Showing papers by "Federal University of São Paulo published in 2002"

Typical and atypical enteropathogenic Escherichia coli.

Abstract: Typical and atypical enteropathogenic Escherichia coli (EPEC) strains differ in several characteristics. Typical EPEC, a leading cause of infantile diarrhea in developing countries, is rare in industrialized countries, where atypical EPEC seems to be a more important cause of diarrhea. For typical EPEC, the only reservoir is humans; for atypical EPEC, both animals and humans can be reservoirs. Typical and atypical EPEC also differ in genetic characteristics, serotypes, and virulence properties. Atypical EPEC is more closely related to Shiga toxin–producing E. coli (STEC), and like STEC these strains appear to be emerging pathogens.

Stress-inducible protein 1 is a cell surface ligand for cellular prion that triggers neuroprotection

Abstract: Prions are composed of an isoform of a normal sialoglycoprotein called PrP(c), whose physiological role has been under investigation, with focus on the screening for ligands. Our group described a membrane 66 kDa PrP(c)-binding protein with the aid of antibodies against a peptide deduced by complementary hydropathy. Using these antibodies in western blots from two-dimensional protein gels followed by sequencing the specific spot, we have now identified the molecule as stress-inducible protein 1 (STI1). We show that this protein is also found at the cell membrane besides the cytoplasm. Both proteins interact in a specific and high affinity manner with a K(d) of 10(-7) M. The interaction sites were mapped to amino acids 113-128 from PrP(c) and 230-245 from STI1. Cell surface binding and pull-down experiments showed that recombinant PrP(c) binds to cellular STI1, and co-immunoprecipitation assays strongly suggest that both proteins are associated in vivo. Moreover, PrP(c) interaction with either STI1 or with the peptide we found that represents the binding domain in STI1 induce neuroprotective signals that rescue cells from apoptosis.

Fall-related factors in a cohort of elderly community residents

Abstract: OBJETIVO: Identificar fatores associados a quedas e a quedas recorrentes em idosos vivendo na comunidade, determinando o risco relativo de cada fator como preditor para quedas. METODOS: Trata-se de um estudo de seguimento de dois anos, por meio de duas ondas de inqueritos multidimensionais domiciliares (1991/92 e 1994/95) com uma coorte de 1.667 idosos de 65 anos ou mais residentes na comunidade, municipio de Sao Paulo, SP. O instrumento utilizado foi um questionario estruturado, versao brasileira do OARS: Brazilian Multidimensional Functional Assessment Questionnaire (BOMFAQ). Foi realizada uma analise de regressao logistica, passo a passo, com p<0,05 e IC de 95%. RESULTADOS: Cerca de 31% dos idosos disseram ter caido no ano anterior ao primeiro inquerito; cerca de 11% afirmaram ter sofrido duas ou mais quedas. Durante o seguimento, 53,4% dos idosos nao referiram quedas, 32,7% afirmaram ter sofrido queda em pelo menos um dos inqueritos e 13,9% relataram quedas em ambos os inqueritos. O modelo preditivo de quedas recorrentes foi composto das variaveis: ausencia de conjuge (OR=1,6 95% IC 1,00-2,52), nao ter o habito de ler (OR=1,5 95% IC 1,03-2,37), historia de fratura (OR=4,6 95% CI 2,23-9,69), dificuldade em uma a tres atividades de vida diaria (OR=2,37 95% CI 1,49-3,78), dificuldade em quatro ou mais atividades de vida diaria (OR=3,31 95% CI 1,58-6,93) e entre aqueles idosos com visao mais comprometida (OR=1,53 95% CI 1,00-2,34). CONCLUSOES: O envelhecimento populacional e o aumento da expectativa de vida demandam acoes preventivas e reabilitadoras no sentido de diminuir os fatores de risco para quedas, como o comprometimento da capacidade funcional, a visao deficiente e a falta de estimulacao cognitiva.

