Allele diversity of the killer cell immunoglobulin-like receptors KIR3DL1/S1 and the combination with their HLA ligands in Mexican Mestizos from Mexico City.

Killer cell immunoglobulin-like receptors (KIRs), expressed on Natural Killer (NK) cells, activate/inhibit NK cell function through interactions with their HLA-A, B and C ligands. KIR3DL1 is one of the most polymorphic genes and its effect varies depending on the interaction of the specific allotype with its Bw4 ligand. We investigated the allelic diversity of KIR3DL1/S1 using sequence based typing and we typed as well, their Bw4 ligands in Mexican Mestizos of Mexico City. The results showed that this population has a great KIR3DL1 allelic diversity with ∗01502 (19.9%), ∗00101 (13.2%) and ∗00501 (12.8%) being the most common alleles, while KIR3DS1 showed predominance of ∗01301 (86%); these data agree with the diversity found in most populations studied. At least one KIR3DL1-HIGH surface expression allele was present in 67.5% of the subjects. Phylogenetic comparisons between Mestizos and 28 different populations showed that allelic diversity of KIR3DL1/S1 was similar in Mexican Mestizos from Mexico and in Hispanics from USA. Knowledge of KIR and MHC diversity worldwide is fundamental for understanding the impact of KIR and KIR-ligand polymorphism on NK cell effector functions and is relevant in genetic anthropology, disease association and transplantation.

Iris pigmentation and susceptibility to noise-induced hearing loss.

The purpose of this retrospective study is to examine the possible association between iris pigmentation and susceptibility to noise-induced hearing loss in 2407 noise-exposed workers. The workers were between 16 to 65 years of age and were exposed to 2 to 42 years of work-related noise. Results demonstrated that dark-eyed workers presented a greater percentage of normal pure-tone thresholds than fair-eyed workers. Fair-eyed workers had threshold averages of 25.1 dB (right ear) and 26.0 dB (left ear) at 3, 4, and 6 kHz, which were significantly worse than workers with dark irises, with threshold averages of 15.8 dB and 17.2 dB in the right and left ear, respectively (p<0.01). Fair-eyed workers with less than 10 years of noise exposure had the same audiometric pattern as the dark-eyed workers exposed for more than 10 years. Workers not exposed to noise did not present significant differences in their audiometric pattern as a function of eye colour. These results suggest that iris pigmentation may be an additional indication of susceptibility to noise-induced hearing loss.

Mortality and morbidity trends in ischemic heart disease in the autonomous region of Madeira in the ten-year period 1987-1996.

The increase in absolute number of deaths from ischemic heart disease (IHD) in the population aged > or = 65 years, in both sexes, in Madeira, when comparing the years 1987 and 1996, led to significant increases in the corresponding standardized death rates that go against the stabilization seen at national level. Significant increases in these rates for the same years were also seen in the district of Beja and in the Azores. The aim of this study was to ascertain the trends for the incidence, morbidity and mortality from acute myocardial infarction (AMI) in patients admitted in Madeira and its contribution to the increase in these rates, particularly in the population aged < 65 years of both sexes, which the number of deaths from ischemic heart disease did not increase. We studied 119 pts with AMI admitted in 1987 (year A), of whom 53 were aged < 65 years, and 186 pts with AMI admitted in 1996 (year B), of whom 72 were aged < 65 years, whose data were included in the Madeira Ischemic Heart Disease Register (RECIMA), an IHD hospital register that covers 1792 patients admitted with AMI in the Coronary Intensive Care Unit of the Department of Medical and Surgical Cardiology of Funchal Hospital over a period of 15 years (1984-1998). Mortality by the 28th day (fatal AMI admissions) in all ages fell slightly in both sexes in the two years studied (A = 19.3%; B = 16.1%). The number of fatal AMI admissions rose among females in the two age groups considered A = 11; B = 20; delta% = +45) and fell among males (A = 12; B = 10; delta% = -20). In males aged > or = 65 years, this number remained the same (A = 7; B = 7) and fell in males aged > or = 65 years (A = 5; B = 3; delta% = -40). The number of pts who survived to the 28th day (non-fatal AMI admissions) rose in all age groups for both sexes (A = 96; B = 156; delta% = +38.46), as did the ratios with deaths from IHD. These increases were roughly double in the group of patients aged 65 years compared to patients aged < 65 years. We found highly significant positive correlations in the population aged < 65 years between the number of non-fatal AMI admissions (morbidity data) and the number of deaths from IHD (mortality data) recorded in every year of the 10-year period 1987-96, these values being highly significant in both sexes (r = 0.89; p < 0.0001), in males (r = 0.87; p < 0.0001) and in females (r = 0.77; p < 0.0001). Since our study was carried out on an island on which all AMI cases are admitted to a single treatment center, we can conclude that these positive correlations represent a trend towards worsening of morbidity and mortality from IHD in Madeira in the population aged < 65 years, even though the number of deaths from IHD did not rise. The establishment of IHD registers similar to RECIMA in other regions of the country would help to identify trends in morbidity, mortality, and morbidity plus mortality in this population that would be useful in improving the orientation of resources allocated to the prevention and treatment of cardiovascular diseases.

