Low bone mineral density and associated factors in patients with haemophilia in Colombia.

INTRODUCTION: Patients with haemophilia may have lower levels of bone mineral density (BMD) compared with the general population. Moreover, haemophilic patients have increased risk factors for low bone mineral density (LBMD) such as arthropathy and resulting immobility, increasing their risk for osteoporosis and fractures. AIM: To assess the prevalence of LBMD and associated risk factors among a group of Colombian haemophilic patients. METHODS: In this case-control study, 90 patients with haemophilia A and B, over the age of five, were recruited. Controls were healthy participants matched by age, gender, body mass index (BMI), socioeconomic status, and race. All participants underwent dual energy X-ray absorptiometry (DXA) and the Global Physical Activity Questionnaire. Blood tests were collected to evaluate LBMD determinants in cases. RESULTS: BMD was lower in cases than in the control group. BMD of femoral necks was 0.907 g/cm2 in cases vs. 1.020 g/cm2 in controls (P = .019), and BMD of hips 0.930 g/cm2 in cases vs. 1030 g/cm2 in controls (P = .019). The greater the severity of haemophilia, the lower BMD in spine, femoral neck, and hips. Elevated C-protein levels were found in 44.1% of patients with LBMD and 14.8% with normal BMD (P = .003). The study found an adjusted prevalence ratio of 2.11, indicating that haemophilic patients are two times more likely to have LBMD (CI95% = 1.43-3.11 P < .001). CONCLUSION: Results from the present study showed that haemophilia was associated with a higher frequency of LBMD. Severity of haemophilia, haemophilic arthropathy, and elevated C-reactive protein levels was directly associated with LBMD.

Selection of common bean genotypes for the Cerrado/Pantanal ecotone via mixed models and multivariate analysis.

The common bean, Phaseolus vulgaris, is predominantly grown on small farms and lacks accurate genotype recommendations for specific micro-regions in Brazil. This contributes to a low national average yield. The aim of this study was to use the methods of the harmonic mean of the relative performance of genetic values (HMRPGV) and the centroid, for selecting common bean genotypes with high yield, adaptability, and stability for the Cerrado/Pantanal ecotone region in Brazil. We evaluated 11 common bean genotypes in three trials carried out in the dry season in Aquidauana in 2013, 2014, and 2015. A likelihood ratio test detected a significant interaction between genotype x year, contributing 54% to the total phenotypic variation in grain yield. The three genotypes selected by the joint analysis of genotypic values in all years (Carioca Precoce, BRS Notável, and CNFC 15875) were the same as those recommended by the HMRPGV method. Using the centroid method, genotypes BRS Notável and CNFC 15875 were considered ideal genotypes based on their high stability to unfavorable environments and high responsiveness to environmental improvement. We identified a high association between the methods of adaptability and stability used in this study. However, the use of centroid method provided a more accurate and precise recommendation of the behavior of the evaluated genotypes.

Lomas-Cooperman technique for rectal prolapse in the elderly patient.

BACKGROUND: A variety of surgical procedures is used to correct complete rectal prolapse (RP). We analysed the immediate and long-term results of the Lomas-Cooperman technique in the management of symptomatic RP in elderly patients with severe concomitant diseases. METHODS: Across a 13-year period, all patients with RP having undergone surgery with this procedure were retrospectively evaluated. The technique consisted in placing a triply folded piece of polypropylene mesh encircling the anal canal through a perineal approach. RESULTS: A total of 22 patients (20 female) with a mean age of 84 years (range, 72-93 years) with severe concomitant pathologies were assessed. Four patients were classified as ASA II and 18 as ASA III. Mean Karnofsky score was 50%, ranging between 40% and 60%. All patients were operated on under regional anaesthesia without incidents. Mean operative time was 35 min(range, 20-60 min) and mean hospital stay was 4.5 days (range, 2-17 days). The most common immediate postoperative complication was urinary tract infection, found in 18% of the cases. Mean follow-up was 32 months (range, 4-84 months). During follow-up, 4 cases (18%) of mesh exteriorisation were detected, requiring mesh trimming at the outpatient clinic. Rectal prolapse recurred in 2 patients; one of them was managed with a new cerclage reaching a satisfactory outcome. Thus, by intention-to-treat basis, the recurrence rate was 4.5%. Constipation was resolved in three out of 4 patients, but in 18% of the cases late faecal impact was recorded. Mean preoperative incontinence score improved from 5.1+/-0.62 to 3.4+/-1.61 (p<0.0001) after surgery. CONCLUSION: Anal cerclage with the Lomas-Cooperman technique constitutes a simple and reproducible surgical technique with an acceptable morbidity and recurrence rate in high-risk elderly patients with RP.

