RESUMO
OBJECTIVE: To analyse the Na content of bread by comparing the amount of salt and Na among the label, laboratory analysis and international guidelines. DESIGN: Ten selected bakeries provided 3239 randomly selected samples of bread, which were weighed on-site. Triplicate samples were retrieved from each bakery (thirty samples) for analysis. Bread production was observed, and ingredient labels were queried to determine salt weights, which were used for comparison with the laboratory analysis. Flame photometry and the method for chlorides were utilised for analysing Na. Laboratory findings were compared to nine different international nutritional guidelines for Na consumption. SETTING: Florianopolis, south of Brazil. PARTICIPANTS: Ninety independent bakeries locally producing Portuguese rolls were queried; rolls from ten conveniently selected bakeries were retrieved for further analysis. RESULTS: The average weight of the rolls was 50·2 ± 5·3 g. The average amount of salt (g) per roll, by laboratory and label analyses, was 0·69 ± 0·0 and 0·62 ± 0·1 g, respectively. The mean level of Na (mg) reported on nutrient labels (478·2 ± 93·4/100 g) was significantly lower than by laboratory analysis (618·2 ± 73·8/100 g), P < 0·001. There was a difference for Na in rolls produced in the bakeries considering the unit weight of rolls (P ≤ 0·001) per 100 g (P = 0·026) and the mode of production. The consumption of two averaged units of rolls was equivalent to 51·7 % of the Brazilian guideline daily amount for Na for children and 31 % for adults. CONCLUSIONS: The nutrient labels underreported Na values. This study strengthens the importance of monitoring Na of breads in Brazil.
Assuntos
Laboratórios , Sódio , Adulto , Brasil , Criança , Análise de Alimentos , Humanos , PortugalRESUMO
Host-parasite systems have been models for understanding the connection between shifts in resource use and diversification. Despite theoretical expectations, ambiguity remains regarding the frequency and importance of host switches as drivers of speciation in herbivorous insects and their parasitoids. We examine phylogenetic patterns with multiple genetic markers across three trophic levels using a diverse lineage of geometrid moths (Eois), specialist braconid parasitoids (Parapanteles) and plants in the genus Piper. Host-parasite associations are mapped onto phylogenies, and levels of cospeciation are assessed. We find nonrandom patterns of host use within both the moth and wasp phylogenies. The moth-plant associations in particular are characterized by small radiations of moths associated with unique host plants in the same geographic area (i.e. closely related moths using the same host plant species). We suggest a model of diversification that emphasizes an interplay of factors including host shifts, vicariance and adaptation to intraspecific variation within hosts.
Assuntos
Cadeia Alimentar , Interações Hospedeiro-Patógeno/genética , Mariposas/genética , Mariposas/parasitologia , Piper/genética , Árvores , Vespas/genética , Animais , Sequência de Bases , Teorema de Bayes , Biologia Computacional , Costa Rica , DNA Mitocondrial/genética , Equador , Evolução Molecular , Especiação Genética , Interações Hospedeiro-Patógeno/fisiologia , Larva/parasitologia , Larva/fisiologia , Modelos Genéticos , Dados de Sequência Molecular , Mariposas/classificação , Mariposas/fisiologia , Filogenia , Análise de Sequência de DNA , Vespas/fisiologiaRESUMO
BACKGROUND: Community-acquired pneumonia (CAP) severity scores can identify patients at low risk for mortality who may be suitable for ambulatory care. Here, we follow the clinical course of hospitalized patients with CAP due to 2009 H1N1 influenza. OBJECTIVE: To evaluate the role of CAP severity scores as predictors of mortality. METHODS: This was a secondary data analysis of patients hospitalized with CAP due to 2009 H1N1 influenza confirmed by reverse transcriptase polymerase chain reaction enrolled in the CAPO (Community-Acquired Pneumonia Organization) international cohort study. CAP severity scores PSI (Pneumonia Severity Index), CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) and CRB-65 (confusion, respiratory rate, blood pressure, age ≥ 65 years) were calculated. Actual and predicted mortality rates were compared. A total of 37 predictor variables were evaluated to define those associated with mortality. RESULTS: Data from 250 patients with CAP due to 2009 H1N1 influenza were analyzed. Patients with low predicted mortality rates (0-1.5%) had actual mortality rates ranging from 2.6% to 17.5%. Obesity and wheezing were the only novel variables associated with mortality. CONCLUSIONS: The decision to hospitalize a patient with CAP due to 2009 H1N1 influenza should not be based on current CAP severity scores, as they underestimate mortality rates in a significant number of patients. Patients with obesity or wheezing should be considered at an increased risk for mortality.
