Repercussões cardiovasculares em usuários de cocaína: uma revisão integrativa / Cardiovascular repercussions in cocaine users: an integrative review

RESUMO: Introdução: O uso da cocaína é considerado um importante problema de saúde, sendo crescente o número de atendimentos nos serviços de emergência de pacientes que referem sintomas relacionados a alterações cardiovasculares após seu uso. Objetivo: Apresentar as repercussões cardiovasculares promovidas pela cocaína, associando o seu consumo a possíveis desfechos fatais, além de discutir as melhores maneiras de abordar o paciente na emergência. Método: Revisão integrativa da literatura nas bases de dados eletrônicas LILACS, MEDLINE, IBECS, SciELO, Secretaria Municipal de Saúde de São Paulo, Secretaria Estadual de Saúde de São Paulo, Coleciona SUS, disponíveis na BVS, bem como no PubMed. Resultados: Após análise criteriosa, 44 artigos atenderam aos critérios de inclusão. Foram estudos realizados na Europa (25%), Austrália (6,82%) e no continente americano (68,18%). Discussão: Abuso de cocaína é considerado um fator de risco isolado para doenças cardiovasculares, independente de outros. Por isso, pacientes jovens admitidos com dor torácica devem ser questionados sobre o consumo dessa droga. O tratamento do IAM associado ao uso de cocaína é semelhante ao realizado em paciente não usuário e, apesar da controvérsia existente sobre existir ou não contraindicação ao emprego de betabloqueador, diversos estudos indicam a utilização de drogas alfa e beta bloqueadores nesses pacientes. Conclusão: constatou-se que as principais repercussões cardiovasculares encontradas em pacientes usuários de cocaína que procuraram atendimento nas emergências hospitalares foram as emergências/urgências hipertensivas, taquicardia supraventricular, angina, infarto agudo do miocárdio, dissecção e aneurisma de aorta. (AU)

ABSTRACT: Introduction: The use of cocaine is considered an important health problem. An increasing number of patients in the emergency services report symptoms related to cardiovascular changes after its use. Objective: To present the cardiovascular repercussions promoted by cocaine, associating its consumption with possible fatal outcomes, besides discussing the best ways to approach the patient in the emergency. Method: Integrative literature review in the electronic databases LILACS, MEDLINE, IBECS, SciELO, Sao Paulo Municipal Health Department, State Health Secretariat of São Paulo, Coleciona UHS, available at the VHL, as well as PubMed. Results: After careful analysis, 44 articles met the inclusion criteria. Studies were conducted in Europe (25%), Australia (6.82%) and the American continent (68.18%). Discussion: Cocaine abuse is considered an isolated risk factor for cardiovascular disease, independent of others. Therefore, young patients admitted with chest pain should be asked about the use of this drug. The treatment of AMI associated with cocaine use is similar to that performed in a non-user patient. Despite the controversy over whether or not there is a contraindication to the use of beta-blockers; several studies indicate the use of alpha and beta-blocker drugs in these patients. Conclusion: it was found that the main cardiovascular repercussions found in cocaine users who sought care in hospital emergencies were hypertensive emergencies/urgencies, supraventricular tachycardia, angina, acute myocardial infarction, dissection, and aortic aneurysm (AU)

Selection of optimized candidate reference genes for qRT-PCR normalization in rice (Oryza sativa L.) during Magnaporthe oryzae infection and drought.

Drought and rice blast disease caused by Magnaporthe oryzae are two of the most serious threats to global rice production. To explore the mechanisms underlying gene expression induced in rice by stresses, studies involving transcriptome analyses have been conducted over the past few years. Thus, it is crucial to have a reliable set of reference genes to normalize the expression levels of rice genes affected by different stresses. To identify potential reference genes for studies of the differential expression of target genes in rice under M. oryzae infection and drought conditions, the present study evaluated five housekeeping genes for the normalization of gene expression. The stability of the expression of these genes was assessed using the analytical software packages geNorm and NormFinder. For all samples analyzed, the stability rank was UBQ5 > GAPDH > eIF-4α> ß-TUB > 18S rRNA. The data showed that the UBQ5, GAPDH, and eIF-4αgenes are appropriate, high-performing reference genes and will be highly useful in future expression studies of fungal infections and drought in rice.

Detection of Leishmania (L.) chagasi in canine skin.

