Showing papers by "Federal University of São Paulo published in 1997"

Glycosylphosphatidylinositol-anchored mucin-like glycoproteins isolated from Trypanosoma cruzi trypomastigotes initiate the synthesis of proinflammatory cytokines by macrophages.

Abstract: Components of Trypanosoma cruzi able to induce the production of IL-12 and other proinflammatory cytokines by macrophages were identified Murine inflammatory macrophages were cultured with live parasites or with cellular components from different developmental forms of T cruzi (ie, trypomastigotes, amastigotes, metacyclic trypomastigotes, and epimastigotes), and the cytokine levels were measured after 24 and 48 h Our results indicate that live trypomastigotes or live amastigotes (but not live epimastigotes or live metacyclic trypomastigotes) as well as trypomastigote extracts (but not extracts derived from epimastigotes) induce IL-12 and TNF-alpha synthesis by macrophages Such biological activity is enhanced in membrane preparations from trypomastigotes Further enrichment of the trypomastigote-derived monokine-inducing factor was obtained by solvent extraction and hydrophobic-interaction chromatography The resultant purified molecules are a family of closely related glycoconjugates with predominant species at 70 to 80 and 120 to 200 kDa These molecules are composed of carbohydrate chains O-linked to a polypeptide backbone that is anchored to the trypomastigote membrane via a glycosylphosphatidylinositol structure The trypomastigote-derived glycoconjugates are active in inducing cytokine synthesis by macrophages at concentrations of 100 ng/ml These effects are highly potentiated by IFN-gamma Mapping of the glycoconjugate molecules to characterize the structural requirements for macrophage activation suggested that nonsaturated acyl fatty acid chains and periodate-sensitive units from the glycosylphosphatidylinositol anchor are important elements for the infective trypomastigote form to initiate cytokine synthesis by macrophages

Dados normativos para o teste de fluencia verbal categoria animais em nosso meio

Abstract: OBJECTIVE: Evaluate the performance on verbal fluency (VF) in our population in a Brazilian sample checking the influence of age and literacy. METHODS: 336 people without neurological or psychiatric complaints evaluated through Mini-Mental State Examination and VF (animals). For comparison, and to determine cut-off points, 65 people with cognitive loss followed at our clinic were also evaluated. RESULTS: We found a mean of 13.8 animals in 1 minute, with the following distribution: illiterates, 11.9; up 4 years of education, 12.8; 4 to 7 years, 13.4; 8 years or more, 15.8 (p= 0.0001). In relation to age the means were: up to 64 years, 13.7; 65 years or more, 13.9. There was no difference between the two groups. The cut-off points were 9 for people under 8 years of education with a sensitivity of 75% for illiterates, 100% for low educational level (up 4 years),and 87% for middle level (4 to 7 years). The specificity was respectively 79%, 84%, and 88%. For the high educational level the mean was 13 with a sensitivity of 86% and specificity of 67%. CONCLUSIONS: In the VF (animals) there is a significant influence of schooling and different cut-off points should be used.

Angiotensin I-converting enzyme activity in tubular fluid along the rat nephron.

Abstract: The activity of angiotensin I-converting enzyme (ACE) was determined in tubular fluid collected from several portions of the rat nephron and urine and in total and efferent arteriolar blood using hippuryl-L-His-Leu as substrate. ACE activity decreased 30% from the pre- to the postglomerular arterioles (P < 0.001), suggesting a role of the glomerulus in ACE clearance. The enzyme activity was found to be present throughout the rat nephron. However, the highest activities were found in the proximal tubule and urine (0.692 +/- 0.007 and 1.05 +/- 0.015 pmol x microl(-1) x min(-1), respectively). Compared with other segments, ACE activity decreased from the initial portion of the proximal tubule to the distal nephron and increased again in the urine. Along the proximal tubule, ACE was secreted and degraded and/or reabsorbed and then secreted again into the collecting duct; no ACE activity was found in the late distal tubule, but a high level was detected in the urine, indicating a potential physiological role in the inactivation of the kinins formed by kallikrein beyond the connecting tubules. Moreover, the possible role of mesangial cells (MC) in the decrease of intraglomerular ACE was also evaluated. The analysis of ACE gene showed that MC in culture are able to express ACE mRNA. Moreover, ACE is produced as an ectoenzyme and as a secreted form of the enzyme, indicating a potential effect of local angiotensin II production on MC function.