Assuntos
Infecções Comunitárias Adquiridas/mortalidade , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/mortalidade , Pneumonia Viral/mortalidade , Adulto , Idoso , Estudos de Coortes , Infecções Comunitárias Adquiridas/fisiopatologia , Infecções Comunitárias Adquiridas/virologia , Feminino , Previsões , Hospitalização , Humanos , Influenza Humana/complicações , Influenza Humana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Sons Respiratórios/fisiopatologia , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
PURPOSE: To provide a head-to-head comparison of the anticaries efficacy associated with two commercially-available and American Dental Association-accepted dentifrices: Crest Cavity Fighting Toothpaste with Fluoristat, containing 0.243% sodium fluoride in a silica base, and Colgate Great Regular Flavor Fluoride Toothpaste, containing 0.76% sodium monofluorophosphate in a dicalcium phosphate dihydrate base. The study was conducted in harmony with the published 1988 American Dental Association guidelines for studies geared toward this purpose. MATERIALS AND METHODS: The study employed a double-blind, parallel-groups, multi-center two-treatment design, and involved third, fourth, and fifth grade schoolchildren from Newark, New Jersey, and from the Cidra and Lares areas of Puerto Rico. Qualifying subjects were stratified according to age and sex, and were randomly assigned to the two treatment groups, with multiple subjects in the same household all assigned to the dentifrice randomly allocated to the first among them. Caries examinations were conducted in accordance with U.S. Food and Drug Administration guidelines for the clinical evaluation of drugs to prevent dental caries. After treatment assignment, study participants were instructed to brush their teeth at home with their assigned dentifrice at least twice daily. Brushing instructions were reinforced by the presentation of educational films and lectures at school, by semi-annual mailings to parents, and through the periodic distribution of small novelty gifts along with the dentifrice deliveries, in order to enhance the interest and enthusiasm of study participants. Post-baseline examinations were performed after 1 and after 2 yrs of product use. Two thousand four hundred seventy-nine (2,479) subjects completed this 2-yr study. For these subjects, the mean (S.D.) DFS scores at baseline were 2.77 (3.35) for the Crest group, and 2.66 (3.18) for the Colgate group. For caries increment after 1 yr, the respective means were 1.68 (2.53) and 1.70 (2.57). After 2 yrs, the mean caries increments were 3.56 (4.11) for the Crest group, and 3.56 (4.05) for the Colgate group. RESULTS: The analysis of the 2-yr caries increment scores support the conclusion that the anticaries efficacy associated with Colgate Great Regular Flavor Fluoride Toothpaste is equivalent to that associated with Crest Cavity Fighting Toothpaste with Fluoristat, in accordance with the procedures and standards provided by the published guidelines of the American Dental Association. Further, consistent with those same standards, the results of this study serve to lend additional support to the conclusion that dentifrices formulated with sodium monofluorophosphate provide an equivalent level of anticaries efficacy as to those formulated with sodium fluoride.