Canine visceral leishmaniasis (CVL) is caused by a protozoa parasite of the specie Leishmania (L.) chagasi endemic for humans and dogs in many regions of Brazil. The purpose of the present study was the detection of (L.) chagasi in canine skin tissues from three different groups of clinical signs: asymptomatic, oligosymptomatic and polysymptomatic Leishmania-infected dogs. Lesional or non-lesional skin tissue samples from 34 naturally infected dogs were obtained and processed by histochemistry (HE) and immunohistochemistry (IMHC) for direct parasitological examination and the results were compared with a polymerase chain reaction (PCR) method. IMHC and HE methods detected intact Leishmania-amastigote parasites in lesional and no lesional skin, particularly in asymptomatic and oligosymptomatic dogs. 50% of skin samples collected from asymptomatic and 21.4% from oligosymptomatic dogs had parasites in their skins even though with mild inflammatory reaction or without any macroscopic dermatological alterations. On the other hand, 100% of polysymptomatic dogs showed several forms of clinical dermatological alterations and 91.7% had intact amastigotes with parasite load ranging from mild to intense. By PCR, DNA of Leishmania spp. was detected in 97.8% skin samples regardless clinical status of the dogs or IMHC/HE test results. PCR on skin was a sensitive procedure for CVL diagnosis, but direct observation of intact parasite in skin biopsies, particularly by IMHC, may be also considered to support the diagnosis.

DNA and heparin chaperone the refolding of purified recombinant replication protein A subunit 1 from Leishmania amazonensis.

Replication protein A (RPA) is a single-stranded DNA-binding protein that has been implicated in DNA metabolism and telomere maintenance. Subunit 1 of RPA from Leishmania amazonensis (LaRPA-1) has previously been affinity-purified on a column containing a G-rich telomeric DNA. LaRPA-1 binds and co-localizes with parasite telomeres in vivo. Here we describe the purification and characterization of native recombinant LaRPA-1 (rLaRPA-1). The protein was initially re-solubilized from inclusion bodies by using urea. After dialysis, rLaRPA-1 was soluble but contaminated with DNA, which was removed by an anion-exchange chromatography of the protein solubilized in urea. However, rLaRPA-1 precipitated after dialysis to remove urea. To investigate whether the contaminating DNA was involved in chaperoning the refolding of rLaRPA-1, salmon sperm DNA or heparin was added to the solution before dialysis. The addition of either of these substances prevented the precipitation of rLaRPA-1. The resulting rLaRPA-1 was soluble, correctly folded, and able to bind telomeric DNA. This is the first report showing the characterization of rLaRPA1 and of the importance of additives in chaperoning the refolding of this protein. The availability of rLaRPA-1 should be helpful in assessing the importance of this protein as a potential drug target.

First Report of Ravenelia spegazziniana on Acacia farnesiana from Brazil.

Leaves, young branches, and fruits of Acacia farnesiana (L.) Willd. (Fabaceae) that were distorted because of hypertrophy causing witches' brooms and other abnormal growth were collected in the area surrounding the Panteón da Liberdade e da Democracia, Brasilia, Brazil, during August 2005. Uredinia and telia were observed in the symptomatic areas. The uredinia were small on leaflets and rachis and on pods in confluent groups as much as 1 cm in diameter, subcuticular becoming erumpent, and cinnamon-brown; paraphyses were mostly clavate and colorless. Urediniospores were 17 to 28 × 12 to 16 µm, ellipsoid to obovoid, with a wall 1.5 to 2 µm thick at the sides and 2 to 3 µm at the apex, cinnamon-brown, with hub and spoke pattern of ornamentation, and pores in two bands of four each above and below the equator. Telia were small, erumpent, on rachis and small branches, and dark cinnamon-brown. Teliospores were 84 to 100 × 65 to 90 µm in diameter, chestnut-brown, (4) 5 to 6 probasidial cells across, and smooth; cysts were globoid, same number as peripheral probasidial cells; pedicels were colorless, multihyphal, and deciduous. The rust was identified as Ravenelia spegazziniana J.C. Lindq, on the basis of the comparison with specimens deposited at the Instituto Spegazzini (LPS) and U.S. National Fungus Collection (BPI), as well as with published descriptions (2). R. spegazziniana has been reported on species of Acacia from Central, North, and South America, and Hawaii (1). A. farnesiana is probably native to tropical America, but it is naturalized and cultivated all over the world where it has become invasive in disturbed areas in some Pacific islands. This species is economically important for fuel wood, flowers used in the perfume industry, and bark and fruits used for tannin production. In Federal District (DF), Brasilia, Brazil, A. farnesiana is commonly used in urban forestation as an ornamental and shade tree. To our knowledge, this is the first report of R. spegazziniana in Brazil. The voucher specimen has been deposited in the herbarium of the Faculty of Biology of Porto Alegre from the Universidade Federal do Rio Grande do Sul as ICN 139085. References: (1) D. F. Farr et al. Fungal Databases. Systematic Botany and Mycology Laboratory. On-line publication. ARS, USDA, 2006. (2) J. R. Hernandez and J. F. Hennen. Mycol. Res. 106:972. 2002.