Monosodium glutamate (msg)-obese rats develop glucose intolerance and insulin resistance to peripheral glucose uptake

Abstract: Different levels of insulin sensitivity have been described in several animal models of obesity as well as in humans. Monosodium glutamate (MSG)-obese mice were considered not to be insulin resistant from data obtained in oral glucose tolerance tests. To reevaluate insulin resistance by the intravenous glucose tolerance test (IVGTT) and by the clamp technique, newborn male Wistar rats (N = 20) were injected 5 times, every other day, with 4 g/kg MSG (N = 10) or saline (control; N = 10) during the first 10 days of age. At 3 months, the IVGTT was performed by injecting glucose (0.75 g/kg) through the jugular vein into freely moving rats. During euglycemic clamping plasma insulin levels were increased by infusing 3 mU.kg-1.min-1 of regular insulin until a steady-state plateau was achieved. The basal blood glucose concentration did not differ between the two experimental groups. After the glucose load, increased values of glycemia (P < 0.001) in MSG-obese rats occurred at minute 4 and from minute 16 to minute 32. These results indicate impaired glucose tolerance. Basal plasma insulin levels were 39.9 +/- 4 microU/ml in control and 66.4 +/- 5.3 microU/ml in MSG-obese rats. The mean post-glucose area increase of insulin was 111% higher in MSG-obese than in control rats. When insulinemia was clamped at 102 or 133 microU/ml in control and MSG rats, respectively, the corresponding glucose infusion rate necessary to maintain euglycemia was 17.3 +/- 0.8 mg.kg-1.min-1 for control rats while 2.1 +/- 0.3 mg.kg-1.min-1 was sufficient for MSG-obese rats. The 2-h integrated area for total glucose metabolized, in mg.min.dl-1, was 13.7 +/- 2.3 vs 3.3 +/- 0.5 for control and MSG rats, respectively. These data demonstrate that MSG-obese rats develop insulin resistance to peripheral glucose uptake.

Analgesic and antiinflammatory activities of the aqueous extract of Plantago major L.

Abstract: This study aimed to validate the pharmacological effects of Plantago major L., a medicinal plant used to decrease pain and inflammation. The aqueous extract (AE) was prepared from the dried ground leaves. Pretreatment with AE (1 g/kg, p.o.) decreased writhing induced by acetic acid in mice, but it did not change the tail flick responses to heat nociceptive stimuli. In rats, AE (1 g/kg, p.o.) reduced the paw edema and pleurisy induced by carrageenin, but it did not alter the paw edema induced by dextran. The effect of AE on the carrageenin inflammatory responses was more intense than that obtained on the ear edema induced by croton oil in mice. In addition, daily treatment with AE (1 g/kg/day during 8 days, p.o.) inhibited the exudative process induced by croton oil injected into the air pouch of rats. The results indicate that the aqueous extract of Plantago major is endowed with effective antiinflammatory and analgesic activities.

Glycoconjugates isolated from Trypanosoma cruzi but not from Leishmania species membranes trigger nitric oxide synthesis as well as microbicidal activity in IFN-gamma-primed macrophages.