Paracoccidioidomycosis mortality in Brazil (1980-1995)

Abstract: This study analyzes 3,181 deaths from paracoccidioidomycosis in Brazil, based on 16 years of sequential data (from 1980 to 1995). During this period paracoccidioidomycosis showed considerable magnitude and low visibility, representing the eighth most common cause of death from predominantly chronic or recurrent types of infectious and parasitic diseases. It also had the highest mortality rate among the systemic mycoses. The mean annual mortality rate was 1.45 per million inhabitants, indicating a downward long-term trend (reduction of 31.28%), while spatial distribution among the different regions and States of Brazil was non-homogenous. The South (with the highest regional rate) and the Southeast showed a downward trend, while the Central West had the second highest rate in the country. At least one-fifth of Brazilian municipalities (or 22.71% of the country's total area) reported deaths from paracoccidioidomycosis. Overall nationwide mortality per area was 3.73/10,000km2. The disease was endemic in non-metropolitan areas. The majority of deaths occurred in males (84.75%), and there was a sex ratio of 562 men/100 women. The 30-59-year and over-60-year age groups were the most affected. The study showed that the mortality rate justifies classifying this disease as a major health problem in Brazil.

Stapled versus handsewn methods for colorectal anastomosis surgery: a systematic review of randomized controlled trials

Abstract: CONTEXTO: O aumento do numero de ensaios clinicos tem demonstrado o alto interesse nos resultados de comparacoes entre sutura manual e grampeamento nas anastomoses colorretais Esses estudos, no entanto, nao permitem conclusoes em virtude da falta de poder estatistico das amostras analisadas OBJETIVO: Comparar anastomoses colorretais realizadas com sutura manual e com grampeamento, testando a hipotese de que a tecnica que utiliza o grampeador e mais vantajosa em relacao aquela realizada com fios de sutura TIPO DE ESTUDO: Revisao sistematica de ensaios clinicos randomizados e controlados ESTRATEGIA DA PESQUISA: Uma revisao sistematica da literatura foi realizada, sem restricoes de lingua, datas ou outras consideracoes As fontes de informacao utilizadas foram Embase, Lilacs, Medline, Base de Dados de Ensaios Clinicos Controlados da Colaboracao Cochrane e cartas para autores e produtores de grampos e fios de sutura CRITERIOS DE SELECAO: Os estudos foram incluidos na amostra de acordo com os criterios de randomizacao A validade externa das pesquisas foi investigada pelas caracteristicas dos participantes, pelas intervencoes e pelas variaveis analisadas Dois revisores realizaram a selecao dos estudos clinicos, os quais enfocaram analises de pacientes adultos atendidos eletivamente COLETA DE DADOS E ANALISE: A qualidade metodologica dos estudos foi investigada pelos mesmos revisores Alem disso, os criterios de randomizacao, o mascaramento, a intencao de tratamento, perdas e exclusoes foram tambem analisadas A metanalise foi realizada utilizando-se diferenca de risco e diferenca de media ponderal, com os respectivos intervalos de confianca de 95% As variaveis estudadas foram mortalidade, deiscencia, estenose, hemorragia, reoperacao, infeccao da parede abdominal, tempo de realizacao da anastomose e tempo de internacao RESULTADOS: Nove ensaios clinicos foram selecionados Apos a constatacao de que era possivel a utilizacao de uma das duas tecnicas que estavam sendo comparadas, 1233 pacientes foram incluidos, dos quais 622 foram submetidos a tecnica do grampeamento e 611 a tecnica de sutura manual com fios As diferencas encontradas entre as variaveis nao foram significantes, exceto para a estenose, que foi mais frequente na tecnica do grampeamento (p < 0,05) e tempo de realizacao da anastomose que foi maior para a tecnica de sutura manual (p < 0,05) CONCLUSAO: As evidencias encontradas foram insuficientes para demonstrar superioridade da tecnica de grampeamento sobre a tecnica de sutura manual nas anastomoses colorretais, independentemente do nivel da anastomose

Aberrant expression of growth differentiation factor-9 in oocytes of women with polycystic ovary syndrome.

