Characterization of HIV risks in a Brazilian sickle cell disease population.

BACKGROUND: A low prevalence of HIV in sickle cell disease (SCD) patients has been reported in the literature though mechanisms for this are not understood. METHODS: HIV risk behaviors were compared between SCD cases and non-SCD controls using a self-administered audio computer-assisted self-interview. SCD cases were recruited from a multi-center SCD cohort established in Brazil; controls were recruited from SCD social contacts. Categorical variables were analyzed using Chi-Square or Fisher exact test. Continuous variables were compared using the Mann-Whitney U test. RESULTS: There were 152 SCD cases and 154 age/location matched controls enrolled at three participating Brazilian centers during 2016-17. No significant differences in number of sexual partners (lifetime or previous 12 months), male-to-male sex partners or intravenous drug use were observed. Cases received more transfusions, surgeries, and acupuncture treatment. CONCLUSIONS: Besides the risk of transfusion-transmitted HIV, which is now exceedingly rare, SCD and non-SCD participants demonstrated similar HIV risk behaviors. Causes other than risk behaviors such as factors inherent to SCD pathophysiology may explain the reported low prevalence of HIV in SCD.

Determining the health-related quality of life in individuals with haemophilia in developing economies: results from the Brazilian population.

INTRODUCTION: Several studies show the negative impact of haemophilia in health-related quality of life (HRQOL). This issue is not well explored in developing countries. OBJECTIVES: This cross-sectional study aimed to evaluate the HRQOL and its associated factors in patients with haemophilia A/B in Brazil. Data were collected by questionnaire and in medical records, including a Portuguese version of Haem-A-Qol. RESULTS: Brazilian patients were invited to the study and 175 participants (147 haemophilics A and 28 haemophilics B) were included. The total score of the Haem-A-QoL had a median of 36.96 (range of 0-100), with worse performance in 'sport and leisure' and best on 'relationships' fields. HRQOL was worst among the older participants, the less educated, non-white, non-working, who were hospitalized in the last year, who did not have a single medical consultation and among those with the highest number of affected joints. Moreover, patients with hepatitis B had a significantly worse HRQOL in the domain 'sports and leisure', also observed in married patients. Otherwise, married individuals reported better HRQOL on 'dealing with the disease' domain. Patients with haemophilia B reported worse HRQOL in the domain 'self-perception'. CONCLUSION: The results obtained could be helpful in guidance of haemophilia treatment which is determinant to improve HRQoL of the most vulnerable groups of patients. This work also reinforced the relevance of joint bleeds in all aspects of HRQoL in haemophilic patients. The use of prophylactic factor concentrates and multidisciplinary treatments could contribute to improve the quality of life in haemophilia.

Influence of tidal volume on pulse pressure variation and stroke volume variation during experimental intra-abdominal hypertension.

BACKGROUND: Pulse pressure variation (PPV) and stroke volume variation (SVV) are frequently used to assess fluid responsiveness in critically ill patients on mechanical ventilation (MV). There are many factors, in addition to preload that influence the magnitude of these cyclic variations. We sought to investigate the effect of tidal volume (V(T)) on PPV and SVV, and prediction of fluid responsiveness in a model of intra-abdominal hypertension (IAH). METHODS: Twelve anesthetized and mechanically ventilated piglets on continuous pulse contour cardiac output monitoring. Hypovolemia was ruled out with 2 consecutive fluid boluses after instrumentation. IAH was induced by intraperitoneal instillation of colloid solution with a goal of reducing respiratory system compliance by 50 %. Subjects were classified as fluid responders if stroke volume increased >15 % after each fluid challenge. SVV and PPV were recorded with tidal volumes (VT) of 6, 12 and 18 ml/kg before IAH after IAH induction and after a fluid challenge during IAH. RESULTS: V(T) influenced PPV and SVV at baseline and during IAH, being significantly larger with higher V(T). These differences were attenuated after fluid administration in both conditions. After IAH induction, there was a significant increase in SVV with the three-tested V(T), but the magnitude of that change was larger with high V(T): with 6 ml/kg from 3 % (3, 4) to 5 % (4, 6.25) (p = 0.05), with 12 ml/kg from 5 % (4, 6) to 11 % (8.75, 17) (p = 0.02) and 18 ml/kg from 5 % (4,7.5) to 15 % (8.75, 19.5) (p = 0.02). Similarly, PPV increased with all the tested VT after IAH induction, being this increase larger with high VT: with 6 ml/kg from 3 % (2, 4.25) to 6 % (4.75, 7) (p = 0.05), with 12 ml/kg from 5 % (4, 6) to 13.5 % (10.25, 15.5) (p = 0.02) and 18 ml/kg from 7 % (5.5, 8.5) to 24 % (13.5, 30.25) (p = 0.02). One third of subjects responded to fluid administration after IAH, but neither SVV nor PPV were able to identify the fluid responders with the tested V(T). CONCLUSION: IAH induction in non-hypovolemic subjects significantly increased SVV and PPV with the three tested V(T), but the magnitude of that change was higher with larger V(T). This observation reveals the dependence of functional hemodynamic markers on intrathoracic as well intra-abdominal pressures, in addition to volemic status. Also, PPV and SVV were unable to predict fluid responsiveness after IAH induction. Future studies should take into consideration these findings when exploring relationships between dynamic preload indicators and fluid responsiveness during IAH.

