III Diretriz Brasileira de Insuficiência Cardíaca Crônica

Universidade de São Paulo Faculdade de Medicina Hospital das ClínicasUniversidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto AlegreUniversidade de Pernambuco Faculdade de Ciências Médicas de PernambucoUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de Minas Gerais Faculdade de MedicinaFaculdade de Medicina de São José do Rio PretoFundação Universitária de Cardiologia do Rio Grande do Sul Instituto de CardiologiaRede Labs D'OrUniversidade Federal FluminenseUniversidade do Estado do Rio de Janeiro Faculdade de Ciencias MédicasInstituto Dante Pazzanese de CardiologiaSanta Casa de MisericórdiaUniversidade de Pernambuco Pronto Socorro Cardiológico de PernambucoHospital Pró CardíacoHospital de MessejanaPontifícia Universidade Católica do ParanáUniversidade Federal de Goiás Faculdade de MedicinaUniversidade de São Paulo Faculdade de Medicina de Ribeirão PretoReal e Benemerita Sociedade de Beneficência PortuguesaFaculdade de Ciências Médicas de Minas GeraisUNIFESP, EPMSciEL

Relatório do representante do Ministério do Ultramar à 2ª Conferência Mundial de Educação Médica

A 2ª Conferência Mundial do Ensino Médico realizou-se em Chicago, de 30 de Agosto a 4 de Setembro de 1959, com a participação de cerca de 800 delegados, representando 66 países, entre os quais Portugal.The 2nd World Conference on Medical Education took place in Chicago, from 30 August to 4 September 1959, with the participation of around 800 delegates representing 66 countries, including Portugal.info:eu-repo/semantics/publishedVersio

A biopsia rectal no diagnóstico da bilharzíase vesical

Contém quadros e ilustrações.1- Num grupo de 110 doentes com bilharzíase vesical encontram-se ovos de S. haematobium em retalhos duma única biopsia rectal em 80% dos casos primitivamente negativos; 2- A biopsia rectal seguida de exame microscópico por transparência do retalho constitui um meio apropriado para o diagnóstico de bilharzíase vesical. Não é, certamente, um processo de rotina para zonas rurais, pois dispomos doutros mais práticas. Deve, porém, usar-se nos casos clinicamente suspeitos quando os exames de urina são negativos. 3- A biopsia rectal é inócua, bem tolerada pelo doente e não dá lugar a qualquer complicação, podendo repetir-se quando necessário para esclarecimento do diagnóstico. Aparentemente a sua execução na parede anterior e a uma altura de cerca de 6 cm do orifício anal aumenta as suas probabilidades de positividade; 4- Levando em consideração a dificuldade de distinguir, em alguns casos, os ovos viáveis dos degenerados, o método não serve para avaliação da eficácia da terapêutica nem dele se pode tirar qualquer conclusão prognóstica, particularmente pelo que respeita à cura dos doentes.1-En 110 malades de bilharziose urinaire, on a trouvé oeufs de S. haematobium après une biopsie rectal en 80% des cas, pourcentage qui a augmenté à 94,5% quando répété dans les cas premièrement negatifs; 2- La biopsie rectal, suivie para examen microscopique morceaux, est un moyen aproprié de diagnostique de la bilharziose urinaire. Elle n’est pas une méthode de routine pour les zones rurales endémiques, mais elle doit être entreprise dans les cas cliniquement suspects quando les examens d’urine sont negatifs; 3- La biopsie rectal est inoffensive, bien tolerée et sans complications. Elle peut être répétée quand necessaire pour éclaircir le diagnostique. Il parait qui, quando faite dans la paroi antérieure et à peu près 6 cm de l’orifice anal, la probabilité de positivité augmente; 4- Considérant les difficultés de distinguer en quelques cas la viabilité des oeufs, la méthode n’est pas pratique pour évaluer l’efficacité thérapeutique et n’a pas valeur prognostique, particulièrement pour établir un critérium de guèrison.1-In 110 patients with vesical schistosomiasis ova of S. haematobium by one rectal biopsy were found in 80 per cent of cases, percentage which increased to 94,5 per cent when repeated in the formerly negative cases; 2- Rectal biopsy, followed by microscopic examination of the snips, is an appropriate mean of diagnosis of vesical schistosomiasis. It is not a routine procedure for rural areas, because we have other more practical methods, but must be used in cases clinically suspicious when the urine examinations are negative; 3- Rectal biopsy is innocuous, well tolerate and has no complications It can be repeated when necessary to clear up the diagnosis. Apparently, when made in the anterior wall and at about 6 cm of the anal opening, the probability of positivity increases; 4- Taking into account the difficulty to distinguish the viable ova in same cases, the method is not useful to evaluate the therapeutic efficacity and has no prognostic value, particularly regarding the clinical cure.info:eu-repo/semantics/publishedVersio

Long-term sucrose solution consumption causes metabolic alterations and affects hepatic oxidative stress in Wistar rats