Abstract: Polycystic ovary syndrome (PCOS) is a major cause of female infertility. Despite substantial effort, the etiology and pathogenesis of PCOS and polycystic ovaries (PCO) in women remain unknown. Recent studies in laboratory animals have documented a link between dysfunction of two oocyte growth factors, growth differentiation factor-9 (GDF-9) and bone morphogenetic factor-15 (BMP-15), and aberrant folliculogenesis. Because aberrant follicle development is a hallmark of PCOS, we wondered whether the expression patterns of these growth factors might be disrupted in PCOS and PCO oocytes. To address this issue, we compared the pattern and level of expression of GDF-9 and BMP-15 mRNA in ovaries from normal cycling (n = 12), PCOS (n = 5), and PCO (n = 7) patients. In situ hybridization studies showed that the expression of GDF-9 and BMP-15 is restricted to the oocytes in all ovaries examined. Interestingly, a decreased level of GDF-9 signal was observed in developing PCOS and PCO oocytes, compared with normal. This difference was evident throughout folliculogenesis, beginning at recruitment initiation and continuing through the small Graafian follicle stage. By contrast, there were no qualitative or quantitative changes in the expression of BMP-15 mRNA in PCOS oocytes during folliculogenesis. There were also no significant differences between normal and PCOS and PCOs in the levels of the mRNA encoding the housekeeping gene, cyclophilin. Together, these results indicate that the expression of GDF-9 mRNA is delayed and reduced in PCOS and PCO oocytes during their growth and differentiation phase. Because oocyte-derived GDF-9 is crucial for normal folliculogenesis and female fertility, we suggest that a dysregulation of oocyte GDF-9 expression may contribute to aberrant folliculogenesis in PCOS and PCO women.

NPHS2 mutations in late-onset focal segmental glomerulosclerosis: R229Q is a common disease-associated allele

Abstract: Mutations in NPHS2, encoding podocin, have been identified in childhood onset focal and segmental glomerulosclerosis (FSGS). The role of NPHS2 in adult disease is less well defined. We studied 30 families with FSGS and apparent autosomal recessive inheritance and 91 individuals with primary FSGS. We screened family members for NPHS2 mutations. NPHS2 mutations appeared to be responsible for disease in nine of these families. In six families, the affected individuals were compound heterozygotes for a nonconservative R229Q amino acid substitution. This R229Q variant has an allele frequency of 3.6% in a control population. In these families, R229Q was the only mutation identified on one of the two disease-associated NPHS2 alleles. We used in vitro–translated podocin and purified nephrin to investigate the effect of R229Q on their interaction and found decreased nephrin binding to the R229Q podocin. These data suggest that this common polymorphism contributes to the development of FSGS. Chromosomes bearing the R229Q mutation share a common haplotype defining an approximately 0.2-Mb region. R229Q appears to enhance susceptibility to FSGS in association with a second mutant NPHS2 allele. Identification of R229Q mutations may be of clinical importance, as NPHS2-associated disease appears to define a subgroup of FSGS patients unresponsive to corticosteroids.

Coxiella burnetii Localizes in a Rab7-Labeled Compartment with Autophagic Characteristics

Abstract: The obligate intracellular bacterium Coxiella burnetii, the agent of Q fever in humans and of coxiellosis in other animals, survives and replicates within large, acidified, phagolysosome-like vacuoles known to fuse homo- and heterotypically with other vesicles. To further characterize these vacuoles, HeLa cells were infected with C. burnetii phase II; 48 h later, bacteria-containing vacuoles were labeled by LysoTracker, a marker of acidic compartments, and accumulated monodansylcadaverine and displayed protein LC3, both markers of autophagic vacuoles. Furthermore, 3-methyladenine and wortmannin, agents known to inhibit early stages in the autophagic process, each blocked Coxiella vacuole formation. These autophagosomal features suggest that Coxiella vacuoles interact with the autophagic pathway. The localization and role of wild-type and mutated Rab5 and Rab7, markers of early and late endosomes, respectively, were also examined to determine the role of these small GTPases in the trafficking of C. burnetii phase II. Green fluorescent protein (GFP)-Rab5 and GFP-Rab7 constructs were overexpressed and visualized by fluorescence microscopy. Coxiella-containing large vacuoles were labeled with wild-type Rab7 (Rab7wt) and with GTPase-deficient mutant Rab7Q67L, whereas no colocalization was observed with the dominant-negative mutant Rab7T22N. The vacuoles were also decorated by GFP-Rab5Q79L but not by GFP-Rab5wt. These results suggest that Rab7 participates in the biogenesis of the parasitophorous vacuoles.

