RESUMO
INTRODUÇÃO: A tuberculose cardíaca é uma doença rara Estima-se que 1% de todos os casos de tuberculose têm envolvimento cardíaco produzido por disseminação linfática, contígua do pericárdio ou por via hematogênica. Miocardite tuberculosa pode permanecer clinicamente assintomática (com diagnóstico feito em autópsia), ou pode se apresentar com morte, arritmias ventriculares intratáveis, síndrome do QT longo, bloqueio cardíaco ou insuficiência cardíaca. Complicações cardíacas, como taquiarritmias ventriculares, são ainda mais raras, mas são potencialmente tratáveis se reconhecimento imediato. RELATO DE CASO: S.A.F.R., 55 anos, sexo feminino, com dispneia e palpitações há cerca de três meses da admissão no pronto socorro. ECG evidenciando QT longo (figura 1) Ecocardiograma mostrou derrame pericárdico com repercussão hemodinâmica. Realizada drenagem de Marfan de urgência. No 2 dia de pós-operatório, apresentou Taquicardia Ventricular (TV) Sustentada Monomórfica Instável. Após cardioversão elétrica, evoluiu com múltiplos episódios de TV com Torsades de Pointes. A arritmia ventricular foi atribuída a QT longo congênito. Medicada com lidocaína EV, passado fio de marcapasso provisório com persistência da arritmia. Análise do líquido pericárdico evidenciou adenosina deaminase de 110 U/l e ressonância magnética (figura 2) apresentando edema miocárdico e sinais de processo inflamatório. Feito diagnóstico de Miopericardite tuberculósica e iniciado esquema RIPE. Após 15 dias, observou-se normalização do intervalo QT e desaparecimento dos sintomas e das arritmias ventriculares, sem recidiva de derrame pericárdico. Evoluiu na sequência com quadro séptico, por endocardite infecciosa, trombo em fio de marcapasso e insuficiência tricúspide. Foi submetida a cirurgia para retirada de fio de marca-passo provisório e troca valvar tricúspide de urgência, evoluindo a óbito no pós-operatório. CONCLUSÃO: O QT longo, inicialmente pensado como congênito, foi considerado a causa das arritmias. O papel da inflamação na gênese do QT longo tem sido descrito e foi comprovado neste caso, pela normalização do intervalo e desaparecimento das arritmias com o tratamento específico da tuberculose. Alto grau de suspeição é importante para diagnóstico precoce, já que alguns casos de miocardite tuberculosa foram relatados no último anos na literatura inglesa, francesa e espanhola, todos eles diagnosticados na necropsia. A terapia antituberculose pode resultar em sucesso com regressão da doença e resolução de arritmias malignas. (AU)
Assuntos
Humanos , Tuberculose , Torsades de PointesRESUMO
Anastrepha fraterculus (Wiedemann) (Diptera: Tephritidae) is the most important pest in South American orchards. When control measures are not adopted, this pest can cause losses of up to 100%. Doryctobracon brasiliensis (Szépligeti) (Hymenoptera: Braconidae) is a larval-pupal endoparasitoid that can be used as a native biological control agent against A. fraterculus. This study aimed to develop a rearing technique for D. brasiliensis in larvae of A. fraterculus. Trials were carried out to: 1) determine the optimal instar for parasitism, 2) define the exposure time of larvae to parasitoids, 3) determine the density requirements of A. fraterculus larvae offered to each parasitoid, and 4) evaluate the effect of diet on adults of D. brasiliensis. In all trials, we evaluated the number of offspring, parasitism rate, and sex ratio. Moreover, in the experiment to investigate the effects of diet, we determined the longevity of males and females. In both choice and nonchoice parasitism tests, the parasitoids preferred third-instar larvae of A. fraterculus over second- and first-instar larvae. An exposure time of 12 h of A. fraterculus larvae produced larger numbers of parasitoids and higher parasitism rates. The density of 15 larvae of A. fraterculus to each female of D. brasiliensis produced a larger number of offspring. A supply of honey solution (20 and 50%) to the parasitoids yielded the highest number offspring and resulted in greater longevity. Our findings can be used to support the development of a mass rearing protocol for D. brasiliensis.
