Toxina botulínica A para o trismo no tétano cefálico

Cephalic tetanus is a localized form of tetanus. As in generalized forms , trismus is a prominent feature of the disease, leading to considerable difficulty in feeding, swallowing of the saliva and mouth hygiene. These difficulties often precede respiratory problems and aspiration bronchopneumonia is a frequent life-threatening complication. Muscle relaxants other than curare drugs may show a limited benefit for relieving trismus. Tetanospasmin, the tetanic neurotoxin, and botulinum toxin share many similarities, having a closely related chemical structure, an origin from related microorganisms (Clostridium tetani and Clostridium botulinum, respectively), and presumably, the same mechanisms of action in the neuron. The difference between the two lies in their peculiar neurospecificity, acting in different neurons. Injection of minute doses of botulinum toxin in the muscles involved in focal dystonias or other localized spastic disorders have proved to be very effective in these conditions. We describe the use of botulinum toxin A in the successful treatment of trismus in a patient suffering from cephalic tetanus. We believe that this form of treatment may be of value in lowering the risk of pulmonary complications in tetanic patients.O tétano cefálico é uma forma localizada de tétano. Da mesma maneira que nas formas generalizadas, o trismo é componente clínico proeminente, que leva a grande dificuldade na alimentação, na deglutição da saliva e para a higiene da boca. Essas dificuldades freqüentemente precedem os problemas respiratórios e as pneumonias aspirativas, que se constituem em complicações que ameaçam a vida dos pacientes. Drogas relaxantes musculares de outro tipo que as drogas curarizantes trazem pouco benefício para o trismo. A neurotoxina tetânica (tetanospasmin) e a toxina botulínica compartilham muitas semelhanças, como estrutura química símile, origem de microorganismos relacionados (Clostridium tetani e Clostridium botulinum, respectivamente) e, presumivelmente, os mesmos mecanismos de ação no neurônio. A diferença entre as duas reside na sua peculiar neuroespecificidade, atuando em diferentes neurônios. Injeção de doses reduzidas da toxina botulínica em músculos envolvidos em distonias focais ou outras desordens com espasticidade muscular localizada tem se mostrado eficaz em abolir as contrações. Descrevemos o uso da toxina botulínica A com sucesso no tratamento do trismo num paciente sofrendo de tétano cefálico. Acreditamos que esta forma de tratamento possa ser de valor no sentido de diminuir o risco de complicações pulmonares nos pacientes com tétano.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Escola Paulista de Medicina Department of Neurology and NeurosurgeryUNIFESP, EPM, Department of Neurology and NeurosurgerySciEL

Melcherite, trigonal Ba2Na2Mg[Nb6O19]·6H2O, the second natural hexaniobate, from Cajati, São Paulo, Brazil: Description and crystal structure

0000-0002-6395-8895© Mineralogical Society of Great Britain and Ireland 2018. This document is the author’s final accepted version of the journal article. You are advised to consult the published version if you wish to cite from it

Human toxocariasis: frequency of anti-Toxocara antibodies in children and adolescents from an outpatient clinic for lymphatic filariasis in Recife, Northeast Brazil