As the number of overweight and obese people has risen in recent years, there has been a parallel increase in the number of people with metabolic syndrome, diabetes and non-alcoholic fatty liver disease. The consumption of artificially sweetened beverages contributes to these epidemics. This study investigated the long-term effects of ingestion of a 40% sucrose solution on serum and hepatic parameters in male Wistar rats (Rattus norvegicus). After 180 days, the glycemic response, lipid profile and hepatic oxidative stress were compared to those of rats maintained on water. Sucrose ingestion led to higher body weight, increased fat deposits, reduced voluntary food intake and reduced feeding efficiency. Rats that received sucrose solution showed early signs of glucose intolerance and insulin resistance, such as hyperinsulinemia. Serum triacylglycerol (TG), very-low density lipoprotein (VLDL), cholesterol, ALT and AST levels increased after sucrose consumption. Elevated malondialdehyde and superoxide dismutase (SOD) levels and reduced glutathione levels characterize the hepatic oxidative stress due to sucrose ingestion. Liver sample histology showed vacuolar traces and increased fibrotic tissue. Our data showed the harmful effects of chronic consumption of sucrose solution, which can cause alterations that are found frequently in obesity, glucose intolerance and non-alcoholic hepatic disease, characteristics of metabolic syndrome

Correlation between apoptosis and in situ immune response in fatal cases of microcephaly caused by Zika Virus

Ministry of Science, Technology and Innovation / National Council for Scientific and Technological Development CNPQ, Brazil grants 303999/2016-0 , 439971/2016-0 , and 440405/2016-5 and Coordination for the Improvement of Higher Level Personnel (CAPES), Brazil (Zika Fast-Track).Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.State University of Pará. Center of Biological and Health Sciences. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil / State University of Pará. Center of Biological and Health Sciences. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Federal University of Pará. Tropical Medicine Center. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil / State University of Pará. Center of Biological and Health Sciences. Belém, PA, Brazil / Federal University of Pará. Tropical Medicine Center. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil / State University of Pará. Center of Biological and Health Sciences. Belém, PA, Brazil.Zika virus (ZIKV) is a single-stranded positive-sense RNA flavivirus that possesses a genome approximately 10.7 Kb in length. Although pro-inflammatory and anti-inflammatory cytokines and apoptotic markers belonging to the extrinsic and intrinsic pathways are suggested to be involved in fatal cases of ZIKV-induced microcephaly, their exact roles and associations are unclear. To address this, brain tissue samples were collected from 10 individuals, five of whom were diagnosed as ZIKV positive with microcephaly and a further five were flavivirus-negative controls that died because of other causes. Examination of material from the fatal cases of microcephaly revealed lesions in the cerebral cortex, edema, vascular proliferation, neuronal necrosis, gliosis, neuronophagy, calcifications, apoptosis, and neuron loss. The expression of various apoptosis markers in the neural parenchyma, including FasL, FAS, BAX, BCL2, and caspase 3 differed between ZIKV-positive cases and controls. Further investigation of type 1 and 2 helper T-cell cytokines confirmed a greater anti-inflammatory response in fatal ZIKV-associated microcephaly cases. Finally, an analysis of the linear correlation between tumor necrosis factor-α, IL-1β, IL-4, IL-10, transforming growth factor-β, and IL-33 expression and various apoptotic markers suggested that the immune response may be associated with the apoptotic phenomenon observed in ZIKV-induced microcephaly

In situ inflammasome activation results in severe damage to the central nervous system in fatal Zika virus microcephaly cases

Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.State University of Pará. Center of Biological and Health Sciences. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil / State University of Pará. Center of Biological and Health Sciences. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Federal University of Pará. Tropical Medicine Center. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil / State University of Pará. Center of Biological and Health Sciences. Belém, PA, Brazil / Federal University of Pará. Tropical Medicine Center. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil / State University of Pará. Center of Biological and Health Sciences. Belém, PA, Brazil.Zika virus (ZIKV) has caused substantial concern worldwide owing to its association with severe birth defects, such as microcephaly and other congenital malformations. Inflammasomes, i.e., multi-protein complexes that induce inflammation and pyroptosis, are predicted to contribute to the immune response to this flavivirus. Accordingly, in this study, the in situ inflammasome response was evaluated in fatal cases of ZIKV-linked microcephaly. Brain tissue samples were collected from eight babies, including four ZIKV-positive microcephalic neonates who died after birth and four flavivirus-negative neonatal controls who died of other causes and whose central nervous system (CNS) architecture was preserved. In the ZIKV-positive newborn/stillbirth babies, the major histopathological alterations included atrophy of the cortical layer, a predominance of mononuclear cell infiltration in the Virchow-Robin space, neuronal necrosis, vacuolization and neuronal degeneration, neuronophagy, and gliosis. An immunohistochemical analysis of tissues in the neural parenchyma showed significantly higher expression of the receptors NLRP1, NLRP3, and AIM2, cytokines IL-1β, IL-18, and IL-33, and enzymes caspase 1, iNOS, and arginase 1 in ZIKV-positive microcephaly cases than in flavivirus-negative controls. These results suggest that inflammasome activation can aggravate the neuroinflammatory response and consequently increase CNS damage in neonates with fetal neural ZIKV infection and microcephaly