Assuntos
Interações Hospedeiro-Parasita , Características de História de Vida , Controle Biológico de Vetores/métodos , Tephritidae/parasitologia , Vespas/fisiologia , Animais , Feminino , Fertilidade , Larva/crescimento & desenvolvimento , Larva/parasitologia , Larva/fisiologia , Longevidade , Masculino , Pupa/crescimento & desenvolvimento , Pupa/parasitologia , Pupa/fisiologia , Razão de Masculinidade , Tephritidae/crescimento & desenvolvimento , Vespas/crescimento & desenvolvimentoRESUMO
Aganaspis pelleranoi (Brèthes, 1924) (Hymenoptera: Figitidae) is a koinobiont endoparasitoid of larvae of species of the genus Anastrepha and of Ceratitis capitata. It is a candidate for use as a biological control agent, as under field conditions, it may reach a parasitism rate of 62%. The objective of this study was to determine the effect of different constant temperatures on biological parameters of A. pelleranoi when parasitizing the larva of Anastrepha fraterculus (Wiedemann, 1830) (Diptera: Tephritidae), as well as to determine its thermal requirements. The study was conducted in environmental chambers at 18, 20, 22, 25, 28, and 30 ± 1°C; 70 ± 10% relative humidity; and a 12-h photophase. Females maintained at 18 and 20°C produced more progeny than females at other temperatures tested. The longevity of males and females was inversely proportional to temperature, ranging from 49.1 to 3.73 d for females and from 32.1 to 3.8 d for males at temperatures of 18-30°C, respectively. The duration of the biological cycle (egg-to-adult) was influenced by temperature, and ranged from 69.1 d at 18°C to 30 d at 25°C. No preimaginal development of A. pelleranoi occurred at 28 and 30°C. The relationship between temperature and the demographic parameters of A. pelleranoi showed a linear effect over the temperature range of 18-25°C. The lower temperature threshold and thermal constant were 11.69°C and 391.70 degree days, respectively.
Assuntos
Tábuas de Vida , Temperatura , Tephritidae/parasitologia , Vespas/fisiologia , Animais , Brasil , Feminino , Umidade , Larva/parasitologia , Modelos Lineares , Masculino , FotoperíodoRESUMO
Epidemiological studies have documented that elevated airborne particulate matter (PM) concentrations, especially those with an aerodynamic diameter less than 10 microm (PM10), are associated with adverse health effects. Two receptor models, UNMIX and positive matrix factorization (PMF), were used to identify and quantify the sources of PM10 concentrations in Tubarão and Capivari de Baixo, Santa Catarina, Brazil. This region is known for its high pollution levels due to intense industrial activity and exploitation of natural resources. PM10 samples were collected using high volume samplers at two sites in the region and statistical exploratory analysis techniques were applied to identify and assess PM10 sources. The two primary PM10 sources were identified as soil re-suspension/road dust emissions and coal burning emissions, contributing 65-75% and 15-25% of the PM10, respectively. The study confirmed the significance of the influence of local PM10 emissions (power plants, soil re-suspension and road dust emissions) on regional air quality, although no violations of the Brazilian PM10 standards (limit of 150 microg/m3) were observed, with a mean concentration of 27.6 microg/m3 measured in this study. This study demonstrated the usefulness of statistical exploratory analysis techniques in assessing the validity of modelling results and contributing to the interpretation of ambient air quality data.
Assuntos
Poluição do Ar/análise , Monitoramento Ambiental , Material Particulado/análise , Brasil , Monitoramento Ambiental/métodos , Modelos Estatísticos , Estações do AnoRESUMO
Although most of the Ascomycetes present DHN-melanin, some reports suggest that A. nidulans does not produce this type of melanin. In this study, we analyzed the pigment extracted from highly melanized strains (MEL1 and MEL2) of Aspergillus nidulans to determine the type of melanin present in this fungus. Our results showed that the pigment produced by MEL1 and MEL2 mutants possesses physical and chemical properties and UV- and IR-spectra very similar to synthetic DOPA-melanin. The characterization of this pigment in terms of its degradation products indicated the presence of indolic units, which were also found in synthetic DOPA-melanin. The analyses of the elemental composition showed that the pigment extracted from these mutants has a high percentage of nitrogen and, therefore, it cannot be DHN-melanin, which presents only trace of nitrogen. This observation was confirmed in the test with tricyclazole because this inhibitor of DHN-melanin biosynthesis did not suppress pigment production in the MEL1 and MEL2 strains. On the other hand, in a medium containing tropolone, an inhibitor of DOPA-melanin biosynthesis, the dark pigmentation of the colonies was not observed indicating that this compound inhibited melanin production in these strains. Taken together, the results obtained in this study indicate that melanin produced by these mutants is DOPA type, representing the first report on characterization of this type of melanin in A. nidulans.