In a transversal study on a sample of 386 children and adolescents from an outpatient clinic for filariasis in Recife, Northeast Brazil, the frequency of anti-Toxocara antibodies and its relation to age, gender, number of peripheral eosinophils, Wuchereria bancrofti microfilariae and intestinal helminths was determined. The total anti-Toxocara IgG antibody frequency was 39.4%, by ELISA technique. The difference in frequency between males (40.1%) and females (37.6%) was not statistically significant. The 6 to 10-year-old subset presented the highest frequency of anti-Toxocara antibodies (60%), and within this age group there was a statistically significant male bias. There was also a significant association between the number of eosinophils and the presence of anti-Toxocara antibodies. Intestinal parasite frequency was 52.1%, but no association was found between this data and the presence of anti-Toxocara antibodies. In the present sample, 42.2% of the patients were Wuchereria bancrofti carriers, however, again this was not associated with the presence of anti-Toxocara antibodies. In conclusion, anti-Toxocara antibodies were highly prevalent in this sample. The present data show that there is no cross correlation between anti-Toxocara IgG antibody and the presence of intestinal helminths and filariasis.Através de estudo do tipo transversal com amostra constituída por 386 crianças e adolescentes atendidos em um ambulatório especializado de filariose, do Recife, nordeste do Brasil, determinou-se a frequência de anticorpos anti-Toxocara e sua relação com faixa etária, sexo, número de eosinófilos periféricos, microfilárias de Wuchereria bancrofti e parasitos intestinais. A freqüência encontrada de anticorpos IgG total anti-Toxocara, realizada através da técnica de ELISA, foi de 39,4%, com 40,1% no sexo masculino e 37,6% no feminino, diferença esta sem significância estatística. O grupo com maior freqüência de anticorpos anti-Toxocara foi o de 6-10 anos (60%) e, apenas nessa faixa etária, encontrou-se uma diferença estatisticamente significante quanto ao sexo, com predomínio do masculino. Observou-se associação estatisticamente significante entre o número de eosinófilos e a presença de anticorpos anti-Toxocara. A freqüência de parasitos intestinais foi de 52,1%, porém sem associação entre este achado e a presença de anticorpos anti-Toxocara. Na presente análise, 42,2% dos pacientes eram portadores de microfilárias de Wuchereria bancrofti, porém esta infecção não esteve associada à presença de anticorpos anti-Toxocara o que sugere que não houve cruzamento do ELISA com a presença de parasitoses intestinais e filariose

Índice de Desenvolvimento em Saúde: conceituação e reflexões sobre sua necessidade

ResumoEste artigo teve como objetivo revisar o conceito de índices sociais, enfocando sua utilidade prática e necessidade no contexto da saúde. Nesse sentido, considerou-se inicialmente como tais índices são definidos, as possibilidades de seu uso e a importância que eles têm como modo de retratar a realidade. Logo, adotou-se um conceito amplo de saúde, coerente com a visão vigente. Posteriormente, descreveu-se a saúde nos contextos internacional e nacional, enfatizando indicadores que podem ser empregados para quantificar problemas de saúde da população. Finalmente, em razão de não ter sido encontrado um índice social específico que descrevesse a saúde no contexto brasileiro, indicou-se a necessidade de contar com o Índice de Desenvolvimento em Saúde. Esse servirá como instrumento para gestores, agentes de fiscalização e população em geral acompanharem os desenvolvimentos alcançados e as deficiências que precisarão ser supridas com o fim de assegurar melhor saúde para a maior parte das pessoas.SummaryThis article aimed to review the concept of social indices by focusing on their practical use and need in the health setting. For this purpose, the initial consideration was how these indices are defined, their possible use, and the importance they have as a means of depicting the real world. Thus, a wide concept of health, consistent with the current view, was adopted. Health was further described within international and national settings, emphasizing indicators that can be employed to estimate health problems in the population were highlighted. Finally, as no specific social index describing health in a Brazilian setting has been developed, the need to rely on the Health Development Index was indicated. This index will serve as a tool for managers, inspection agents, and the general population to follow-up the developments reached and the shortcomings that should be addressed to ensure a better health status for the majority of the population

GASTRO PROTECTIVE AND ANTI-HELICOBACTER PYLORI EFFECTS OF A FLAVONOID RICH FRACTION OBTAINED FROM ACHYROCLINE SATUREOIDES (LAM) D.C.