[Outcome evaluation of a health promotion among the elderly]. / Ergebnis-Evaluation einer Gesundheitsförderungsmaßnahme für ältere Menschen.

The programme "active health promotion in old age" focuses on responsible self determination in old age (empowerment) and places special emphasis on physical activity and nutrition. The intervention, successfully conducted in an urban setting (Hamburg), was tested in a rural area (Kinzigtal, Baden-Wuerttemberg). In this paper we present the results of the outcome evaluation. The intervention group consisted of older people, without care need and without cognitive impairment who lived in their own home (N=468). For the evaluation of the results a pre-post comparison was conducted (2 measuring points within an interval of 12 months). 4 out of 5 participants reported changes in their behaviour after the intervention. However, the pre-post comparison shows significant changes only for nutrition behaviour, but not of physical activity. Health related quality of life (SF-36) did not change after 12 months. These findings indicate that health promotion in old age may lead to changes in nutrition behaviour.

[Active health promotion among the aged in a rural region. Participants, acceptance, and implementation]. / Gesundheitsförderung für ältere Menschen in einer ländlichen Region. Teilnehmerstruktur, Akzeptanz und Durchführung.

The program "active health promotion in old age" focuses on persons aged 60 years and older who are not in need of care and are living independently without cognitive impairment. The objective of the intervention is to improve physical activity, healthy nutrition, and the integration of older people into network structures. The intervention was successfully conducted in an urban setting and has now been transferred to a rural area in southwestern Germany (Baden-Wuerttemberg). It was offered to statutory health insured people of Baden-Wuerttemberg within an integrated care program and was free of charge. This article reports the results of the process evaluation. For data collection, participants were interviewed using a standardized questionnaire. Semistructured interviews were conducted with the intervention team and involved general practitioners. In addition, secondary data were used to analyze selection bias between participants and nonparticipants. Although the rural area has a major impact on recruitment, access, and factors of implementation, results demonstrate that the intervention is highly accepted by participants. Moreover, structural conditions (e.g., fitness clubs, exercise classes) are essential for a successful transfer.

[Experience with the linkage of primary and secondary claims data in an intervention trial]. / Erfahrungen mit der Datenverknüpfung von Primär- und Sekundärdaten in einer Interventionsstudie.

The data linkage of health-related primary and secondary data provides new opportunities for health services research. The advantages of both data sources can be used synergistically, in this way their disadvantages can be overcome. In the context of the evaluation of a health intervention - the integrated health services project ('Gesundes Kinzigtal') - the conditions and requirements for an individualised data linkage of primary data (survey) and claims data of a statutory health insurance are described in this paper. The integration of secondary data permits us not only to assess the intervention concerning physical activity, nutrition and social participation of elderly people ('AGil') but, above all, also to measure and analyse the program effects on the utilisation of health care services. Recommendations regarding the data linkage of primary and secondary data in health services research are derived from the results and experiences of the AGil study. Suggestions are made concerning the suitable pseudonymisation algorithm for primary and secondary data, the matching method, approaches to reduce mismatching and their validation, as well as the legal basis for such a data linkage. Overall, an individualised data linkage of primary and secondary data does not pose any technical problems. Nevertheless a couple of data protection rules have to be followed; the data linkage offers a high knowledge insight to many health and epidemiological research questions and might be the new gold standard for health services research.

[Inguinal impalement. Report of two cases]. / Empalamiento inguinal. Presentación de dos casos clínicos.