Assuntos
Aspergillus nidulans/metabolismo , Di-Hidroxifenilalanina/química , Di-Hidroxifenilalanina/metabolismo , Melaninas/química , Melaninas/metabolismo , Nitrogênio/análise , Espectrofotometria Infravermelho , Espectrofotometria UltravioletaRESUMO
Ethnicity has been shown to be associated with micro- and macrovascular complications of diabetes in European and North American populations. We analyzed the contribution of ethnicity to the prevalence of micro- and macrovascular complications in Brazilian subjects with type 2 diabetes attending the national public health system. Data from 1810 subjects with type 2 diabetes (1512 whites and 298 blacks) were analyzed cross-sectionally. The rates of ischemic heart disease, peripheral vascular disease, stroke, distal sensory neuropathy, and diabetic retinopathy were assessed according to self-reported ethnicity using multiple logistic regression models. Compared to whites, black subjects [odds ratio = 1.72 (95%CI = 1.14-2.6)] were more likely to have ischemic heart disease when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, smoking habit, and serum creatinine. Blacks were also more likely to have end-stage renal disease [3.2 (1.7-6.0)] and proliferative diabetic retinopathy [1.9 (1.1-3.2)] compared to whites when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, and smoking habit. The rates of peripheral vascular disease, stroke and distal sensory neuropathy did not differ between groups. The higher rates of ischemic heart disease, end-stage renal disease and proliferative diabetic retinopathy in black rather than in white Brazilians were not explained by differences in conventional risk factors. Identifying which aspects of ethnicity confer a higher risk for these complications in black patients is crucial in order to understand why such differences exist and to develop more effective strategies to reduce the onset and progression of these complications.
Assuntos
População Negra/estatística & dados numéricos , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Idoso , Brasil/epidemiologia , Brasil/etnologia , Doença Crônica , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/etnologia , Angiopatias Diabéticas/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
Ethnicity has been shown to be associated with micro- and macrovascular complications of diabetes in European and North American populations. We analyzed the contribution of ethnicity to the prevalence of micro- and macrovascular complications in Brazilian subjects with type 2 diabetes attending the national public health system. Data from 1810 subjects with type 2 diabetes (1512 whites and 298 blacks) were analyzed cross-sectionally. The rates of ischemic heart disease, peripheral vascular disease, stroke, distal sensory neuropathy, and diabetic retinopathy were assessed according to self-reported ethnicity using multiple logistic regression models. Compared to whites, black subjects [odds ratio = 1.72 (95 percentCI = 1.14-2.6)] were more likely to have ischemic heart disease when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, smoking habit, and serum creatinine. Blacks were also more likely to have end-stage renal disease [3.2 (1.7-6.0)] and proliferative diabetic retinopathy [1.9 (1.1-3.2)] compared to whites when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, and smoking habit. The rates of peripheral vascular disease, stroke and distal sensory neuropathy did not differ between groups. The higher rates of ischemic heart disease, end-stage renal disease and proliferative diabetic retinopathy in black rather than in white Brazilians were not explained by differences in conventional risk factors. Identifying which aspects of ethnicity confer a higher risk for these complications in black patients is crucial in order to understand why such differences exist and to develop more effective strategies to reduce the onset and progression of these complications.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Negra/estatística & dados numéricos , /epidemiologia , Angiopatias Diabéticas/epidemiologia , Brasil/epidemiologia , Brasil/etnologia , Doença Crônica , Estudos Transversais , /complicações , /etnologia , Angiopatias Diabéticas/etnologia , PrevalênciaRESUMO
Diabetic retinopathy is one of the leading causes of blindness in working-age individuals. Diabetic patients with proteinuria or those on dialysis usually present severe forms of diabetic retinopathy, but the association of diabetic retinopathy with early stages of diabetic nephropathy has not been entirely established. A cross-sectional study was conducted on 1214 type 2 diabetic patients to determine whether microalbuminuria is associated with proliferative diabetic retinopathy in these patients. Patients were evaluated by direct and indirect ophthalmoscopy and grouped according to the presence or absence of proliferative diabetic retinopathy. The agreement of diabetic retinopathy classification performed by ophthalmoscopy and by stereoscopic color fundus photographs was 95.1% (kappa = 0.735; P < 0.001). Demographic information, smoking history, anthropometric and blood pressure measurements, glycemic and lipid profile, and urinary albumin were evaluated. On multiple regression analysis, diabetic nephropathy (OR = 5.18, 95% CI = 2.91-9.22, P < 0.001), insulin use (OR = 2.52, 95% CI = 1.47-4.31, P = 0.001) and diabetes duration (OR = 1.04, 95% CI = 1.01-1.07, P = 0.011) were positively associated with proliferative diabetic retinopathy, and body mass index (OR = 0.90, 95% CI = 0.86-0.96, P < 0.001) was negatively associated with it. When patients with macroalbuminuria and on dialysis were excluded, microalbuminuria (OR = 3.3, 95% CI = 1.56-6.98, P = 0.002) remained associated with proliferative diabetic retinopathy. Therefore, type 2 diabetic patients with proliferative diabetic retinopathy more often presented renal involvement, including urinary albumin excretion within the microalbuminuria range. Therefore, all patients with proliferative diabetic retinopathy should undergo an evaluation of renal function including urinary albumin measurements.