Clinical and Immunologic Evaluation of 31 Patients with Acute Schistosomiasis mansoni

Abstract: Thirty-one patients with acute schistosomiasis were evaluated clinically and immunologically. Cytokine levels were determined in peripheral blood mononuclear cell (PBMC) supernatants. Levels of total and antigen-specific IgE, tumor necrosis factor (TNF)-alpha, and immune complexes were measured in serum samples. Clinical findings included general symptoms, liver damage, pulmonary involvement, and pericarditis. All patients had eosinophilia. Immune complexes were detected in 55% of the patients (mean+/-SD, 7.8+/-7.6 microg Eq/mL) and were associated with cough, dyspnea, and abnormal chest radiographic findings. Levels (mean +/- SD) of TNF-alpha (1349.3+/-767.6 pg/mL), interleukin (IL)-1 (2683+/-1270 pg/mL), and IL-6 (382 +/- 52.3 pg/mL) were elevated in PBMC. Serum TNF-alpha levels were elevated in 87% of the patients and were associated with abdominal pain. Higher interferon-gamma levels were detected in PBMC of patients with acute disease than in those of patients with chronic schistosomiasis; IL-5 levels were higher in those with chronic disease. Low IL-5 levels were associated with weight loss. Proinflammatory cytokines and immune complexes with low Th2 responses might explain the immunopathogenesis of acute schistosomiasis.

Brachial endothelial function is impaired in patients with systemic lupus erythematosus.

Abstract: OBJECTIVE: To verify if endothelial function is impaired in pre-menopausal women with systemic lupus erythematosus (SLE) and whether endothelial dysfunction is related to disease duration, cumulative prednisone dose, antimalarial use, anticardiolipin antibody (aCL), hypertension, Raynaud9s phenomenon, disease activity score, and vasculitis. METHODS: Using high-resolution ultrasound, we measured the diameter of brachial artery at rest, during reactive hyperemia, and after glyceryl trinitrate (GTN). We compared 69 pre-menopausal female patients with SLE (mean age 29 +/- 8 years) with 35 age and sex-matched controls (mean age 29 +/- 6 years), The mean disease duration was 72 months. RESULTS: There was no significant difference in baseline brachial artery diameter. The flow-mediated dilation (endothelial dependent dilation) was significantly impaired in SLE patients when compared to controls (5.0 +/- 5.0% vs 12.0 +/- 6.0%, p

Assessment of dental maturity of Brazilian children aged 6 to 14 years using Demirjian's method

Abstract: Summary. Dental maturity, often expressed as dental age, is an indicator of the biological maturity of growing children. A method for the assessment of dental maturity was first described by Demirjian, and is widely used and accepted, mainly because of its ability to compare different ethnic groups. This is possible, as the maturity scoring system proposed by the method is universal in application, although the conversion to dental age depends on the population considered. Objectives. The aim of this study was to apply Demirjian's method to Brazilian children aged 6–14 years in order to obtain dental maturity curves for each sex, to compare this data with that obtained by Demirjian, and to determine whether there is a significant correlation between dental maturity and body mass index. Methods. We retrospectively reviewed the orthopantomograms, height and weight measurements of 689 healthy children. Curves of dental maturity of males and females were constructed. Results. When compared to the French-Canadian sample of Demirjian, Brazilian males and females were 0·681 years and 0·616 years, respectively, more advanced in dental maturity. There was no significant correlation between dental maturity and body mass index.

Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study.

Abstract: The aim of the present study was to carry out a controlled pilot study on the putative anxiolytic effect of valepotriates. Thirty-six outpatients with generalized anxiety disorder (DSM III-R), after a 2-week wash-out, were randomized to one of the following three treatments for 4 weeks (n = 12 per group): valepotriates (mean daily dose: 81.3 mg), diazepam (mean daily dose: 6.5 mg), or placebo. A parallel, double-blind, flexible-dose, placebo-controlled design was employed. No significant difference was observed among the three groups at baseline or in the change from baseline on the Hamilton anxiety scale (HAM-A) or in the trait part of the state-trait anxiety inventory (STAI-trait). Moreover, the three groups presented a significant reduction in the total HAM-A scores. On the other hand, only the diazepam and valepotriates groups showed a significant reduction in the psychic factor of HAM-A. The diazepam group also presented a significant reduction of the STAI-trait. Although the principal analysis (HAM-A between group comparison) found negative results (probably due to the small sample size in each group), the preliminary data obtained in the present study suggest that the valepotriates may have a potential anxiolytic effect on the psychic symptoms of anxiety. However, since the number of subjects per group was very small, the present results must be viewed as preliminary. Thus, further studies addressing this issue are warranted. Copyright © 2002 John Wiley & Sons, Ltd.

Classification and genetics of dystonia

Abstract: Dystonia is a syndrome characterised by sustained muscle contractions, producing twisting, repetitive, and patterned movements, or abnormal postures. The dystonic syndromes include a large group of diseases that have been classified into various aetiological categories, such as primary, dystonia-plus, heredodegenerative, and secondary. The diverse clinical features of these disorders are reflected in the traditional clinical classification based on age at onset, distribution of symptoms, and site of onset. However, with an increased awareness of the molecular and environmental causes, the classification schemes have changed to reflect different genetic forms of dystonia. To date, at least 13 dystonic syndromes have been distinguished on a genetic basis and their loci are referred to as DYT1 to DYT13. This review focuses on the molecular and phenotypic features of the hereditary dystonias, with emphasis on recent advances.

Cardiovascular effects of successful renal transplantation: a 1-year sequential study of left ventricular morphology and function, and 24-hour blood pressure profile.

Abstract: Background Cardiovascular disease is the leading cause of death in renal transplant recipients. The purpose of this study was to determine the effects of a successful renal transplantation on left ventricular morphology and function and on the 24-hr blood pressure profile. Methods Twenty-four patients with end-stage renal disease were prospectively studied by ambulatory blood pressure monitoring and echocardiography before and at 3, 6, and 12 months after renal transplantation. Patients were also analyzed according to their renal function after transplantation. Results We observed a significant drop in the mean values of daytime and nocturnal systolic blood pressure and in the 24-hr systolic pressure load at 12 months after transplantation. The most frequent echocardiographic finding was left ventricular hypertrophy (LVH), for which the incidence decreased from 75% before transplantation to 52.1% at 12 months after transplantation (P = 0.125). There was a significant decrease in left ventricular dilatation, and systolic dysfunction normalized in all patients after 12 months. The variables that best independently predicted the decrease in LVH were serum creatinine levels and the 24-hr systolic pressure load as registered by ambulatory blood pressure monitoring at 12 months after transplantation. We observed significant decreases in left ventricular mass and left ventricular mass index in the group of patients who had adequate renal function, as compared with no changes in patients who did not. Conclusions Correction of the uremic state by renal transplantation leads to complete resolution of systolic dysfunction, regression of LVH, and improvement of left ventricular dilatation. In fact the reduction of LVH was dependent on adequate renal function and on a decrease in the systolic pressure levels.