BACKGROUND: Traumatic inguinal lesions in children are relatively unusual and those caused by impalement are less common. The purpose of this paper is to demonstrate the clinical course of two similar cases. CLINICAL CASES: A 13-year-old male and a 7-year-old female are presented in this report. During an accidental fall, they sustained an inguinal wound. In the emergency room, a wooden stake and a metallic bar were seen in the inguinal region. The surgical procedure shows absence of vascular, neurological, visceral and testicular damage. Both wounds caused by foreign bodies were subcutaneous and removed without complications. CONCLUSIONS: These types of accidents are uncommon and the absence of damage is the most relevant issue.

Empalamiento inguinal: presentación de dos casos clínicos / Inguinal impalement: report of two cases

BACKGROUND: Traumatic inguinal lesions in children are relatively unusual and those caused by impalement are less common. The purpose of this paper is to demonstrate the clinical course of two similar cases. CLINICAL CASES: A 13-year-old male and a 7-year-old female are presented in this report. During an accidental fall, they sustained an inguinal wound. In the emergency room, a wooden stake and a metallic bar were seen in the inguinal region. The surgical procedure shows absence of vascular, neurological, visceral and testicular damage. Both wounds caused by foreign bodies were subcutaneous and removed without complications. CONCLUSIONS: These types of accidents are uncommon and the absence of damage is the most relevant issue.

Onconase, an anti-tumor ribonuclease suppresses intracellular oxidative stress.

Onconase (ONC), an antitumor ribonuclease from oocytes of a frog Rana pipiens, capable of inducing apoptosis in many cell lines is synergistic with several other anticancer drugs. Since cytotoxic effects of numerous drugs are modulated by reactive oxygen intermediates (ROI), we have studied effects of ONC on the intracellular level of oxidants in several normal cell types as well as tumor cell lines. It is demonstrated for the first time that ONC substantially decreases the content of ROI in all cell lines studied. This effect depends on the ribonucleolytic activity of the enzyme and is due to both, decreased rate of ROI generation and accelerated rate of their degradation. Onconase decreases the mitochondrial transmembrane potential and consequently, generation of ATP. Simultaneously the enzyme decreases the expression of an antiapoptotic protein Bcl-2, and upregulates the proapoptotic Bax protein. These finding are consistent with the enzyme propensity to induce apoptosis. The observed antioxidant activity of ONC may be an important element of its cytotoxicity towards cancer cells. The enzyme seems to exert its biological activities by interfering with the redox system of cellular regulation.

[Enterocutaneous fistula in the pediatric population. Clinical experience]. / Fistula enterocutánea en la edad pediátrica. Experiencia clínica.

BACKGROUND: The presence of fistulous communications between the small bowel and the skin continues to be one of the most perplexing and challenging problems facing the surgeon today. Their occurrence is a major catastophe of surgical practice because are frequently a result of technical failure or errors in surgical judgement. MATERIAL, METHOD AND RESULTS: Thirty four patients with high-output enterocutaneous fistulae arising from the small intestine are reported. Fourteen were due to appendicitis and sixteen were infants. Fistula resection were performed in six patients. Spontaneous fistula closure occurred in twenty-eight. Six died. The treatment program included parenteral nutritition thorugh central venous line, local care and antibiotics. CONCLUSIONS: In recent years, more aggressive therapy accompanied by the development of high caloric parenteral alimentation shows promise of reducing the mortality and morbidity rates associated with these fistulas.

[Renal trauma in childhood. Second-level hospital experience]. / Trauma renal en la edad pediátrica. Experiencia de un hospital de segundo nivel.

UNLABELLED: The leading cause of death in children is accidents. Severe craniocerebral trauma and injuries to the heart or major vessels are mainly responsible for immediate death. This phenomenon is also reflected in the increasing number of pediatric admissions for renal trauma. MATERIAL AND METHODS: From 1990 to 2000, the charts of 132 patients with renal injuries secondary to blunt and penetrating trauma in childhood are reviewed. RESULTS: A total of 88 were male patients and 126 sustained blunt trauma (motor accidents, falls, etc.). Gross and microscopic hematuria were the most important finding at the time of presentation, and correlated with severe renal injury, and both were present in 122 cases. Intravenous pyelography and CT scan were the most useful diagnosis tools. Only 27 patients were managed operatively, the majority because of associated intra-abdominal injury. CONCLUSIONS: Intravenous pyelography remains the most cost-effective means of investigating renal injuries in a second-level hospital. Renal contusion and most laceration should be managed conservatively. Only few a renal transactions should be managed operatively.