Thrombolytic therapy impact on prognosis after twelve months of first acute myocardial infarction.

INTRODUCTION AND OBJECTIVES: Thrombolytic therapy is still widely used to restore antegrade flow in the infarct related artery (IRA), with unquestionable benefits in mortality reduction of such patients. The aim of this study was to evaluate early (< or = 28 days) and one-year mortality of patients with a first Q wave myocardial infarction (Q AMI), comparing those who underwent thrombolytic therapy with those who did not. POPULATION AND METHODS: A retrospective study was done on 907 patients (median age: 35 +/- 13 years, 66% male) admitted to a Coronary Unit with the diagnosis of first Q AMI, from January 1988 to December 1997, all in the same geographical area (minimum follow-up period of one year, mean follow-up 43 +/- 37 months). We compared demographics and clinical characteristics (coronary risk factors, previous history of angina, MI location and evolution, cardiac events, 28 day and one-year mortality) of patients who underwent thrombolysis (group T = 355) versus those who did not undergo reperfusion therapy (group NT = 552). RESULTS: Of these patients 39% underwent thrombolytic therapy. Group NT had a greater number of female patients (40% vs 25%; p < 0.001), a significantly higher mean age (67 +/- 12.2 vs 61 +/- 12; p < 0.001), and a higher percentage of diabetics (29% vs 19%; p < 0.001), in comparison to group T. The Q AMI developed into Killip class > or = 2 in 43% of patients in group NT and 23% in group T (p < 0.001). A higher number of AV block (NT-13% vs T-8%; p < 0.05) and higher in-hospital mortality (NT-14% vs T-9%; p < 0.05) was observed in patients not undergoing thrombolysis. The early (NT-22% vs T-12%; p < 0.001) and one-year (NT-33% vs T-16%; p < 0.001) mortalities were significantly higher in group NT than in group T, even after multivariate analysis. CONCLUSIONS: 1--Patients who did not undergo thrombolytic therapy initially had a profile of greater severity, and a higher early and one-year mortality rate. 2--Those who underwent thrombolytic therapy presented a significantly lower mortality, a benefit that was still observed after one year of follow-up and after multivariate correction.

Survival analysis within one year of first acute myocardial infarction: comparison between non-Q and Q wave myocardial infarction.

BACKGROUND: Non-Q wave Myocardial Infarction (non-Q AMI) is related pathophysiologically to Q wave AMI, as each represents different stages of plaque rupture and thrombosis. Post-hospital re-infarction and recurrent angina are more frequent in non-Q AMI than in Q wave AMI, offsetting the higher early risk with Q wave AMI, with one-year survival rates similar in the two types of MI. OBJECTIVES: 1--Evaluation of early (< or = 28 days) and one-year total mortality from first non-Q AMI in comparison to QMI. 2--Analysis of recurrent acute ischaemic events (non-fatal reinfarction and unstable angina) in both types of MI in the same periods of time. POPULATION AND METHODS: A retrospective study of 1146 patients, mean age 65 +/- 13 years, 65% male, admitted at CCU with a first MI, from January 1988 to December 1997 (minimum follow-up period of one year, mean follow-up 42 +/- 37 months). We compared the baseline demographics and clinical characteristics (coronary risk factors, previous angina, MI evolution, recurrent cardiac events, 28 day mortality and one year mortality) of patients with non-Q AMI (NQ group = 239) and Q wave AMI (Q group = 907). RESULTS: The NQ group patients were significantly older (mean age: 67 +/- 12.6 vs 65 +/- 12.5 years; p < 0.05), included fewer smokers (29% vs 43%; p < 0.001) and were more symptomatic before the index infarction (stable angina: 40% vs 30%; p < 0.05; unstable angina: 16% vs 6%; p < 0.001), when compared to the Q group patients. There were no significant differences in MI evolution, in Killip-Kimbal class > or = 2, recurrent angina and in-hospital mortality (Q-12% vs NQ-9%; ns), although there was a higher combined risk of arrhythmias and AV conduction disturbances in patients with QMI (Q-34% vs NQ-26%; p < 0.05). The combined risk of unstable angina and reinfarction at one year was significantly higher in group NQ (NQ-13% vs Q-8.1%; p < 0.05). The NQ group showed no significant difference in 28 day total mortality (NQ-14% vs Q-17%; ns) or at one year follow-up (NQ-24% vs Q-26%; ns) when compared to the Q group. CONCLUSION: 1--Despite a lower severity of non-Q AMI in the acute phase, 28 day and one year total mortality were similar in the two groups. 2--Patients with non-Q AMI showed a higher incidence of recurrent ischemic events at one year follow-up.