First isolation of West Nile virus in Brazil

BACKGROUND Serological evidence of West Nile virus (WNV) infection has been reported in different regions of Brazil from equine and human hosts but the virus had never been isolated in the country. OBJECTIVES We sought to identify the viral etiology of equine encephalitis in Espírito Santo state. METHODS We performed viral culture in C6/36 cells, molecular detection of WNV genome, histopathology and immunohistochemistry from horse cerebral tissue. We also carried out sequencing, phylogenetic analysis and molecular clock. FINDINGS Histopathologic analysis from horse cerebral tissue showed injury related to encephalitis and WNV infection was confirmed by immunohistochemistry. The virus was detected by reverse transcription quantitative polymerase chain reaction (RT-qPCR) from brain tissue and subsequently isolated in C6/36 cells. WNV full-length genome was sequenced showing the isolated strain belongs to lineage 1a. The molecular clock indicated that Brazilian WNV strain share the same common ancestor that were circulating in US during 2002-2005. MAIN CONCLUSIONS Here we report the first isolation of WNV in Brazil from a horse with neurologic disease, which was clustered into lineage 1a with others US WNV strains isolated in beginning of 2000’s decade

Zika no Brasil. I. Doença fatal em adultos: aspectos clínicos e laboratoriais

This study was partially supported by the Ministry of Health through the Evandro Chagas Institute official budget and by CNPq (PFCVby grants573739/2008-0,301641/2010-2and457664/2013- 4), CAPES Zika Fast-track, the CNPq Zika fund, and FINEP Zika and other aarboviruses fund; RBT is supported by the grant R24 AT 120992 from National Institute of Health.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Programa de Pós-Graduação em Virologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Universidade do Estado do Pará. Departamento de Patologia. Belém, PA, Brazil.Universidade Federal do Maranhão. São Luiz, MA, BrazilUniversidade Federal do Pará. Hospital Universitário João de Barros Barreto. Belém, PA, Brazil.Universidade Federal do Pará. Hospital Universitário João de Barros Barreto. Belém, PA, Brazil.Universidade Federal do Pará. Hospital Universitário João de Barros Barreto. Belém, PA, Brazil.Universidade do Estado do Pará. Departamento de Patologia. Belém, PA, Brazil.Universidade do Estado do Pará. Departamento de Patologia. Belém, PA, Brazil.Secretaria de Saúde Pública do Rio Grande do Norte. Laboratório Central. Natal, RN, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Programa de Pós-Graduação em Virologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.University of Texas Medical Branch. Department of Pathology. Galveston, TX, USA.University of Texas Medical Branch. Department of Pathology. Galveston, TX, USA.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Universidade do Estado do Pará. Departamento de Patologia. Belém, PA, Brazil.Background: Zika virus (ZIKV) was first detected in Brazil in May 2015 and the country experienced an explosive epidemic. However, recent studies indicate that the introduction of ZIKV occurred in late 2013. Cases of microcephaly and deaths associated with ZIKV infection were identified in Brazil in November, 2015. Objectives: To determine the etiology of three fatal adult cases. Study design: Here we report three fatal adult cases of ZIKV disease. ZIKV infection in these patients was confirmed by cells culture and/or real-time reverse transcriptase polymerase chain reaction (RT-qPCR) and by antigen detection using immunohistochemical assay. Samples of brain and other selected organs taken at autopsy from three patients were also analyzed by histopathological and immunohistological examination. Results: The first patient, a 36-year-old man with lupus and receiving prednisone therapy, developed a fulminant ZIKV infection. At autopsy, RT-qPCR of blood and tissues was positive for ZIKV RNA, and the virus was cultured from an organ homogenate. The second patient, a previously healthy female, 16 years of age, presented classic symptoms of Zika fever, but later developed severe thrombocytopenia, anemia and hemorrhagic manifestations and died. A blood sample taken on the seventh day of her illness was positive RT-PCR for ZIKV RNA and research in the serumwas positive for antinuclear factorfine speckled (1/640), suggesting Evans syndrome (hemolytic anemia an autoimmune disorder with immune thrombocytopenic purpura) secondary to ZIKV infection. The third patient was a 20-year-old woman hospitalized with fever, pneumonia and hemorrhages, who died on 13 days after admission. Histopathological changes were observed in all viscera examined. ZIKV antigens were detected by immunohistochemistry in viscera specimens of patients 1 and 3. These three cases demonstrate other potential complications of ZIKV infection, in addition to microcephaly and Guillain-Barre syndrome (GBS), and they suggest that individuals with immune suppression and/or autoimmune disorders may be at higher risk of developing severe disease, if infected with ZIKV