensive episodes and symptoms of hypotension were recorded. The measurements obtained for each patient during dialyses with acetate and bicarbonate were compared. There was no difference in predialysis chemistries, osmolality or osmolality fall, no change in mean arterial blood pressure or hypotensive episodes and symptoms and ultrafiltration. PCO2 and pH were slightly lower for the acetate group at the 2nd h but not at the end of dialysis. 4 patients had serum acetate determinations, all metabolized acetate normally. These findings contradict recent suggestions that severely ill patients should not be dialyzed against acetate. Since acetate is technically much easier to use and has no clinical drawbacks, it does not need to be replaced with bicarbonate in acute patients. Other factors must be more important than acetate in generating hypotension during acute dialysis.

Dialysis symptoms and stabilization in long-term dialysis. Practical application of the CUSUM plot.

Six symptoms that occur during hemodialysis were investigated to determine their frequency and to define when a patient's condition becomes "stable." Three symptoms--nausea, hypotension, and muscle cramps--stabilized after 13 dialysis treatments (approximately one month). Two symptoms, hypertension and vomiting, stabilized after 17 and 20 dialyses, respectively. Headache showed little variation per dialysis. The changes in the frequency of these symptoms were detected through the use of the cumulative sum technique (CUSUM). This technique was found to be much more discriminating than the original data. Hemodialysis patients should not be considered "stable" for investigation of changes in techniques or therapy until after 1 1/2 months of dialysis. Even then, symptoms will be found during each dialysis.