Diffusely Adherent Escherichia coli as a Cause of Acute Diarrhea in Young Children in Northeast Brazil: a Case-Control Study

Abstract: In a prospective study carried out in two urban centers in northeastern Brazil, 195 HEp-2-adherent Escherichia coli strains were isolated; 110 were identified as the only pathogen in stools of children with diarrhea, and 85 were from controls. Enteropathogenic E. coli isolates were identified in 21 children with diarrhea (8.9%) and 7 children without diarrhea (3.0%), and they were significantly associated with diarrhea (P 0.5). In 49 children with diarrhea (20.7%) and 40 children without diarrhea (17.3%), diffusely adherent E. coli (DAEC) isolates were detected and were not found to be associated with diarrhea (P = 0.41). However, after stratification, for children older than 12 months of age a significant correlation between DAEC infection and diarrhea was detected (P = 0.01). These results suggest that DAEC isolates should be considered potential pathogens in northeastern Brazil and also confirm the association of DAEC with age-dependent diarrhea.

Prevalence and 7-year incidence of Type II diabetes mellitus in a Japanese-Brazilian population: an alarming public health problem.

Abstract: Aims/hypothesis. In 1993, the prevalence of glucose intolerance was studied in a sample of 647 first-generation and second-generation Japanese-Brazilians. Their cohort was followed until 2000, when a second survey was conducted, this included the first and second generations, aged 30 or more years. The aims were to estimate the prevalence of glucose intolerance and 7-yr incidence of Type II (non-insulin-dependent) diabetes mellitus in this population. Methods. Prevalence rates were obtained for 1330 subjects examined in 2000. The incidence of diabetes mellitus was calculated for those classified as normal glucose tolerant in 1993 (n=253). A Student's t test and the Cox proportional hazard model were used in data analysis. Results. In the year 2000, higher proportions of subjects were observed in all categories of glucose intolerance than those found in 1993. The overall incidence of diabetes was 30.9 per 1000 per year. A worse profile was observed among incident cases of diabetes, characterized by higher baseline values of anthropometric and metabolic variables as compared to those who had not developed diabetes. Analysis considering the simultaneous effects of demographic, nutritional and metabolic variables and physical activity levels for the development of diabetes showed that age, sex, waist circumference, fasting and 2-h plasma glucose concentrations were independent predictors. Conclusion/interpretation. Our data point towards a worsening of glucose tolerance status among Japanese-Brazilians, who show one of the highest prevalence rates of diabetes mellitus worldwide. This could reflect their strong genetic susceptibility associated with unfavourable environmental conditions.

Seqüência de drogas consumidas por usuários de crack e fatores interferentes

Abstract: OBJETIVO: Identificar, entre usuarios de crack, uma progressao no uso de drogas e seus fatores interferentes. METODOS: Utilizou-se metodologia qualitativa para uma investigacao mais profunda, considerando o ponto de vista que o entrevistado tem do fenomeno. Foram aplicados entrevistas de longa duracao e questionarios semi-estruturados. Foi delineada uma amostra intencional, e uma amostragem com criterios foi conseguida. Para atingir a saturacao teorica, foram entrevistados 31 usuarios ou ex-usuarios de crack. RESULTADOS: Foram detectadas duas fases distintas de uso de drogas. A primeira, com drogas licitas, sendo o cigarro e o alcool as mais citadas pela amostra. Parentes e amigos dos entrevistados foram os incentivadores do consumo, e o motivo alegado para o uso dessas substâncias foi a necessidade de autoconfianca. A idade precoce do consumo e o uso pesado de uma ou ambas as drogas foram determinantes para o inicio de uma escalada de drogas ilicitas. A maconha foi a primeira droga dessa segunda fase. Uma postura mais ativa na busca da droga como fonte de prazer passou a ser o motivo do consumo. CONCLUSOES: O estudo revela que a identificacao de uma sequencia de drogas parece estar mais associada a fatores externos (pressoes de grupo, influencia do trafico etc.) do que a preferencia do usuario. Foram identificadas duas progressoes diferentes: entre os mais jovens (=30 anos), cuja a escalada comecou com o cigarro e/ou alcool e passou pela maconha e cocaina aspirada ate o uso de crack; e os mais velhos (>30 anos), que iniciaram o uso de drogas pelo cigarro e/ou alcool, seguido de maconha, medicamentos endovenosos, cocaina aspirada, cocaina endovenosa e, por fim, crack.