Assuntos
Albuminúria/complicações , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/etiologia , Albuminúria/diagnóstico , Estudos Transversais , Retinopatia Diabética/diagnóstico , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Análise de Regressão , Fatores de RiscoRESUMO
Diabetic retinopathy is one of the leading causes of blindness in working-age individuals. Diabetic patients with proteinuria or those on dialysis usually present severe forms of diabetic retinopathy, but the association of diabetic retinopathy with early stages of diabetic nephropathy has not been entirely established. A cross-sectional study was conducted on 1214 type 2 diabetic patients to determine whether microalbuminuria is associated with proliferative diabetic retinopathy in these patients. Patients were evaluated by direct and indirect ophthalmoscopy and grouped according to the presence or absence of proliferative diabetic retinopathy. The agreement of diabetic retinopathy classification performed by ophthalmoscopy and by stereoscopic color fundus photographs was 95.1 percent (kappa = 0.735; P < 0.001). Demographic information, smoking history, anthropometric and blood pressure measurements, glycemic and lipid profile, and urinary albumin were evaluated. On multiple regression analysis, diabetic nephropathy (OR = 5.18, 95 percent CI = 2.91-9.22, P < 0.001), insulin use (OR = 2.52, 95 percent CI = 1.47-4.31, P = 0.001) and diabetes duration (OR = 1.04, 95 percent CI = 1.01-1.07, P = 0.011) were positively associated with proliferative diabetic retinopathy, and body mass index (OR = 0.90, 95 percent CI = 0.86-0.96, P < 0.001) was negatively associated with it. When patients with macroalbuminuria and on dialysis were excluded, microalbuminuria (OR = 3.3, 95 percent CI = 1.56-6.98, P = 0.002) remained associated with proliferative diabetic retinopathy. Therefore, type 2 diabetic patients with proliferative diabetic retinopathy more often presented renal involvement, including urinary albumin excretion within the microalbuminuria range. Therefore, all patients with proliferative diabetic retinopathy should undergo an evaluation of renal function including urinary albumin measurements.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Albuminúria/complicações , /complicações , Retinopatia Diabética/etiologia , Albuminúria/diagnóstico , Estudos Transversais , Progressão da Doença , Retinopatia Diabética/diagnóstico , Oftalmoscopia , Análise de Regressão , Fatores de RiscoRESUMO
AIM: To investigate the association between angiotensin-converting enzyme gene I/D polymorphism and diabetic nephropathy (DN) in patients with Type 2 diabetes mellitus (DM) taking into consideration the known duration of DM. METHODS: Cross-sectional study with 982 patients categorized according to urinary albumin excretion (UAE) into normoalbuminuria (UAE < 20 microg/min or < 17 mg/l, 24-h timed urine or spot random sterile urine, respectively), incipient DN (UAE 20-199 microg/min or 17-174 mg/l) and overt DN (UAE > 200 microg/min or > 174 mg/l or dialysis). Patients were further grouped regarding presence of the D allele (DD/ID vs. II) and DM duration (< or = 10 years or > 10 years). RESULTS: Incipient DN was diagnosed in 17.3% (n = 170), and 20.7% (n = 203) had overt DN (macroalbuminuria, n = 129; dialysis, n = 74). Genotype distribution (DD/ID/II) was similar in patients with incipient (49/92/29) or overt DN (77/89/37) if compared with patients without DN (181/308/120, P = 0.172). In patients with DM < or = 10 years, having the D allele (DD/ID) resulted in an odds ratio (OR) of 2.66 (95% CI: 1.12-6.58, P = 0.015) for incipient DN, and 3.19 (95% CI: 1.18-9.30, P = 0.012) for overt DN. In patients with longer DM duration, the D allele did not increase the risk for incipient (OR 0.68, 95% CI 0.36-1.29, P = 0.206) or overt DN (OR 0.67, 95% CI 0.39-1.17, P = 0.138). CONCLUSION: The DD/ID genotypes were associated with incipient or overt DN in patients with DM < or = 10 years.