Abstract: In the present study, we investigated the role of glycosylphosphatidylinositol-anchored mucin-like glycoproteins (GPI-mucins) from Trypanosoma cruzi trypomastigotes in triggering the synthesis of nitric oxide as well as the microbicidal activity in murine macrophages. Our results show that GPI-mucins isolated from trypomastigote membranes are potent inducers of nitric oxide synthesis by IFN-gamma-primed macrophages, even at concentrations as low as 10 ng/ml. Our data also indicate the important role of glycosylphosphatidylinositol anchors from GPI-mucins as the second signal responsible for induction of nitric oxide synthesis by macrophages. To further investigate the role of these parasite molecules in inducing parasiticidal function, we cultured macrophages in the presence or absence of trypomastigote GPI-mucins and/or IFN-gamma and then infected these cells with either Leishmania spp. or T. cruzi. IFN-gamma was sufficient to induce microbial activity in macrophages infected with T. cruzi trypomastigotes. In contrast, killing of different species of Leishmania was further enhanced when macrophages exposed to IFN-gamma were also costimulated with trypomastigote-derived GPI-mucins. Our results also indicate that different glycolipids obtained from Leishmania major or Leishmania donovani (i.e., lipophosphoglycans or glycoinositolphospholipids) were unable to potentiate nitric oxide synthesis and/or microbicidal activity displayed by IFN-gamma-primed macrophages.

Functional and morphometric evaluation of offspring kidney after intrauterine undernutrition

Abstract: Pregnant rats were subjected to 50% food restriction during the first or the second half of pregnancy, or throughout pregnancy. The effects of intrauterine food restriction, on kidney function and morphometry were studied in newborn and adult (3 months) offspring. No differences in glomerular diameter were observed in newborn restricted rats compared with controls. The number of glomeruli was significantly lower both in newborn and 3-month-old restricted rats. However, glomerular diameter was increased in 3-month-old rats, which suggests that hypertrophic stimuli were present. The medulla/cortex ratio increased in adult rats submitted to food restriction during pregnancy, a finding that agrees with the preserved sodium and acid excretion, and the normal osmolar and free water clearance observed in these groups. These results show that the reduction in glomerular number is still present 3 months after birth in the progeny of mothers submitted to severe food restriction during pregnancy, suggesting impairment of glomerulogenesis even after birth. Intra utero undernutrition can be regarded as an experimental model of glomerular hypertrophy.

Normative data on the verbal fluency test in the animal category in our milieu

Abstract: Objective Evaluate the performance on verbal fluency (VF) in our population in a Brazilian sample checking the influence of age and literacy. Methods 336 people without neurological or psychiatric complaints evaluated through Mini-Mental State Examination and VF (animals). For comparison, and to determine cut-off points, 65 people with cognitive loss followed at our clinic were also evaluated. Results We found a mean of 13.8 animals in 1 minute, with the following distribution: illiterates, 11.9; up 4 years of education, 12.8; 4 to 7 years, 13.4; 8 years or more, 15.8 (p = 0.0001). In relation to age the means were: up to 64 years, 13.7; 65 years or more, 13.9. There was no difference between the two groups. The cut-off points were 9 for people under 8 years of education with a sensitivity of 75% for illiterates, 100% for low educational level (up 4 years), and 87% for middle level (4 to 7 years). The specificity was respectively 79%, 84%, and 88%. For the high educational level the mean was 13 with a sensitivity of 86% and specificity of 67%. Conclusions In the VF (animals) there is a significant influence of schooling and different cut-off points should be used.

Juvenile fibromyalgia: Clinical and polysomnographic aspects

Abstract: Objective To identify the child-mother diagnostic correlation in fibromyalgia (FM), to study sleep disturbance in juvenile FM, and to compare clinical aspects and sleep disorders between these groups. Methods We studied 34 children with confirmed FM aged 11 +/- 1 years, 10 children with diffuse pain, and 17 age and sex matched asymptomatic controls. The respective 61 mothers were included: 34 asymptomatic and 27 with FM. All participants were subjected to clinical evaluation, a sleep questionnaire, and nocturnal polysomnography, preceded by a night of adaptation. Sleep scoring was done visually and a computerized analysis was performed for alpha, theta, and delta waves in slow wave sleep (SWS). Results A significant predominance of mothers with FM was observed in the group of children with FM (71%) compared to children with diffuse pain (30%) and asymptomatic children (0%). According to the sleep questionnaire, the complaints of superficial sleep and nonrestorative sleep were more prominent in mothers with FM than in children with FM, whereas motor agitation during sleep was more frequent in the children with FM. Polysomnographic anomalies were also more prominent in mothers with FM than in children with FM in terms of decrease in sleep efficiency, increase of number of arousals during sleep, and alpha intrusion in SWS. Both FM groups presented an increased alpha + theta time/delta time index during SWS compared to respective controls, and mothers with FM also showed an increase in alpha time/delta time index during SWS, compared to asymptomatic mothers. A correlation was found between alpha + theta time/delta time index during SWS and intensity of clinical manifestations of pain and sleep anomalies in children and their mothers. Conclusion Significant concordance was observed regarding FM diagnosis in children and their mothers. Sleep complaints and polysomnography findings were less prominent in affected children compared to mothers with FM. In addition, we observed a significant correlation between polysomnographic indexes, sleep anomalies, and pain manifestations in children and their mothers.