Assuntos
Cariostáticos/uso terapêutico , Cárie Dentária/prevenção & controle , Dentifrícios/uso terapêutico , Fluoretos/uso terapêutico , Fosfatos/uso terapêutico , Fluoreto de Sódio/uso terapêutico , Fosfatos de Cálcio , Cariostáticos/administração & dosagem , Criança , Intervalos de Confiança , Índice CPO , Método Duplo-Cego , Feminino , Fluoretos/administração & dosagem , Seguimentos , Humanos , Masculino , New Jersey , Educação de Pacientes como Assunto , Fosfatos/administração & dosagem , Porto Rico , Dióxido de Silício , Fluoreto de Sódio/administração & dosagem , Estatística como Assunto , Escovação Dentária/métodos , Resultado do TratamentoRESUMO
OBJECTIVE: To assess the relation between coronary artery disease and the calcification index on helical computed tomography. METHOD: We studied 22 patients (ages ranging from 40 to 70 years) who underwent coronary angiography because of chest pain suggestive of angina pectoris. Findings on coronary angiography were classified as follows: significant obstructive disease (stenosis > or = 50 %), nonobstructive disease (stenosis <50 %), and no disease. With no previous knowledge of the results of the coronary angiography and within 7 days, helical computed tomography of the chest was performed. Then, data of the coronary angiography were correlated with the calcification index obtained by helical computed tomography. RESULTS: The sensitivity of helical computed tomography to the presence of significant obstructive lesions on coronary angiography was 87.5 %, specificity was 100 %, and negative and positive predictive values were 75 % and 100 %, respectively. The mean calcification index was greater in patients with severe coronary lesions, mainly when involvement of 2 or 3 vessels occurred, than that in patients with no coronary artery disease or with nonobstructive coronary artery lesions (p<0.05). CONCLUSION: Helical computed tomography is an effective method for detecting and quantifying coronary artery calcification, and it has proved to be sensitive to and specific for the noninvasive diagnosis of coronary artery stenosis.
Assuntos
Calcinose/diagnóstico por imagem , Angiografia Coronária/métodos , Doença das Coronárias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
PURPOSE: To evaluate retrospectively stent implantation (SI) in patients with coronary artery disease (CAD) performed in 7 hospitals in Rio de Janeiro. METHODS: From June/94 to December/96 2,220 procedures were performed among which we analyzed 783 SI in 660 (29.7%) patients using coronary angiography without digital subtraction. Several types of stents were used: Palmaz-Schatz (40.9%), Gianturco-Roubin (29.1%) e NIR (22.0%). Indications for SI: 1--de novo lesion (67.9%); 2) restenotic lesion (16.0%); 3) sub-optimal results after PTCA (8.2%); 4) abrupt or threatened closure after PTCA (4.9%); 5) chronic occlusion (3.0%). All stents were implanted using high pressure balloon inflation without intracoronary ultrasound guidance. Sub-acute stent thrombosis prevention, in the majority of patients (87.8%) was done with ticlopidine and aspirin. RESULTS: Early outcome: a) the success rate of SI in 770 lesions was 98.0% in 646 (97.9%) patients; b) the clinical success rate in 634 patients was 96.0%; c) the major complications were acute myocardial infarction (1.1%); coronary artery bypass graft (1.4%) and death (0.8%); d) vascular complications with surgical correction and/or bleeding occurred in 3.0%. Late outcome: a) the clinical follow-up of 399 (60.4%) and the coronary angiographies of 121 patients (30.3%) showed in-stent lesion in 79 (19.8%); b) other event rates: myocardial infarction (1.5%); coronary bypass (2.3%); death: 1.0% and other PTCA or similar procedure (12.5%). CONCLUSION: This multicentric study showed that SI for CAD can be performed with safety, high early success rate, few complications and low rate of cardiac events during the late follow-up.
Assuntos
Doença das Coronárias/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
PURPOSE: To evaluate morphologically by spiral computed tomography (SCT) bovine pericardial grafts as aortic substitutes. METHODS: Ten patients were submitted to aortic graft evaluation with SCT. There were 8 ascending and 2 descending grafts. Examination was done after 2 to 7 years post operative. Ages ranged from 49 to 67 years, with 6 male and 4 female patients. All had implanted smooth surface naked pericardial grafts. RESULTS: Surgical result was good in all. Distal dissection persisted in some cases. One had a peri-graft hematoma, 5 had no structural changes and 4 presented mild graft dilatation. There were no graft calcification or pseudoaneurysm. CONCLUSION: Glutaraldehyde preserved naked smooth surface bovine pericardial aortic grafts present satisfactory structural aspect, as seen by SCT, at medium term follow-up. Mild dilatation may be seen in some cases.