Objectives: The study aimed to investigate the gastroprotective effects of a flavonoid rich fraction (FRF) obtained from Achyrocline satureoides. Methods: The following protocols were employed: ethanol and NSAID-induced ulcer, ligature pylorus model, and free mucus quantification. Nitric oxide (NO) and sulfhydryl group participation were observed by pretreatment with L-NAME or NEM. Besides, it was assayed the acetic acid-induced chronic ulcer andthe anti-Helicobacter pyloriactivity in vitro. Results: The phytochemical profile of FRF showed three main flavonoids, luteolin, quercetin and 3-O-methyl-quercetin. The administration of FRF was able to prevent the damage evoked by ethanol and NSAID-induced ulcer models. The pH and concentration of H+ in the stomach were not modified by FRF treatment. However, the FRF treatment induces mucus secretion. The effect presented by FRF was mediated by nitric oxide (NO). In chronic ulcer model FRF reduced significantly the lesion area, promoting a cure ratio of 65.42±13.00, a similar data presented by cimetidine treated animals (61.35±11.88). Using an in vitro assay was observed that FRF at 500 µg/mL was able to inhibit bacterial growth. Conclusions: The results show that FRF provided a significant gastroprotective and ulcer healing activity, mainly due to their capacity to enhance mucus secretion

Cardiopulmonary exercise and 6-min walk tests as predictors of quality of life and long-term mortality among patients with heart failure due to Chagas disease

Universidade Federal de São Paulo, Div Cardiol, São Paulo, BrazilSanta Izabel Hosp, Div Cardiol, Salvador, BrazilBrazilian Clin Res Inst, São Paulo, BrazilDuke Clin Res Inst, Durham, NC USAUniversidade Federal de São Paulo, Div Cardiol, São Paulo, BrazilWeb of Scienc

Potential health impact of ultrafine particles under clean and polluted urban atmospheric conditions: a model-based study

The main goal of this study was to improve the knowledge of ultrafine particle number distributions in large urban areas and also to call the attention to the importance of these particles on assessing health risks. Measurements of aerosol size distributions were performed during 2 weeks, with distinct pollutant concentrations (polluted and clean periods), on the rooftop of a building located in downtown of the megacity of São Paulo, Brazil. CO, NO2, PM10, SO2, and O3 concentrations and meteorological variables were also used. Aerosol size distribution measurements showed that geometric mean diameters of the size spectra in the polluted period are on average considerably larger than those in the clean one. Besides the fact that total number of ultrafine particles did not show significant differences, during the polluted period, geometric mean diameter was larger than during the clean one. The results of a mathematical model of particle deposition on human respiratory tract indicated a more significant effect of smaller particles fraction of the spectra, which predominate under clean atmospheric conditions. The results also indicated that urban environmental conditions usually considered good for air quality, under the criteria of low mass concentration, do not properly serve as air quality standard to very small particles. In the size range of ultrafine particles, this traditional clean atmospheric condition can offer a strong risk to pulmonary hazards, since the cleansing of the atmosphere creates good conditions to increase the concentration of nucleation mode particles

Magnetic resonance imaging-guided occult breast lesion localization and simultaneous sentinel lymph node mapping

Background: Radio-guided occult lesion localization is a valid technique for the diagnosis of suspicious non-palpable lesions. Here we determine the feasibility of pre-operative localization of occult suspect non-palpable breast lesions using radio-guided occult lesion localization, as well as for identifying the sentinel lymph node.Methods: This is a descriptive study of data collected retrospectively. Pre-operative mapping of 34 breast lesions in 25 patients suspected of being malignant was performed using conventional imaging methods with a magnetic resonance imaging-guided radiopharmaceutical injection.Results: the mean time required to perform the localization was 25 minutes. After resection of the lesions using a gamma probe, malignancy was confirmed in fifteen patients (60.0%), with nine invasive ductal carcinomas, two invasive lobular carcinomas, and four in situ ductal carcinomas the resection was confirmed by the complete removal of the radioactive material. the pathologic results and images were concordant in all but two cases, which were submitted for new magnetic resonance imaging examinations and surgery that confirmed the malignancies. of the 15 patients with confirmed malignancies, 10 had sentinel lymph node resection. of these, eight were negative for metastases, one had micro-metastases and one had confirmed metastases. Three patients had full axillary node dissection, with metastases found in only one. No side effects were observed with magnetic resonance-guided radiopharmaceutical injection.Conclusions: the sentinel node occult lesion localization technique is a simple, reproducible and effective alternative approach to occult lesions compared to other methods, such as mammotomy and the hook-wire localization technique, for mapping suspect breast lesions and identifying lymph node metastasis.Hosp Sirio Libanes, Magnet Resonance Imaging Dept, BR-01308000 São Paulo, BrazilHosp Sirio Libanes, BR-01308000 São Paulo, BrazilHosp Sirio Libanes, Mastol Studies Dept, BR-01308000 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Discipline Mastol, BR-04023062 São Paulo, BrazilHosp Sirio Libanes, Dept Diagnost Imaging, BR-01308000 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Discipline Mastol, BR-04023062 São Paulo, BrazilWeb of Scienc