Temperature differences for trans-glycosylation and hydrolysis reaction reveal an acceptor binding site in the catalytic mechanism of Trypanosoma cruzi trans-sialidase.

Abstract: Trypanosoma cruzi, the agent of Chagas disease, expresses on its surface a trans-sialidase that catalyzes preferentially the transference of alpha-2,3-linked sialic acid to acceptors containing terminal beta-galactosyl residues, instead of the typical hydrolysis reaction, found in most sialidases. The trans-sialidase is responsible for the acquisition of the host sialic acid by this protozoan parasite, which does not synthesize sialic acids. Here, we have studied some kinetic properties of a recombinant trans-sialidase expressed in Escherichia coli. We found that it has sequential-type kinetics for the transferase reaction, as shown for the parasite-derived enzyme. The rates of sialic acid transfer to water (hydrolysis), and to beta-galactosyl residues have a unique behavior with respect to the reaction temperature. While the hydrolysis rate of sialyllactose increases continuously up to 35 degrees C, the temperature for the maximal rate of trans-glycosylation depends on the acceptor concentration. At low acceptor concentrations the rate of trans-glycosylation is maximal at 13 degrees C and independent of the amount of sialic acid donors. With increasing acceptor concentrations, maximal rates of trans-glycosylation are shifted to higher temperatures. This finding is explained by an 8-fold increase in the Km for the acceptor from 13 degrees C to 33 degrees C. Differences in hydrolysis and transfer rates were also obtained by using 4-methylumbelliferyl-N-acetyl-neuraminic acid. However, its hydrolysis rate is much higher than the rate of transference to lactose, suggesting that a long-lived enzyme-sialosyl intermediate is not formed. In addition, lactose does not increase the rate of methyl-umbelliferone release at any temperature, indicating that the rate limiting step is the aglycon release. Based on these results we propose that transglycosylation in T. cruzi sialidase is favored by the existence of a binding site for beta-galactosyl residues, which accepts the new glycosidic bond as sialic acid is released from the donor. With increasing temperature the affinity for the acceptor decreases, resulting in a concomitant increase in the rate of transfer to water, which, in turn, can be suppressed by increasing the acceptor concentration.

Time of diagnosis of chronic renal failure and assessment of quality of life in haemodialysis patients.