Posterior pelvic exenteration for primary rectal cancer.

BACKGROUND: Indications for and the prognosis of posterior pelvic exenteration (PPE) in rectal cancer patients are not clearly defined. The aim of this study was to analyse the indications, complications and long-term results of PPE in patients with primary rectal cancer. METHODS: A retrospective review included patient demographics, tumour and treatment variables, and morbidity, recurrence, and survival statistics. These results were compared with a group of female patients who underwent standard resection for primary rectal cancer in the same period (non PPE group). RESULTS: The series included 30 women with an average age of 56.7 years (range 22-78). Tumour location was recorded in three cases in the upper rectum, 13 cases in the medium rectum and 14 cases in the lower rectum. A sphincter-preserving procedure was performed in 70% of the patients. Mean operative time was 4.2 h (range 2-7.5 h). Overall major morbidity rate in this series was 50% and mean hospital stay was 19.7 days (range 9-60 days). There was no hospital mortality. Pathological reports showed direct invasion of uterus, vagina or rectovaginal septum in 19 cases, involvement of perirectal tissue in 25 cases and positive lymph nodes in 18 cases. Comparison between PPE and non PPE groups showed no differences in mean tumour diameter, histological grade and tumour stage, but patients in the first group were younger. Although low tumours were seen more frequently in the PPE group (P = 0.003), the rate of sphincter-preserving procedure was comparable in both groups. Operative time was longer (P = 0.04) and morbidity was higher (P = 0.0058) in the PPE group. Local recurrence with or without distant metastases for the whole series was 30%. Five-year survival rate for patients who underwent curative resections (TNM I-III) was 48% in the PPE group vs 62% in the non PPE group (P = 0.09). CONCLUSIONS: In the present series, PPE prolonged operative time, increased postoperative complications and showed a trend toward poor prognosis in recurrence and survival. However, PPE offers the only hope for cure to patients with a primary rectal cancer that is adherent or invades reproductive organs.

Contribuiçåo da medicina complementar para a integralidade da assistência das ações de educaçåo em saúde da Unidade de Saúde da Família de Nazaré-Inabi, nos grupos de hipertensos e diabéticos / Contribution of complementary medicine to integrate assistance of helth education actions in Nazaré-Inabi's Family Health Unit, in hypertensive and diabetic groups

Estresse, correria, poluiçåo e preocupações såo alguns dos problemas da vida moderna que mexem com a nossa saúde e tiram nossa energia. Atividades como a medicina complementar podem repor essa energia perdida, proporcionando a vitalidade, a calma, o alívio das dores, a melhoria da circulaçåo sangüinea e o tônus muscular, dentre outros benefícios. Este trabalho tem como objetivo apresentar a experiência com atividades de medicina complementar, inicidas em maio de 2002, dentro da ações de educaçåo em saúde, desenvolvidas na comunidade de Nazaré-Inabi, no município de Macaragibe. O trabalho ocorreu sob a orientaçåo dos profissionais da equipe e de convidados que realizam, em outros espaços, atividades com este fim.