[Familial aggregation of blood pressure over 17 years in children and young adults]. / Agrégation familiale de la pression artérielle de l'enfance à l'âge adulte après un suivi de 17 ans.

UNLABELLED: Familial aggregation of blood pressure is well known although its causes remain controversial. The aim of the present study is to evaluate the presence of a familial aggregation for blood pressure and body mass index over a 17-year period, in order to evaluate the importance of a primary prevention strategy beginning in familial environment. DESIGN AND METHODS: A longitudinal cohort study was constructed from two cross-sectional surveys 17 years apart: 1,032 individuals, of both sexes, aged 5 to 24 years were seen in the initial study, and their parents whenever possible. Correlation coefficients and stepwise regression analysis were used to analyse the relationship between parents and children. RESULTS: The correlation between parents' and children BP are: systolic BP-0.34 (p < 0.01) and diastolic BP 0.19 (0.05); and for the anthropometric variables are: height-0.29 (0.01); weight-0.41 (p < 0.01); ponderal index -0.21 (p < 0.05); tricipt skinfold-0.21 (p < 0.05). All the coefficients are statistically significative. The variance of children's SBP and DBP explained through a stepwise regression analysis was 47%. The children's weight, skinfold, ponderal index, and parents' SBP and DBP were accepted by the model. CONCLUSION: The relation between BP and obesity variables suggest that a large proportion of familial aggregation for BP may be explained by aggregation for obesity, still after 17 years.

[Tracking indices of the blood pressure in a longitudinal study in infants and adolescents]. / Indices de tracking da pressão arterial num estudo longitudinal de crianças e adolescentes.

OBJECTIVE: The objective of this study was to assess the degree of BP Tracking from childhood to adulthood and to evaluate whether high BP levels persist over time and progress to adult hypertension. PATIENTS AND METHODS: Two hundred and twenty-two healthy schoolchildren living in the North of Portugal were assessed at 17 year intervals, starting in 1979 (cohort 1) aged 5 to 18 years, and again in 1996 (cohort 2). Tracking indices (Ti) were calculated as follows: Ti = (2x + y-z) /N/0.89, where x, y and z refer to the total number in the same, adjacent and remote trisections, respectively, and N = x + y + z. If Ti > 1 there is positive tracking. RESULTS AND CONCLUSIONS: For systolic and diastolic blood pressure, all Ti were greater than 1.0. All individuals that remained in the 3rd tertil, 17 years later, weigh more and are more obese than those of the 1st tertil. 56.6% of the individuals that belong to the 3rd tertil are now hypertensive, which means that a significant percentage of the children with high blood pressure in the first survey will be hypertensive in the future.

[Blood pressure normal values in children and adolescents according to age and height]. / Normogramas da pressão arterial em crianças e adolescentes de acordo com a idade e a altura.

The assessment of blood pressure in children and adolescents is of great importance in order to gain a better understanding of its pattern of evolution. The authors publish the normal values of blood pressure in Portuguese children and adolescents, according to age and sex, as well as the mean values of the 90th percentile, which are very important to separate normal children from those with high blood pressure. In this study the fifth Korotkoof sound is used to define diastolic blood pressure in all ages. New blood pressure tables are also published, for children and adolescents, that now include the height percentile for age and blood pressure. These new charts have been developed to guide practising clinicians in antihypertensive drug therapy, when indicated.

Screening of Asteraceae (Compositae) plant extracts for larvicidal activity against Aedes fluviatilis (Diptera:Culicidae).

Ethanol extracts of 83 plants species belonging to the Asteraceae (Compositae) family, collected in the State of Minas Gerais, Brazil, were tested for larvicidal activity against the mosquito Aedes fluviatilis--Diptera: Culicidae). The extract from Tagetes minuta was the most active with a LC90 of 1.5 mg/l and LC50 of 1.0 mg/l. This plant has been the object of several studies by other groups and its active components have already been identified as thiophene derivatives, a class of compounds present in many Asteraceae species. The extract of Eclipta paniculata was also significantly active, with a LC90 of 17.2 mg/l and LC50 of 3.3 mg/l and no previous studies on its larvicidal activity or chemical composition could be found in the literature. Extracts of Achryrocline satureoides, Gnaphalium spicatum, Senecio brasiliensis, Trixis vauthieri, Tagetes patula and Vernonia ammophila were less active, killing more than 50% of the larvae only at the higher dose tested (100 mg/l).