Effect of the crude extract of Vernonia polyanthes Less. on blood pressure and renal sodium excretion in unanesthetized rats.

This study evaluated the effect of oral crude Vernonia polyanthes Less. hydroalcoholic extract administration (CHE, 0.5 and 1.0 g/kg body wt., daily for 7 days) on arterial blood pressure and renal sodium excretion in conscious rats. CHE administration decreased arterial blood pressure dose-dependently followed by a significant rise in creatinine clearance and a fall in fractional post-proximal sodium excretion was compared to the control group. These results suggest that blood pressure decrease induced by the oral crude Vernonia hydroalcoholic extract may be blunted by reduction of the post-proximal renal sodium excretion. Thus, the present study shows that Vernonia extract is a potential vasodilatation agent in normotensive rats without any effects on renal tubule autoregulation mechanisms.

Total erupção dos primeiros dentes incisivos permanentes em fêmeas ovinas da raça Santa Inês

RESUMO: Acompanhou-se a substituição total das pinças em 26 fêmeas da raça Santa Inês, nascidas no período de 1998 e criadas em sistema de criação extensivo. Foram realizadas observações semanais a partir de 360 dias de vida. Obteve-se como idade média de substituição total das pinças 13,26 meses. Palavras chave: Idade, Dentição, Incisivos Permanentes, Ovino Santa Inês SUMMARY: Total eruption of the incisor teeth was evaluated in 26 female sheep of Santa Inês breed born during 1998 and raised in an extensive system. Observations were weekly done from 360 days of age. The substitution of the temporary by the permanent incisor teeth occurred at the mean age of 13.26 months. Keywords: Age, Dentition, Permanent Incisors, Sheep Santa Inês

Total erupção dos primeiros dentes incisivos permanentes em fêmeas ovinas da raça Santa Inês.

RESUMO: Acompanhou-se a substituição total das pinças em 26 fêmeas da raça Santa Inês, nascidas no período de 1998 e criadas em sistema de criação extensivo. Foram realizadas observações semanais a partir de 360 dias de vida. Obteve-se como idade média de substituição total das pinças 13,26 meses. Palavras chave: Idade, Dentição, Incisivos Permanentes, Ovino Santa Inês SUMMARY: Total eruption of the incisor teeth was evaluated in 26 female sheep of Santa Inês breed born during 1998 and raised in an extensive system. Observations were weekly done from 360 days of age. The substitution of the temporary by the permanent incisor teeth occurred at the mean age of 13.26 months. Keywords: Age, Dentition, Permanent Incisors, Sheep Santa Inês

Morphological and biochemical evidence of blood vessel damage and fibrinogenolysis triggered by brown spider venom.

The venom of the brown spider is remarkable because it causes dermonecrotic injury, hemorrhagic problems, hemolysis, platelet aggregation and renal failure. The mechanism by which the venom causes hemorrhagic disorders is poorly understood. Rabbits intradermally exposed to the venom showed a local hemorrhage starting 1 h after inoculation and reaching maximum activity between 2 and 3 days. Biopsies examined by light and transmission electron microscopy showed subendothelial blebs, vacuoles and endothelial cell membrane degeneration in blood vessels, plasma exudation into connective tissue, and fibrin and thrombus formation within blood vessels. Loxosceles intermedia venom incubated with fibrinogen partially degrades Aalpha and Bbeta chains of intact fibrinogen, and significantly cleaves all Aalpha, Bbeta and gamma chains when they were separated or when fibrinogen is denatured by boiling. Proteolytic kinetic studies showed that the Aalpha chain is more susceptible to venom hydrolysis than the Bbeta chain. The fibrinogenolysis is blocked by ethylenediamine tetraacetic acid and 1,10-phenanthroline, but not by other protease inhibitors. Human plasma incubated with the venom had coagulation parameters such as prothrombin time, activated partial thromboplastin time and thrombin time increased. Through molecular sieve chromatography, we isolated a venom toxin of 30 kDa with fibrinogenolytic activity. We propose that the local and systemic hemorrhagic disorders evoked in loxoscelism are consequences of direct venom fibrinogenolysis together with cytotoxicity to subendothelial structures and endothelial cells in blood vessels.