Trauma renal en la edad pediátrica. Experiencia de un hospital de segundo nivel / Renal trauma in childhood. Second-level hospital experience

The leading cause of death in children is accidents. Severe craniocerebral trauma and injuries to the heart or major vessels are mainly responsible for immediate death. This phenomenon is also reflected in the increasing number of pediatric admissions for renal trauma. MATERIAL AND METHODS: From 1990 to 2000, the charts of 132 patients with renal injuries secondary to blunt and penetrating trauma in childhood are reviewed. RESULTS: A total of 88 were male patients and 126 sustained blunt trauma (motor accidents, falls, etc.). Gross and microscopic hematuria were the most important finding at the time of presentation, and correlated with severe renal injury, and both were present in 122 cases. Intravenous pyelography and CT scan were the most useful diagnosis tools. Only 27 patients were managed operatively, the majority because of associated intra-abdominal injury. CONCLUSIONS: Intravenous pyelography remains the most cost-effective means of investigating renal injuries in a second-level hospital. Renal contusion and most laceration should be managed conservatively. Only few a renal transactions should be managed operatively.

High affinity binding of fluorescein isothiocyanate to eosinophils detected by laser scanning cytometry: a potential source of error in analysis of blood samples utilizing fluorescein-conjugated reagents in flow cytometry.

BACKGROUND: In samples of peripheral blood cells processed using the commercial kits for detection of apoptosis based on DNA strand break labeling, a subpopulation of cells characterized by high green fluorescence, similar in intensity to that of apoptotic cells but more uniform, was consistently observed by flow cytometry. The labeled cells had no other features of apoptosis. The labeling was observed regardless of the fixative used and was evident in control samples lacking terminal deoxynucleotidyltransferase. Common to all the kits that generated this labeling pattern was the presence of fluorescein (f) conjugated reagents, f-dUTP, f-avidin, or f-antibody. METHODS: Laser scanning cytometry was used to identify the labeled cells and study the mechanism of labeling. Because it was suspected that the traces of unconjugated f-isothiocyanate (FITC) that may contaminate the reagents were responsible for the labeling, FITC binding affinity to white blood cells was studied. Gel electrophoresis was used to detect the presence of unconjugated FITC in the reagents. RESULTS: After staining with Giemsa, the strongly fluorescent objects were identified as eosinophils with normal morphology and no evidence of apoptosis. The fluorescence was localized exclusively within the cytoplasmic granules. Labeling of eosinophils was observed at 2 nM concentration of FITC, which was over three orders of magnitude lower than that needed to label neutrophils, monocytes, or lymphocytes. Gel electrophoresis of the f-conjugated reagents revealed only minor contamination with FITC. CONCLUSIONS: (1) Trace amounts of unconjugated FITC contaminating the reagents are adequate to strongly label eosinophils thereby introducing experimental bias in analysis of apoptosis and in other studies on blood cells utilizing f-labeled antibodies, e.g., in detecting cytokines. (2) FITC at concentration 2-500 nM can be used as a marker of eosinophiles; (3) Because of high affinity to FITC, eosinophiles (or the protein from these cells) may serve as a means of removing traces of unconjugated FITC from the reagents during their manufacture or prior to use.

Malignancy: A New Approach to the Analysis of Apoptosis in the Leukemic Subpopulation by Flow Cytometry Using a CD45 Gating Strategy.

Bone marrow and peripheral blood are heterogeneous tissues containing cells of different hematopoietic lineages. It is possible to detect leukemic cells by flow cytometry using a gating strategy, which combines CD45 expression on the cell surface with right angle light scatter (SS). This approach was applied to 15 cases of AML. Myeloblasts had the lowest CD45 fluorescence intensity of any of the cells in the myeloid series and also had the lowest SS, approximately equivalent to monocytes, but greater than lymphoblasts and lymphocytes. Using this gating strategy in each sample we could identify up to 5 separate cell compartments. Our results showed good correlation between the flow differential and the manual differential cell count. However in some cases, especially when a sample became hypocellular, the flow differential was more sensitive in identifying leukemic blasts. Total apoptosis (i.e. apoptosis in all cell populations combined) varied during the treatment between 0-34%. In the blood, the highest percentage of total apoptotic cells usually occurred between day 3-5 of treatment. The percentage of apoptotic cells varied depending on the cell type on a percentage basis. The leukemic population was lesslikely to undergo apoptosis compared to the lymphocytes, monocytes and more mature myeloid cells. In normal cells, apoptosis occurred mostly in G(1) and S phases of the cell cycle. Apoptosis among CD45-blasts usually varied between 0-5%. Myeloblasts also had a tendency to undergo apoptosis in G(1) and S phases of the cell cycle. The CD45-blast apoptotic peak in the blood occurred between day 5-7 of treatment. Analysis of drug-induced apoptosis in bone marrow seems to provide more information than such measurements in peripheral blood.