Índices reprodutivos e características de desempenho em bovinos de corte infectados pelo Herpevírus Bovino 1

Reproductive rates and performance traits in beef cattle females infected by Herpesvirus Bovine-1 (BoHV-1) were evaluated in a farm at São Paulo state, Brazil. Gir, Guzerá, Nelore and Caracu purebred animals were examinated to BoHV-1 (ELISA) at the beginning of the breeding season and the occurrence of reactors was 54.2% (386/712). BoHV-1 did not interfere in the pregnancy rates of both reagent - 80.3% (310/386) and non-reagent - 74.5% (243/326) females. It did not reduce the parturition rate of both reagent - 97.7% (300/307) and non-reagent - 93.8% (225/240) females. Total rate of stillbirths in BoHV-1 reagent females - 1.3% (4/300) did not differ from non-reagent females - 2.2% (5/225). BoHV-1 did not affect performance traits for reagent and non-reagent females, respectivelly, to daily weight gain during the breeding season (459.90 ± 2.82 g and 466.63 ± 2.87 g), body condition score at the beginning of the breeding season (6.89 ± 0.08 and 6.99 ± 0.08), body condition score at the end of the breeding season (7.73 ± 0.06 and 7.71 ± 0.06), weight at parturition (419.17 ± 3.34 kg and 425.97 ± 3.22 kg). It was concluded that non-vaccinated beef cattle females infected by BoHV-1 and bred under adequate extensive management, with body condition score over 5 and gain of weight during the breeding season presented good pregnancy, parturition and birth rates, no matter the breed, genetic group, age and seroconvertion.Avaliou-se índices reprodutivos e características de desempenho em fêmeas bovinas de corte, infectadas pelo Herpesvírus Bovino-1 (BoHV-1), em um rebanho no Estado de São Paulo, Brasil. Animais das raças Gir, Guzerá, Nelore e Caracu foram monitorados no início da estação de monta e a sororeatividade ao BoHV-1 pelo teste ELISA foi 54,2% (386/712). O BoHV-1 não interferiu no índice de prenhez de matrizes reagentes - 80,3% (310/386) e não reagentes - 74,5% (243/326) e nem reduziu a taxa de parição de matrizes reagentes - 97,7% (300/307) e não reagentes - 93,8% (225/240). O coeficiente de natimortalidade de matrizes reagentes ao BoHV-1 - 1,3% (4/300) não diferiu da encontrada para as não reagentes - 2,2% (5/225). O BoHV-1 não afetou a média de algumas características de desempenho de fêmeas reagentes e não reagentes, respectivamente, como ganho de peso médio diário durante a estação de monta (459,90 ± 2,82 g e 466,63 ± 2,87 g), condição corporal na entrada da estação de monta (6,89 ± 0,08 e 6,99 ± 0,08), condição corporal na saída da estação de monta (7,73 ± 0,06 e 7,71 ± 0,06) e peso à parição (419,17 ± 3,34 kg e 425,97 ± 3,22 kg). Concluiu-se que matrizes de corte infectadas pelo BoHV-1 e não vacinadas, criadas sob condições adequadas de manejo zootécnico extensivo e nutricional, como escore corporal acima de 5 e ganho de peso durante a estação de monta, apresentaram bons índices de prenhez, parição e natalidade, independente da raça, grupo genético, faixa etária e soroconversão