Effects of mandibular posture on obstructive sleep apnea severity and the temporomandibular joint in patients fitted with an oral appliance.

Abstract: Study objectives The purposes of this study were to assess the relationship between different increments of mandibular protrusion and a reduction of obstructive sleep apnea (OSA) severity and to use magnetic resonance imaging to assess temporomandibular joint (TMJ) morphology and condyle position after the insertion of an oral appliance (OA). Design Six mild to moderate OSA patients were treated with a titratable OA (Klearway) and changes in the apnea hypopnea index (AHI) secondary to the amount of mandibular advancement were evaluated. In seven patients, the morphology of the TMJ was compared before insertion and after titration of the appliance and the anterior displacement of the condyle with the titrated appliance in place was evaluated. Setting Federal University of Sao Paulo, Brazil. Patients or participants 7 males (mean age 47.4 years, SD 5.6). Interventions N/A. Measurements and results A total of 21 polysomnographic recordings in different mandibular positions were compared. A significant reduction in the mean AHI from 12.21 to 5.64 was seen and the the AHI reduction was related to the amount of mandibular protrusion. In six out of seven patients, the translation of the condyle with the OA was equal to or less than that observed in the maximal open position. No TMJ morphologic parameters revealed significant alterations during the period of the study. Conclusion Sequential polysomnographic studies facilitate OA titration. OA effects on the AHI seem to be dose-dependent on the amount of mandibular protrusion, and the OA proved over the period of one year to be innocuous for TMJ in the treatment of patients with OSA.

Weight excess and abdominal fat in the metabolic syndrome among Japanese-Brazilians

Abstract: OBJECTIVE: Obesity, especially abdominal, has been associated with cardiovascular risk factors such as dyslipidemia, hypertension and diabetes mellitus (DM). The importance of these risk factors among Japanese-Brazilians was previously shown, although obesity is not a typical characteristic of Japanese migrants. In this study the prevalence of weight excess and central adiposity (CA) among Japanese-Brazilians and their association with metabolic disorders was evaluated. METHODS: A sample of 530 1st and 2nd generation Japanese-Brazilians (aged 40¾79 years) went through anthropometric and blood pressure measurements, lipid profile and oral glucose tolerance tests. The prevalence rate (point and confidence interval) of overweight was calculated using a cut-off value of >26.4 kg/m2. CA diagnosis was based on waist-to-hip circumference ratio (WHR): ³ 0.85 and 0.95 in women and men, respectively. RESULTS: The prevalence of weight excess was 22.4% (CI 95% 20.6¾28.1), and CA was 67.0% (95% CI 63.1¾70.9). In addition to higher prevalence of DM, hypertension and dyslipidemia, stratifying by BMI and WHR, people with weight excess and CA revealed a poorer metabolic profile: blood pressure levels were significantly higher among those with weight excess with or without CA; CA individuals had higher glucose, triglycerides, total and LDL cholesterol, and lower HDL than those without weight excess or CA; fasting insulinemia was significantly higher among subjects with weight excess (with or without CA) than among those without weight excess or CA. CONCLUSION: Comparing subgroups with and without CA supports the hypothesis that abdominal fat accumulation represents a risk factor for insulin resistance-related diseases, even among Japanese descendants. The increased prevalence of metabolic syndrome among Japanese migrants could be attributed to visceral fat deposition, which has been implicated in the genesis of insulin resistance.

Hormonal and behavioural responses of paradoxical sleep-deprived rats to the elevated plus maze.