Abstract: Introduction Background. Time of diagnosis of chronic renal failure and predialysis care may be important factors related It has been suggested that late diagnosis of chronic to the quality of life of patients on dialysis treatment. renal failure and late referral of these patients to Methods. We evaluated the quality of life of 113 nephrology units are associated with an increase in haemodialysis patients who had a late (∏1 month morbidity and mortality during dialysis treatment before starting dialysis, n=53) or early (� 6 months, [1–4]. In a prospective study, we recently showed that n=60) diagnosis of chronic renal failure. At the time end-stage renal disease (ESRD) patients starting of the survey patients had been on dialysis for a median chronic dialysis programmes shortly after the diagnosis duration of 55 days (range 1–109). Quality of life is made have more severe metabolic disorders and a was measured by the Kidney Disease Questionnaire higher mortality risk during the first months of main( KDQ), including five dimensions with scales ranging tenance dialysis than their counterparts who had been from 1.0 to 7.0 (1.0=more impairment); the health diagnosed earlier [5,6 ]. and life satisfaction indices (higher score=more dissat- Assessing the quality of life in patients with ESRD isfied), functional status ( Karnofsky scale), and the treated by haemodialysis has been considered an time trade-off technique. important aspect of therapy [7]. It has been recognized Results. Mean scores of quality of life measures were that the objective of treatment of ESRD patients is to worse in the late- than in the early-diagnosis group. A rehabilitate and not only increase their survival. significant difference (P<0.05) was observed in the Although some studies have suggested that patients depression (4.46±1.45 vs 5.23±1.36), relationships without adequate care in the predialysis phase have a with others (3.95±1.31 vs 4.53±1.31) and frustration poorer short-term survival [2,6 ], none has explored (4.08±1.51 vs 5.21±1.34) dimensions of the KDQ, the impact of time of diagnosis of chronic renal failure and in life satisfaction (4.11±1.92 vs 3.32±1.57). or the influence of predialysis management on their Functional status declined compared to 1 year before quality of life during the initial dialysis period. dialysis, particularly in the late-diagnosis group. The objectives of this study were to assess the quality Among the elderly patients, the magnitude of the of life of patients with ESRD, using multiple measures, difference was more pronounced, (including in the in the first months of haemodialysis therapy and to physical symptoms item of the KDQ). compare it between patients who had a late or an early Conclusions. Our findings demonstrate that late dia- diagnosis of chronic renal failure. gnosis of chronic renal failure and the consequent lack of predialysis care adversely affect the quality of life of haemodialysis patients. Early diagnosis and regular Subjects and methods predialysis care should be encouraged to improve the quality of life during dialysis treatment. Patients

Prognostic Factors in Carcinoma of the External Auditory Canal

Abstract: Background: Carcinomas of the external auditory canal are rare neoplasms ( Objective: To evaluate the prognostic factors in 79 patients treated in a single institution. Patients and Methods: The disease was staged as follows: 34 patients with stage T1 to T2 tumors; 43 patients with stage T3 to T4 tumors; 2 patients with stage TX tumors; 68 patients with stage NO tumors; and 11 patients with stage N1 tumors. The initial treatment was surgery in 59 patients and radiotherapy in 9 patients. Eleven patients were not considered candidates for treatment. Results: To date, 29 patients have experienced local recurrences and 2, neck metastases. The 5-year survival rates were 65% for patients who underwent surgery, 29% for patients who underwent radiotherapy, and 63% for patients who underwent a combination of surgery and radiotherapy. Univariate survival analysis showed statistical difference according to tumor type ( P =.003), bone involvement ( P =.002), and tumor stage ( P Conclusion: Every effort must be undertaken to make an early diagnosis and perform radical surgical resection of squamous cell carcinomas in the external auditory canal. This study validates the staging system used for squamous cell carcinoma of the ear treated with surgery. Arch Otolaryngol Head Neck Surg. 1997;123:720-724

Clinical implications of autoantibodies in HIV infection.

Abstract: Objective To study the frequency and specificity of autoantibodies in HIV-infected subjects and their association with rheumatic manifestations, immunodeficiency, and prognosis. Design Prospective study of sequentially selected HIV-infected patients. Indirect immunofluorescence reading was performed by two independent observers blinded for the patient diagnosis. Enzyme-linked immunosorbent assay (ELISA) was performed using coded serum samples. Setting The study was performed at the Infectious Disease and Rheumatology Divisions of a tertiary care university hospital. Patients One hundred sequentially selected HIV-infected patients formed group A. Controls included 80 non-HIV-infected high-risk individuals (group B), 20 herpesvirus-infected patients (group C), and 30 healthy blood donors (group D). Main outcome measures Patients were followed for 2 years and evaluated for the presence of immunodeficiency, rheumatic manifestations, circulating autoantibodies and total CD4+ cell count. Indirect immunofluorescence was used to investigate antinuclear antibodies, antibodies to native DNA, smooth muscle, parietal cell, glomeruli, thyroid, and neutrophil cytoplasm. Agglutination was used to detect antibodies to erythrocytes and rheumatoid factor. ELISA was used to determine antibodies to cardiolipin and denatured DNA. CD4+ lymphocytes were counted by flow cytometry. Immunoglobulin (Ig) G, IgM and IgA serum levels were determined by radial immunodiffusion. Results HIV-infected patients presented higher overall frequency of autoantibodies than the other groups. No difference was observed between immunodeficient and asymptomatic HIV-infected patients. The most frequent specificities were antibodies to cardiolipin and to denatured DNA. Ig serum levels did not correlate with the occurrence of autoantibodies. The presence of autoantibodies was associated with lower CD4+ cell counts and with higher mortality within 2 years. Rheumatic manifestations were observed in 35 HIV-infected patients and were not associated with the occurrence of autoantibodies or the presence of immunodeficiency. Conclusions HIV infection is associated with an increased incidence of autoantibodies. Although not related to the occurrence of rheumatic manifestations, the presence of autoantibodies was significantly associated with lower CD4+ lymphocyte counts and increased mortality, which implies prognostic significance to this phenomenon in the context of HIV infection.