Assuntos
Aorta/cirurgia , Pericárdio/patologia , Pericárdio/transplante , Tomografia Computadorizada por Raios X/métodos , Transplantes , Idoso , Animais , Aorta Torácica/cirurgia , Aneurisma Aórtico/cirurgia , Bovinos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pericárdio/diagnóstico por imagem , UltrassonografiaRESUMO
OBJETIVO - Avaliar, morfologicamente, por tomografia computadorizada espiral, enxertos de pericárdio bovino liso empregados como substitutos aórticos. MÉTODOS - Dez pacientes foram submentidos a exame por tomografia computadorizada espiral para reconstituiçäo da imagem dos enxertos. Os critérios de seleçäo foram tempo de seguimento superior a 2 anos, enxertos de pericárdio liso näo revestido, implantados na aorta ascendente ou descendente. RESULTADOS - Os exames demonstram bom resultado cirúrgico em todos os casos, persistindo em alguns, a imagem de dissecçäo aórtica distal à anastomose. Um caso apresentava hematoma entre o enxerto e a parede aórtica, em 5 näo foram encontradas alteraçöes estruturais no pericárdio e, nos demais, foi detectada dilataçäo de grau leve, em relaçäo ao diâmetro descrito do enxerto implantado. Näo foram vistos sinais de calcificaçäo ou pseudoaneurismas. CONCLUSÄO - Os enxertos tubulares de pericárdio bovino liso, näo revestido, apresentam resultados satisfatórios quando empregados como substitutos aórticos. A médio prazo, näo foram detectados anormalidades estruturais relacionadas ao material empregado, pela tomografia computadorizada espiral, exceto dilataçäo em alguns casos.
Assuntos
Humanos , Masculino , Feminino , Idoso , Aorta/transplante , Bioprótese/efeitos adversos , Pericárdio/transplante , Tomografia Computadorizada de Emissão/métodos , Doença Aguda , Fatores Etários , Aneurisma Aórtico/cirurgia , Bovinos , Seguimentos , Período Pós-OperatórioRESUMO
Os autores analisam a utilização da Angioplastia Transluminal Coronária, na fase intrahospitalar no infarto. Incluindo subgrupos de alto risco, mesmo nos pacientes tratados após as primeiras 12 horas. Mostram o estudo de 129 pacientes submetidos a ATC no IAM: 41 (32 'por cento') nas primeiras 6 h: 22 (17 'por cento') de 6 as 12 h e 66 (51 'por cento') após 12 horas. As Classes Funcionais (Killip), foram: I - 43 (33 'por cenro'); II - 26 (20 'por cento'); III - 26 (20 'por cento'); IV - 34 (27 'por cento'). O sucesso angigráfico nas 146 lesöes foi de 95 'por cento' de reperfusão, com 138 vasos dilatados. O sucesso clínico foi de 89 'por cento', (115 em 129), com onze óbitos (todos em CF III e IV). Houve três reoclusöes agudas, duas delas redilatadas com sucesso, foi submetido a revascularização cirúrgica devido a lesöes mjultiarteriais. Vinte e cinco pacientes foram tratados com ATC e implante de stent coronário. Concluem ser a ATC uma forma abrangente e segura de tratamento na fase intrahospitalar do IAM, principalmente nos subgrupos de alto risco, mesmo ultrapassadas as primeiras 6 horas.
Assuntos
Humanos , Angioplastia Coronária com Balão , Infarto do Miocárdio/fisiopatologia , Doença Aguda , Estudos Multicêntricos como Assunto , Stents , Resultado do TratamentoRESUMO
Relata-se um caso de raiva humana submetido a tratamento com interferon leucocitário humano injetado por via ventricular, através de reservatório de Rickham, e parte por via intramuscular. As doses diárias injetadas foram de 5 x10**6 unidades por via intraventricular e de 20 x 10**6 unidades por via intramuscular, a partir do 7§ dia de doença durante nove dias, quando entäo ocorreu o óbito em conseqüência de sepse por Klebsiella pneumoniae (16§ dia de doença). O vírus da raiva foi isolado inicialmente através de biopsia do tecido nervoso cerebral. O nível de interferon no sangue e no líquor era inferior a 10 U/ml antes do início do tratamento. O esquema terapêutico utilizado propiciou títulos elevados de interferon no sangue e no líquor 10 a 2.000 vezes maiores que aqueles atingidos usualmente na infecçäo natural. O nível residual, após 24 horas, foi de 212 ñ 14 U no sangue e 451 ñ 81 U no líquor. Foi observada menor soroconversäo (anticorpos neutralizantes) contra o vírus rábico (1/75 a partir do 13§ dia), em conseqüência da imunossupressäo induzida pelo interferon, provavelmente