Abstract: Activation of the hypothalamic-pituitary-adrenal (HPA) axis is observed immediately after 96 h of paradoxical sleep (PS) deprivation. However, when individually or group PS-deprived rats are challenged with a mild stressor, they exhibit a facilitation of the corticosterone response, and a faster return to basal levels than control rats. Because the housing condition influences coping behaviour, we tested whether the type of PS deprivation (individually or in group) influenced anxiety-like behaviour in the elevated plus-maze and the accompanying adrenocorticotropin (ACTH) and corticosterone responses. Individually (I-DEP) or group deprived (G-DEP) rats and their appropriate control groups were either killed immediately after 96 h of sleep deprivation (time-point 0 or 'basal') or exposed to a 5-min test on the elevated plus maze and sampled 5, 20 or 60 min after test onset. Control of I-DEP rats showed reduced locomotor activity and augmented anxiety-like behaviour, replicating the effects of social isolation. Although I-DEP rats exhibited higher motor activity than cage control rats, these groups did not differ in regard to the percentage of entry and time spent in the open arms. G-DEP rats, in turn, ambulated more, entered and remained longer in the open arms, exhibiting less anxiety-like behaviour. PS-deprived rats exhibited higher ACTH and corticosterone 'basal' secretion than control rats. For all groups, peak ACTH secretion was reached at the 5-min time-point, returning to unstressed basal levels 60 min after the test, except for G-DEP rats, which showed a return at 20 min. Peak levels of corticosterone occurred at 5 min for PS-deprived groups and at 20 min for control groups. G-DEP rats showed a return to 'basal' unstressed levels at 20 min, whereas the I-DEP and control groups did so at 60 min. A negative correlation between exploration in the open arms and hormone concentrations was observed. These data indicate that housing condition influences the subsequent behaviour of PS-deprived rats in the EPM which, in turn, seems to determine the secretion profile of ACTH and corticosterone in response to the test.

Oral theophylline for chronic obstructive pulmonary disease.

Abstract: Background Oral theophylline has, for many years, been used as a bronchodilator in patients with COPD. Despite the introduction of new drugs, and its narrow therapeutic index, theophylline is still recommended for COPD treatment. Objectives To determine the effectiveness of oral theophylline when compared to placebo in patients with stable COPD. Search methods We searched the Cochrane Airways Group trial register and Cochrane Central Register of Controlled Trials Cochrane Controlled Clinical Registers were searched. Selection criteria All studies were randomised controlled trials (RCTs). Data collection and analysis Two reviewers independently abstracted data and asessed the methodological quality. Main results Twenty RCTs met the inclusion criteria. Concomitant therapy varied from none to any other bronchodilator plus corticosteroid (oral and inhaled). The following outcomes were significantly different when compared to placebo. Forced expiratory volume in one second (FEV1) improved with treatment: Weighted Mean Difference (WMD) 100 ml; 95% Confidence Interval (CI) 40 to 160 ml. Similarly for forced vital capacity (FVC): WMD 210 ml 95%CI 100 to 320. Two studies reported an improvement in maximum oxygen consumption (VO2 max); WMD 195 ml/min, 95%CI 113 to 278. At rest, arterial oxygen tension at rest (PaO2) and arterial carbon dioxide tension at rest (PaCO2) both improved with treatment (WMD 3.2 mm Hg; 95%CI 1.2 to 5.1, and WMD -2.4 mm Hg; 95%CI -3.5 to -1.2, respectively). Walking distance tests did not improve (four studies, Standardised Mean Difference 0.30, 95%CI -0.01 to 0.62), neither did Visual Analogue Score for breathlessness in two small studies (WMD 3.6, 95%CI -4.6 to 11.8). The Relative Risk (RR) of nausea was greater with theophylline (RR 7.7; 95%CI 1.5 to 39.9). However, patients' preference for theophylline was greater than that for placebo (RR 2.27; 95%CI 1.26 to 4.11). Very few participants withdrew from these studies for any reason. Authors' conclusions Theophylline has a modest effect on FEV1 and FVC and slightly improves arterial blood gas tensions in moderate to severe COPD. These benefits were seen in participants receiving a variety of different concomitant therapies. Improvement in exercise performance depended on the method of testing. There was a very low dropout rate in the studies that could be included in this review, which suggests that recruited participants may have been known by the investigators to be theophylline tolerant . This may limit the generalisability of these studies.