Identification of high molecular weight serine-proteases in Loxosceles intermedia (brown spider) venom.

High molecular weight serine-proteases have been identified in Loxosceles intermedia (brown spider) venom. The mechanism by which Loxosceles spp venoms cause dermonecrotic injury (a hallmark of loxoscelism) is currently under investigation, but it seems to be molecularly complex and in some instance proteases might be expected to play a role in this skin lesion. In the present investigation, when we submitted L. intermedia venom to linear gradient 3-20% SDS-PAGE stained by a monochromatic silver method we detected a heterogeneous protein profile in molecular weight, ranging from 850- to 5-kDa. In an attempt to detect zymogen molecules of proteolytic enzymes, venom aliquots were treated with several exogenous proteases. Among them, trypsin activated two gelatinolytic molecules of 85- and 95-kDa in the venom. In experiments of hydrolysis inactivation using different protease inhibitors for four major class of proteases, we detected that only serine-type protease inhibitors were able to inactivate the 85- and 95-kDa enzymes in the venom. An examination of the 85- and 95-kDa gelatinolytic activities as a function of pH showed that these proteases had no apparent activities at pH below 5.0 and higher than 9.0 and displayed little activity at pH 6.0. with the optimal pH for their activities ranging from 7.0 to 8.0. Evaluation of the functional specificities of the 85- and 95-kDa venom proteases showed that these proteases efficiently degrade gelatin (denatured collagen) but have no proteolytic activity on hemoglobin, immunoglobulin, albumin, librinogen or laminin, suggesting specificity of their proteolytic actions. We describe here two serine-proteases activities in L. intermedia venom probably involved in the harmful effects of the venom.

Structural and ultrastructural description of the venom gland of Loxosceles intermedia (brown spider).

The brown spider, genus Loxosceles, is becoming of great medical importance, with envenomation (Loxoscelism) occurring throughout the world. The biological activities of the brown spider venom usually include dermonecrotic lesions at the bite site accompanied by hemolytic and haemorrhagic effects and also by renal failure. The objective of the present study was to describe the histology of the venom gland of L. intermedia using glands from adult spiders which were investigated by light microscopy, using immunohistochemical and staining methods, by transmission electron microscopy, and by scanning electron microscopy. The organization of the venom gland of Loxosceles intermedia follows the general architecture of spiders' venom glands. Using light microscopy and transmission electron microscopy we observed that the venom glands of L. intermedia present two layers of striated muscle fibers, an external layer and an internal layer in touch with an extracellular matrix which is a basement membrane structure and a fibrillar collagen matrix separating the muscular region from epithelial cells of the venom gland. Muscle cells are multinucleated, with nuclei peripherally placed and their cytoplasm rich in sarcoplasmic reticulum, myofibrills and continuous Z lines. By using scanning electron microscopy we can detect muscular cells from external layer as branching cells. Epithelial cells have their cytosol extremely rich in rough endoplasmic reticulum, mitochondria collection, Golgi apparatus, interdigitating membranes and secretory vesicles that ultimately accumulate the venom, a complex protein mixture.

Tumoral form of cerebral schistosomiasis mansoni. A report of four cases and a review of the literature.

We describe four cases of the tumoral form of cerebral schistosomiasis mansoni. The patients had symptoms of increased intracranial pressure and focal neurological signs that varied according to the site of the lesion. Computerized tomography showed a hyperdense, enhancing lesion located in the cerebellum (2 patients), frontal lobe and thalamus (1 patient), and temporal subdural region (1 patient), with associated mass effects. The lesion was resected in three patients and a stereotactic biopsy was performed in one. Histopathologic specimens of all four patients revealed multiple schistosomal granulomas in various evolutive phases. Two of these patients differ from previously described cases; one because of the subdural location of the lesion, mimicking a meningioma, and the other one because two lesions were present.