A prion-linked psychiatric disorder

Abstract: The finding that new variant Creutzfeldt-Jakob disease, the recently discovered prion disease thought to be associated with ingestion of bovine offal1, has a prolonged course and can present with psychiatric symptoms2 raised the possibility that hereditary forms of prion disease may also be associated with serious psychiatric disorders We have sequenced the open reading frame of the prion protein (PrP) gene isolated from 10 patients with a strong family history of psychiatric illness In one patient we discovered a previously undescribed sequence alteration, N171S, which raises the possibility of a significant extension in the pathologies associated with inherited prion diseases

Excitatory Effects of Nitric Oxide Within the Rostral Ventrolateral Medulla of Freely Moving Rats

Abstract: The aim of the present study was to examine the participation of NO in the rostral ventrolateral medulla (RVLM) of freely moving rats. We utilized NO donors and l-arginine, which were microinjected into the RVLM. Unilateral microinjection (100 nL) of 2.5 nmol sodium nitroprusside produced a biphasic response consisting of an initial, rapid increase in arterial pressure (AP) from 125±5 to 161±8 mm Hg ( P P S -nitroso- N -acetylpenicillamine (SNAP; 2.5 nmol), also produced immediate hypertension from 118±5 mm Hg to 168±7 mm Hg ( P P P

Long-term effects of maternal deprivation on the corticosterone response to stress in rats

Abstract: Twenty-four hours of maternal deprivation result in activation of the infant rat's adrenocortical axis. In the present study we examined the long-term effects of maternal deprivation on the corticosterone (Cort) response to stress. Pups were maternally deprived (Dep) on postnatal day (PND) 11 and tested immediately (PND 12) or returned to their mothers and tested at later ages. Testing consisted of a time course of the Cort response to a saline injection (5, 15, 30, and 60 min). At PND 12, the response of Dep pups was higher than that of nondeprived (non-Dep) pups. No group differences were observed at PND 16 and 22. On PND 30, Dep rats showed lower Cort levels than non-Dep pups at 0, 5, and 30 min after saline. At PND 60, non-Dep females showed higher Cort levels than males at 5, 15, and 30 min. This gender difference for Dep pups was observed only at 5 min. Male and female Dep animals presented lower Cort levels than non-Dep counterparts at 60 and 30 min after saline, respectively. These findings indicate that maternal deprivation effects on Cort secretion are long lasting. Dep rats showed a smaller adrenal response to stress at PND 30, whereas as adults the stress response was similar but the turnoff was different.

Osteopenia occurs in a minority of patients with acromegaly and is predominant in the spine.

