RESUMO
Severe scorpion envenoming is characterized by cardiocirculatory failure which may lead to pulmonary oedema. These are the major causes of death among victims of scorpion stings. Involvement of the heart has been attributed to the massive release of catecholamines and/or to a direct toxic effect of the venom on cardiac fibres, while pulmonary oedema has been considered to be of cardiogenic or non-cardiogenic origin. We present here the clinical, laboratory, electrocardiographic and echocardiographic data of 12 victims of severe Tityus serrulatus stings. These patients had important echocardiographic evidence of moderate to severe left ventricular (LV) dysfunction with diffuse LV hypokinesia and reduced ejection fraction. Seven developed pulmonary oedema. The clinical course of all the patients was satisfactory and the laboratory, electrocardiographic and echocardiographic changes returned to normal, usually within 1 week of the sting. The important alterations detected by echocardiography as early as during the 1st few hours after the sting, taken together with the enzymatic and electrocardiographic data, confirm that LV dysfunction is responsible, either alone or in combination with other factors, for the cardiac insufficiency and pulmonary oedema encountered in scorpion envenoming.
Assuntos
Edema Pulmonar/induzido quimicamente , Picadas de Escorpião/fisiopatologia , Venenos de Escorpião/intoxicação , Função Ventricular Esquerda/efeitos dos fármacos , Adolescente , Amilases/sangue , Animais , Antivenenos/uso terapêutico , Criança , Pré-Escolar , Creatina Quinase/sangue , Ecocardiografia , Eletrocardiografia , Feminino , Coração/efeitos dos fármacos , Coração/fisiopatologia , Humanos , Masculino , Edema Pulmonar/fisiopatologia , Picadas de Escorpião/terapia , Escorpiões , Taquicardia/induzido quimicamente , Taquicardia/fisiopatologiaRESUMO
PURPOSE: Evaluation of the clinical effects of captopril addition to the conventional therapy of functional class II and III (NYHA) congestive heart failure (CHF). METHODS: One hundred and fifteen patients with CHF, 46 (40%) class II and 69 (60%) class III, on conventional treatment (digitalis and diuretic) were the subject of this study. The age ranged from 22 to 75 years (mean 56.6 +/- 11); 67 were male and 66 were caucasians. The etiologies of the heart failure were: hypertensive heart disease 47 (40.9%), ischemic heart disease 27 (23.5%), Chagas cardiomyopathy 20 (17.4%), idiopathic cardiomyopathy 15 (13.0%), and other causes 6 (5.2%). Diuretic and digitalis were maintained in the same dosage during all the treatment. Captopril therapy was started with 6.25 mg b.i.d. or t.i.d., and the dosage was increased gradually to 25 mg b.i.d. or t.i.d. The duration of the study was 12 weeks. Clinical visits occurred every four weeks and laboratory tests were performed in the beginning and at the end of the study. RESULTS: The dosage of captopril ranged from 12.5 to 75 mg (mean 28.5 +/- 13.1 mg/day). The addition of captopril to the conventional therapy of CHF was associated with significant reduction (p < 0.01) of heart rate, systolic and diastolic blood pressure. In the end of the study 13 patients (11.3%) were in functional class III, 50 (43.5%) in class II and 52 (45.2%) in class I. Globally, functional class was improved in 98 (85.2%) patients and remained unchanged in 17 (14.8%) (p < 0.01). The side effects (dizziness, cough, hypotension and headache) were moderate and uncommon and did not need interruption of the treatment. CONCLUSION: The addition of captopril to the conventional therapy of class II and III CHF was associated with significant improvement of functional class and with good tolerability.
Assuntos
Captopril/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Adulto , Idoso , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The clinical and epidemiological characteristics of hospitalizations due to cardiac and cerebral-vascular diseases (CCVD-ICD 390-438), which occurred in 1986, were studied on the basis of data from an information system relating to medical care in the City of Ribeirão Preto, State of S. Paulo, Brazil. These causes accounted for 4,673 of the annual total of 43,449 hospital admissions. Using the sources of payment of the hospitalization as an indicator of the patients' social strata, the following four study groups were defined: private, social insurance, non-paying and "others". These groups showed significant differences in relation to the following variables: hospitalization rates due to CCVD, mean and median age at admission and time of death, occupation, average length of stay in the hospital, mortality rates and relative frequencies of specific sub-group diagnosis. These differences are attributed to inequalities in the standard of living and in the working conditions of the groups, which determine diverse patterns of disease, medical care and mortality.