Proposta de um modelo de padronizaçäo para o exame sumário de urina / Proposal to standardization model for the urinalysis

O exame sumário de urina representa sem dúvida um elemento indispensável na detecçäo de diversas doenças do trato urinário, metabólicas ou sistêmicas näo relacionadas com o rim. Quando realizado e interpretado criteriosamente, oferece ao solicitante valiosas informaçöes para o esclarecimento diagnóstico. O presente trabalho tem como objetivo propor um modelo de padronizaçäo de resultados, descritos de acordo com o exame físico (volume, cor, aspecto, depósito e densidade), pesquisas bioquímicas realizadas através de tiras reativas (pH, proteínas, glicose, corpos cetônicos, hemoglobina, urobilinogênio, bilirrubina, esterase leucocitária e nitrito) e os elementos encontrados na sedimentoscopia urinária (células epiteliais de descamaçäo, leucócitos, hemácias, cilindros, bactérias, muco, cristais, sais amorfos, leveduras, espermatozóides e parasitas). Além desses parâmetros, algumas observaçöes podem ser descritas, quando necessárias, com a finalidade de fornecer informaçöes ao clínico que possam auxiliar no diagnóstico de doenças mais específicas. Sabe-se da existência de vários interferentes na urina que podem provocar reaçöes falso-negativas. Por este motivo, a confirmaçäo de alguns componentes urinários (proteínas, glicose, bilirrubina e urobilinogênio) é necessária para garantir a exatidäo do resultado. A padronizaçäo de procedimentos poderá evitar as diferentes formas de transcriçäo do laudo interlaboratorial, o que ocasiona interpretaçäo e tratamento inadequados

Perfil eletroforético das proteínas e concentraçäo das imunoglobulinas plasmáticas em pacientes assintomáticos e sintomáticos portadores de HIV / Proteins electrophoretic profile and immunoglobulins plasmatics concentration in asymptomatics and symptomatics patients infected by HIV

Estudos têm demonstrado que 81 por cento dos pacientes infectados pelo HIV apresentam um padräo proteico anormal devido ao estado hipermetabólico. Os achados laboratoriais revelam que as anormalidades da imunidade humoral precedem a imunidade mediada pelas células e portanto, o diagnóstico da infecçäo pelo HIV depende do estabelecimento da infecçäo definindo o estado imunológico e o quadro clínico do paciente que ocorre secundário à infecçä e à perda da funçäo imune. No presente trabalho, realizamos um estudo comparativo do perfil eletroforético das proteínas, bem como a determinaçäo da concentraçäo das imunoglobulinas plasmáticas em pacientes portadores de HIV (assintomáticos e sintomáticos) com o objetivo de investigarmos alteraçöes específicas das fraçöes protéicas (albumina e globulina) durante os diferentes estágios da doença. Foram analisadas 30 amostras de sangue coletado de pacientes HIV positivos divididos em dois grupos (assintomáticos e sintomáticos). As proteínas totais foram determinadas pelo método do Biureto, sendo observada uma hipoproteinemia em 60 por cento dos pacientes sintomáticos e valores normais em todos os assintomáticos. A eletroforese das proteínas foi realizada em gel de agarose mostrando hipoalbuminemia em 70 por cento dos pacientes assintomáticos e 90 por cento sintomáticos. A hipergamaglobulinemia predominou em 100 por cento dos sintomáticos e 90 por cento dos assintomáticos. As fraçöes alfa e beta globulinas apresentaram-se normais nos dois grupos. As imunoglobulinas foram avaliadas por turbidimetria e uma elevaçäo significativa foi verificada na concentraçäo de IgG em todos os pacientes sintomáticos. Por outro lado, os valores de IgA e IgM apresentaram-se dentro dos valores de referência. Os resultados estäo de acordo com vários trabalhos citados na literatura, comprovando que a AIDS é uma gamopatia monoclonal, caracterizada por hipoalbuminemia e hipergamaglobulinemia. O trabalho mostra portanto, que, a avaliaçäo de parâmetros laboratoriais mais simples säo úteis no monitoramento da síndrome em estudo, como também fortes indicadores do estágio da doença.