Abstract: Acromegaly may induce abnormalities in bone metabolism; however, there are limited data related to bone mineral density (BMD) in this condition. To evaluate the effects of an excess of growth hormone/ insulin-like growth fractor I (GH/IGF-I) in the skeleton, we measured the BMD in spine and femoral region, total body calcium and body composition in 45 patients (24 females and 21 males) aged 21–77 years (median 43 years) with acromegaly for 11.4+7.5 years (range 0.5–26 years) using a dual-energy X-ray absorptiometer (Lunar DPX). Thirty-four patients had had hypogonad-ism for 8.6+6.5 years (1–24 years). Mean serum GH and IGF-I levels were respectively 159±183 µg/1 and 843±497 jig/1. Total body calcium was increased in the acromegalics (males: 1272±217 g, range 916–1816 g; females: 1041±223 g, range 739–1609 g) when compared with normal individuals (males: 1115±144 g, range 856–1398 g; females: 909±144 g, range 511–1311 g;p=0.01). The lean body mass was significantly higher in acromegalic patients(p<0.001) compared with normal individuals. There was a tendency for a lower fat percentage in the acromegalics; however, this difference was not significant. Osteopenia (1Z-score below the mean) was found in the spine in 20% (n=9) of the patients, while BMD was decreased in the femoral region in only 8.8% (n=4). The group with osteopenia had a greater duration of hypogonadism than the normal BMD group (14±11 years vs 4.4±4.0 years;p=0.01). A negative correlation was also found between the duration of hypogonadism and BMD in spine (r=−0.4;p=0.003) and femoral region (r=−0.37;p=0.013). The hypogonadal patients had a lower BMD in spine (p<0.005), but not in other regions analyzed. No correlation was found between duration of hypersomato-tropism, GH/IGF-I levels and BMD. We conclude that the majority of patients with acromegaly have preserved BMD despite the presence of hypogonadism.

Improvement of Bronchial Hyperresponsiveness in Asthmatic Children Treated for Concomitant Sinusitis

Abstract: Background There appears to be an association between sinusitis and asthma. The effect on bronchial hyperresponsiveness of clinical therapy for sinusitis in children may help to decipher whether sinusitis and asthma are independent manifestations of the same disease. Objective To evaluate the effect of clinical treatment for sinusitis in patients with rhinitis and/or asthma on symptoms and on bronchial hyperresponsiveness to methacholine. Methods Open label, randomized, non-treatment control in a teaching hospital in Sao Paulo, Brazil. Forty-six atopic and 20 normal children were studied. The atopic children consisted of 18 with allergic rhinitis (12 without sinusitis and 6 with sinusitis), and 28 children with rhinitis with asthma (13 with normal sinus radiographs and 15 with complete opacification of the maxillary sinuses). Methacholine PC 20 was determined before and 30 days after treatment with nasal saline, sulfamethoxazole-trimethoprim, antihistamine/decongestant, and five days of prednisone. Sinus radiographs were also repeated. Results The only patients with increase in methacholine PC 20 were patients with rhinitis and asthma with opacified maxillary sinuses at entry and who at 30 days had normal sinus radiographs ( P Conclusion In this study, children with allergic rhinitis and sinusitis with asthma improved their bronchial hyperresponsiveness to methacholine and decreased their symptoms with appropriate response of their sinuses to clinical therapy.

IDDM and Milk Consumption: A case-control study in São Paulo, Brazil

Abstract: OBJECTIVE To test the hypothesis that breast-feeding is a protective factor against IDDM and that early exposure to cow's milk is a risk factor for the disease. RESEARCH DESIGN AND METHODS A case-control study was conducted in Sao Paulo, Brazil. A total of 346 diabetic children, aged < 18 years, were identified in two institutions in the city of Sao Paulo. Duration of exclusive breast-feeding and age of introduction to cow's milk products in infant diet were compared with 346 sex-, age-, and neighborhood-matched control children. All comparisons between diabetic and control children were done using paired tests. RESULTS Statistically significant differences were found for the duration of exclusive breast-feeding ( P = 0.007) and for the age of introduction to cow's milk products ( P = 0.047). Control children had a longer time of exclusive breast-feeding and had received cow's milk later in their diet than the case children. CONCLUSIONS The results suggest that a shorter duration of exclusive breast-feeding is a risk factor for IDDM (odds ratio [OR] 2.13; 95% CI 1.8–3.55) and that the introduction to cow's milk products before age 8 days is a risk factor for the disease (OR 2.29;95% CI 1.37–3.83).