Occurrence of an acyl-CoA:1-acylglycerophosphorylcholine acyltransferase in plant mitochondria.

In the presence of oleoyl-CoA, purified and intact mitochondria from potato tuber formed phosphatidylcholine from labeled lysophosphatidylcholine. The labeled oleoyl moiety of the acyl-CoA was also incorporated in the absence of exogenous lysolipids, such incorporation being largely increased by the addition of exogenous lysophosphatidylcholine. In the presence of various other lysophospholipids, no synthesis of the corresponding phospholipids was observed, suggesting a high specificity of the acyltransferase towards the acyl acceptor. This enzyme was chiefly located in the outer membrane of mitochondria. These results indicate that any acylglycerophosphorylcholine transferred from the endoplasmic reticulum to mitochondria may be acylated to phosphatidylcholine.

Duplicación intestinal tóraco-abdominal / Thoraco-abdominal duplication

Introducción. Es bien conocido que la duplicación intestinal intraabdominal es una malformación congénita poco frecuente; la torácica es aún menos; y la tóraco-abdominal es excepcional. Presentamos el caso de un niño que sufrió este último defecto y estudiamos en detalle los hallazgos clínicos, radiológicos y quirúrgicos. Caso clínico. Lactante masculino de 11 meses de edad que fue hospitalizado por infección de vías respiratorias y palidez cutánea. el día de su ingreso se le efectuo estudio radiológico de tórax, que revelo la presencia de un nivel hidroaéro en el hemitórax izquierdo y hemivértebras. La tomografía axial computada mostró la presencia de tumoración en mediastino posterior. Fue intervenido quirúrgicamente encontrándose duplicación tóraco-abdominal. Esta fue extirpada y el extremo diafragmático fue suturado. Como externo, se le efectuó tránsito intestinal y gamagrafía abdominal, refiriéndose posible comunicación con el tubo digestivo proximal y mucosa gástrica ectópica. En la laparotomía exploradora se encontró conexión del yeyuno con el residuo de la duplicación Se efectuó resección intestinal y entero-enteroanastomosis. Conclusiones: este es un defecto raro que requiere de intervención quirúrgica

[Comparative analysis of ultrastructure and lipid composition of plastids from sun and shade plants (author's transl)]. / Analyse comparative de l'ultrastructure et de la composition lipidique des chloroplastes de plantes d'ombre et de soleil.

The ultrastructure and lipid composition of chloroplasts, isolated from various shade and sun plants, were compared. Depending on the origin of the plastid, significant differences were observed in the percentage of appressed thylakoids. Accordingly, plastids could be classified into three different types: Type I chloroplasts, from mesophyll cells of sun plants (barley, corn, spinach, bean), display well-developed grana and intergrana thylakoid membranes. Type II chloroplasts, typical of shade plant (Arum), show giant grana stacks with few interconnecting thylakoids. Type III chloroplasts, from bundle sheath cells of leaves from C4-plants (corn), are characterized by an extensive development of stroma thylakoids with only occasional rudimentary grana. The percentages of appressed membranes are in the ranges of 50 to 60%, 80% and 2% for type I, II and III plastids respectively. Striking differences are observed in the fatty acid composition of phosphatidylglycerol molecules. Trans-delta3-hexadecenoic acid is found only in this phospholipid and amounts to 30 to 40%, 50% and less than 8% of total fatty acids in type I, II and III plastids respectively. The comparison of ultrastructural and biochemical data suggests a strong correlation between the amounts of phosphatidylglycerol molecules containing trans-delta3-hexadecenoic acid and the percentages of appressed membranes (grana stacks) within plastid stroma.

Sur l'incorporation de la radioactivite du sn-glycerol-3-phosphate-(14)C dans le monogalactosyldiglyceride des plastes isoles.

Isolated plastids (chloroplasts and etioplasts) that are morphogically intact and free of any contamination from other cell structures can incorporate label from sn-glycerol-3-phosphate-(14)C into monogalactosyldiglyceride.