[Systemic vasculitis as the initial presentation of a left atrial myxoma]. / Vasculite sistémica como apresentação inicial de um mixoma auricular esquerdo.

Left atrial myxoma remains a diagnostic challenge. The authors briefly review previously reported cases and their individualistic clinical and laboratory features. This report documents an unusual clinical presentation, initially directing attention to the central nervous system as well as bilateral tenderness and weakness of the extremities. The illness was considered to be a vasculitis until thirty-one months later when the diagnosis of left atrial myxoma was made. The tumor was successfully removed.

Prevalence of high blood pressure in children and adolescents. Influence of obesity.

Obesity is associated with high blood pressure BP, mainly in adults. It has been suggested that body fat patterning plays a role in the etiology of hypertension. This relationship also exists in children, however it is less well known. The aim of this study was to evaluate the prevalence of high blood pressure (HBP) in children and adolescents, and the influence of obesity on this population, as well as the presence of familial aggregation for these factors. Eight hundred and eighty-nine children (389 boys and 500 girls aged 5-18 years) and their parents, from the North of Portugal were studied. Systolic blood pressure, diastolic blood pressure, weight, height, triceps skinfold, body mass index and sexual maturation were measured. The criterion of high blood pressure was defined as the BP being higher than the 90th percentile. All variables were converted to age and sex in specific "Z-scores". A SPSS package was used. We found 47 (5.2%) people of both sexes to have high blood pressure. The children of this group were compared with the normotensive group. These children were heavier (p < 0.005) and more obese (p < 0.0001) than the others. No difference was found for sexual maturation or height. The parents of the group with high blood pressure were heavier (p < 0.001) and more obese (p < 0.01) than the parents of the normotensive group. In conclusion, obesity is an important factor in children with higher values. Children with HBP are more likely to come from families with history of obesity. The identification of these risk factors in children is an important contribution to the prevention of cardiovascular disease in adulthood.

[Blood pressure in a population of youngsters and adults observed after 17 years]. / Estudo da pressão arterial numa população de jovens e adultos jovens observados após um período de 17 anos.

Many studies have assessed the blood pressure tracking among children and adolescents, but the results have been controversial. This study assessed the blood pressure tracking in 224 Portuguese school children and young adults following them for 17 years. The correlations obtained for systolic and diastolic blood pressure in both sexes are not very high, although positive and statistically significant. On the other hand, there was a stronger correlation between anthropometric variables and blood pressure and indices of obesity.

Aggregation of blood pressure in families: genetic and environmental influences.

A study was undertaken to determine whether parent-child blood pressure (BP) resemblances reflect parent-child similarities in body build. Those studied were 889 children, 5-18 years old, their parents and relatives because of recognized correlations between body build and BP in individuals, along with familial clustering of these variables. To maximize the likelihood of demonstrating correlations between BP and body build in family members, BP and anthropometric variables of parents whose children were in the upper quintile (group I) and lower quintile (group II) of the same variables were compared. Variance analysis has shown that group I children were heavier (P less than or equal to 0.001) and more obese (P less than or equal to 0.01) than group II. The parents of group I had higher systolic BP (P less than or equal to 0.001), diastolic BP (P less than or equal to 0.01), were taller (P less than or equal to 0.0001), heavier (P less than or equal to 0.001) and more obese (P less than or equal to 0.01), than the parents of group II. Parent-children BP resemblances reflect parent-children similarities in body build. The study of group I children and their families may give important information about determinants of high BP in children.

Left ventricular outflow tract obstruction due to tricuspid valve prolapse through a high ventricular septal defect.

A rare case is described of fixed subaortic obstruction due to a prolapsed redundant fibrous septal leaflet of the tricuspid valve, herniated through a membranous ventricular septal defect in a boy aged 11 years. The type of obstruction was not suspected before surgery and there was no shunt through the septal defect. Left ventriculography, was attempted and abandoned due to dangerous arrhythmia. Echocardiogram showed definite fixed subvalvular left ventricular outflow obstruction. Corrective surgery was carried out through aortotomy and right ventriculotomy. Ruptured chordae were resected and the tricuspid valve was replaced into the right ventricle. Redundant fibrous tissue was used to close the septal defect. The postoperative recovery was uneventful after complete AV block in the first 5 days.