Proposta de um método alternativo para a determinação da concentração de hemoglobina / Proposed an alternative method to determinate the hemoglobin concentration

A hemoglobina (Hb), principal componente das células vermelhas sanguíneas, é um conjugado de proteínas que serve como transporte de O2 e CO2, sendo assim, indispensável à manutenção da vida dos mamíferos. A quantidade de hemoglobina por 100 mL de sangue pode ser utilizada como índice da capacidade de transporte de oxigênio. O teor total de hemoglobina no sangue depende principalmente do número de eritrócitos e, em menor grau, da quantidade de hemoglobina existente em cada eritrócito. Dependendo do método utilizado e dos cuidados com os quais o laboratório afere seus instrumentos, os métodos para a determinação da hemoglobina que utilizam o espectrofotômetro e contadores automáticos, apresentam uma precisão de 4 a 5% e 2 a 3% respectivamente. Como alguns métodos para dosagem da hemoglobina baseiam-se na medida do índice de hemólise, introduzimos no presente trabalho uma técnica na qual foi utilizada apenas água deionizada como diluente, que, seguramente também provoca tal fenômeno. O método proposto tem como objetivo investigar a compatibilidade entre os resultados obtidos com os que fazem uso do ferricianeto de potássio e hidróxido de amônia. A concentração de hemoglobina foi determinada em 30 amostras de sangue recentemente colhidas com EDTA em tubo a vácuo. Para efeito comparativo, foram utilizados dois tipos de padrão: o que acompanha o kit e uma amostra de sangue devidamente padronizada pelo laboratório (LACT). Os resultados obtidos demonstram diferenças significativas entre os métodos realizados com o padrão do fabricante, enquanto que, com o padrão de referência do laboratório, foi verificada uma significativa compatibilidade. Portanto, os dados indicam que o método proposto poderá ser útil na determinação da concentração de hemoglobina no laboratório clínico, não esquecendo o fato de que, além de outras vantagens, a toxicidade causada pelo ferricianeto é totalmente eliminada.

Investigations on the gastroprotective and antidiarrhoeal properties of ternatin, a tetramethoxyflavone from Egletes viscosa.

The study was designed to verify the gastroprotective and antidiarrhoeal effects of ternatin, tetramethoxyflavone isolated from Egletes viscosa Less. The gastroprotective function of ternatin was evaluated in rats against gastric mucosal damage induced by hypothermic restraint stress, absolute ethanol, and indomethacin, whereas the antidiarrhoeal activity was investigated by studying its influence on gastrointestinal transit as measured by a charcoal marker and on castor oil-induced accumulation of intestinal fluid in mice and also on contractile responses evoked by acetylcholine, histamine, serotonin, and barium chloride in isolated guinea-pig ileum. The results demonstrate that pretreatment of animals with the plant flavonoid (25 and 50 mg/kg, i.p.) produces a significant inhibition of gastric lesions induced by ethanol but not those induced by restraint stress or indomethacin and suggest a probable involvement of a prostaglandins-independent mechanism of gastroprotection. At similar doses, both the intestinal transit as well as the accumulation of intestinal fluids induced by castor oil in mice were significantly inhibited by ternatin. Furthermore, the flavonoid antagonised the contractile responses evoked by different agonists on guinea-pig ileum in vitro and its inhibitory potential for the drugs are in the order of acetylcholine > histamine > serotonin > barium chloride. Taken together, these results point out a possible antidiarrhoeal effect of ternatin since inhibition of intestinal motility and secretion can greatly control clinical diarrhoea.

Protective effect of ternatin, a flavonoid isolated from Egletes viscosa less., in experimental liver injury.

The effect of ternatin, a tetramethoxyflavone from Egletes viscosa Less., on liver injury induced by carbon tetrachloride (CCl4) was investigated in rats. Twenty-four hours following CCl4 insult (2.5 ml/kg s.c.), changes in the serum enzymes, alanine aminotransferase, aspartate aminotransferase and gamma-glutamyltransferase, as well as liver cell histology were used as indices of hepatic dysfunction. The results show that ternatin (30 mg/kg i.p. daily for 5 consecutive days) causes marked inhibition of CCl4-induced serum enzymes and morbid histologic changes. The observation suggests that ternatin possesses antihepatotoxic activity.