Assuntos
Transtornos Cerebrovasculares/epidemiologia , Cardiopatias/epidemiologia , Hospitalização/estatística & dados numéricos , Fatores Etários , Brasil/epidemiologia , Transtornos Cerebrovasculares/diagnóstico , Feminino , Cardiopatias/diagnóstico , Humanos , Masculino , Fatores Sexuais , Classe SocialRESUMO
We measured the effect of marginal malnutrition on physical work capacity of adolescent children of agricultural migrant workers in Southern Brazil. Nutritional status was evaluated using 24-h dietary recall. Body size was evaluated anthropometrically. Biochemical assessments were also made. Physical work capacity (PWC170) was assessed by measuring heart rate, blood lactic acid levels, and oxygen consumption during submaximal bicycle ergometer work. The same tests were also carried out on a comparable group of local well-to-do boys of the same age in the same community who served as controls. The dietary results suggest that adolescent boys of migrant families were marginally malnourished. Their physical growth and development were retarded by at least 1 yr. They had significantly lower reserves of body fat and less muscle mass when compared with controls. Their Hb levels were normal. At the submaximal work loads measured (0, 25, 50, 75 W) the migrant children exhibited similar oxygen consumption and gross exercise efficiency as the control children, but achieved this work at a higher percentage of their maximum work capacity as shown by significantly higher heart rates for the same oxygen consumption. Higher blood lactic acid levels in the migrant children suggest that the available muscle mass was under greater stress to accomplish the same task. PWC170 was reduced one-third in the migrant children (migrant 643 +/- 162 kpm/min, control 905 +/- 345 kpm/min; p less than 0.005). These differences were largely associated with weight (migrant 20.6 +/- 5.9 kpm/min; control 18.8 +/- 4.3 kpm/kg/min; p greater than 0.1). These observations suggest that marginal as well as severe malnutrition affect physical work capacity at levels low enough to affect growth and development.
Assuntos
Deficiências Nutricionais/metabolismo , Avaliação da Deficiência , Migrantes , Avaliação da Capacidade de Trabalho , Antropometria , Brasil , Criança , Deficiências Nutricionais/sangue , Dieta , Metabolismo Energético , Frequência Cardíaca , Humanos , Lactatos/sangue , Ácido Láctico , Masculino , Rememoração Mental , Consumo de Oxigênio , Esforço FísicoAssuntos
Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Amiodarona , Cardiomiopatia ChagásicaAssuntos
Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Amiodarona , Complexos Cardíacos Prematuros , Cardiomiopatia ChagásicaRESUMO
A three-month trial was carried out on 14 agricultural migrant workers (Bóias-Frias) residing on the periphery of Ribeirão Preto, an agricultural and industrial town in the interior of the State of São Paulo in southern Brazil. This group can be considered as marginally malnourished. Their nutritional status and physical work performance was measured before and after receiving a supplemented lunch over a three-month period. The main change in their nutritional status during this period was an increase in body weight. Their physical work performance, as measured by a bicycle ergometer test, improved significantly after the supplementation of their traditional diet.
Assuntos
Avaliação da Deficiência , Alimentos Fortificados , Nível de Saúde , Saúde , Fenômenos Fisiológicos da Nutrição , Avaliação da Capacidade de Trabalho , Brasil , Dieta , Teste de Esforço , Comportamento Alimentar , HumanosRESUMO
Se llevo a cabo un ensayo de tres meses de duracion en l4 peones agricolas migrantes (Boias-Frias) residentes en la periferia de Ribeirao Preto, ciudad agricola e industrial situada en el interior del Estado de Sao Paulo en el sur del Brasil. Este grupo se puede considerar como marginalmente malnutrido. Su estado nutricional y rendimiento en el trabajo fisico se midio antes y despues de recibir un almuerzo suplementado durante el periodo mencionado.En ese lapso, el principal cambio observado en su estado nutricional fue un incremento del peso corporal. Segun mediciones practicadas utilizando la prueba de bicicleta con ergometro, su rendimiento en el trabajo fisico mejoro en forma significativa despues de la suplementacion de su dieta tradicional