Pre-and postoperative nutritional evaluation in patients with chagasic megaesophagus

Chagasic megaesophagus is a chronic disease that courses with progressive dysphagia, regurgitation and protein-calorie malnutrition. Advanced or recurrent megaesophagus can be treated with Serra Dória's operation (cardioplasty, partial gastrectomy and gastrojejunal Roux-en-Y anastomosis). A nutritional evaluation was performed on 27 patients (mean age 58 +/- 10 years) with chagasic megaesophagus at admission and after postoperative day 90. The nutritional state was assessed through global subjective nutritional evaluation (GSNE), anthropometry and laboratorial exams, besides the analysis of alimentary intake. In the preoperative period, GSNE pointed to malnutrition in 2/3 patients, while the anthropometric and laboratorial evaluation revealed that over 60% of the patients had protein-calorie malnutrition of the marasmic type. The preoperative nutritional state as evaluated by GSNE did not correlate with complications or postoperative mortality. The postoperative evaluation showed an increase in the intake of proteins, recovery in the body mass index and a reduction in the hemoglobin levels of the peripheral blood.

A New Dehydrogenase Specific Towards Aromatic Aldehydes From A Halophilic Bacterium

A new enzyme showing a dehydrogenase activity towards aromatic aldehydes was isolated, purified and characterized from a halophilic strain isolated from saline environment. The enzyme is a monomer of 54 kDa; it is rather thermostable (optimal temperature: 50 degrees C) showing a broad spectrum of activity in a large pH range with the maximum at pH 9.5. The substrate specificity and the effect of ions were evaluated and compared with analogous described proteins.

Characterisation and application of glycanases secreted by Aspergillus terreus CCMI 498 and Trichoderma viride CCMI 84 for enzymatic deinking of mixed office wastepaper

Two enzymatic extracts obtained from xylan-grown Aspergillus terreus CCMI 498 and cellulose-grown Trichoderma viride CCMI 84 were characterised for different glycanase activities. Both strains produce extracellular endoxylanase and endoglucanase enzymes. The enzymes optimal activity was found in the temperature range of 45-60 degrees C. Endoglucanase systems show identical activity profiles towards temperature, regardless of the strain and inducing substrate. Conversely, the endoxylanases produced by both strains showed maximal activity at different pH values (from 4.5 to 5.5), being the more acidic xylanase produced by T. viride grown on cellulose. The endoglucanase activities have an optimum pH at 4.5-5.0. The endoxylanase and endoglucanase activities exhibited high stability at 50 degrees C and pH 5.0. Mannanase, beta-xylosidase, and amylase activities were also found, being the first two activities only present for T. viride extract. These two enzymatic extracts were used for mixed office wastepaper (MOW) deinking. When the enzymatic extract from T. viride was used, a further increase of 24% in ink removal was obtained by comparison with the control. Both enzymes contributed to the improvement of the paper strength properties and the obtained results clearly indicate that the effective use of enzymes for deinking can also contribute to the pulp and paper properties improvement.

[Evaluation of a social and environmental indicator used in the identification of lymphatic filariasis transmission in urban centers]

The concept of a "socially organized space" supported by new analytical techniques and mapping of health events has guided innovative methodological developments in public health interventions. This study aimed to evaluate a social/environmental indicator constructed with a scoring methodology to stratify areas in the city of Olinda by different levels of risk for Bancroftian filariasis transmission. The study mapped areas and the location of sample households and identified all residents ages 5 to 65 years as part of the parasitological survey. Among the 3,232 individuals who had blood samples taken, 42 were microfilaremic (1.3% prevalence). Global statistical analysis of filarial case distribution has suggested spatial clustering. Some 85.7% of positive individuals resided in the two strata with the highest transmission risk. The high sensitivity of the proposed indicator for predicting the places where the vast majority of filariasis cases occurred justifies its use in planning and implementing interventions.

Depression is common and precludes accurate assessment of functional status in elderly patients with congestive heart failure

BACKGROUND

Congestive heart failure (CHF) and depression are independently known to result in physical decline and diminished functional capacity in the general population. The prevalence and relationship of depressive symptoms in CHF to physical limitations has not been objectively examined.

METHODS AND RESULTS

The Center for Epidemiological Studies Depression Scale (CES-D) was used to ascertain depressive symptoms in 33 elderly ambulatory individuals with CHF. Self-report assessment of functional status, cardiopulmonary exercise testing (CPX), and measurement of energy expenditure by doubly labeled water and Caltrac Accelerometer (Muscle Dynamics, Torrance, CA) were performed. Depressed and nondepressed groups were compared. Forty-two percent of the patients scored in the depressed range (CES-D score of 16 or greater). There were no differences in demographic variables or severity of illness between the depressed and nondepressed patients. Energy expenditure was comparable across groups. Although obtaining similar maximal heart rate and maximal oxygen consumption (VO2max) on CPX, the depressed group showed less exertion on exercise testing with a significantly lower respiratory quotient (P = .017).

CONCLUSION

Depressive symptoms were common and unrelated to the severity of CHF. Although depressed individuals tended to report worse physical functioning than nondepressed individuals, objective assessment of energy expenditure was comparable. Depressed patients appear to underestimate their functional ability. Subsequently, inaccurate assessment of functional status may occur.

Upregulation by glucocorticoids of responses to eosinopoietic cytokines in bone-marrow from normal and allergic mice

Since the production of eosinopoietic cytokines (GM-CSF, IL-3, IL-5) is inhibited by glucocorticoids, while responsiveness to these cytokines is enhanced in bone-marrow of allergic mice, we studied the ability of glucocorticoids to modulate murine bone-marrow eosinopoiesis. Progenitor (semi-solid) and/or precursor (liquid) cultures were established from bone-marrow of: (a) normal mice; (b) ovalbumin-sensitized and challenged mice or (c) dexamethasone (1-5 mg kg(-1)) injected mice. Cultures were established with GM-CSF (2 ng ml(-1)) or IL-5 (1 ng ml(-1)), respectively, alone or associated with dexamethasone, hydrocortisone or corticosterone. Total myeloid colony numbers, frequency and size of eosinophil colonies, and numbers of eosinophil-peroxidase-positive cells were determined at day 7. In BALB/c mice, dexamethasone (10(-7) M) increased GM-CSF-stimulated myeloid colony formation (P = 0.01), as well as the frequency (P=0.01) and size (P<0.01) of eosinophil colonies. Dexamethasone (10(-7) M) alone had no effect. Dexamethasone (10(-7)-10(-10) M) increased (P<0.002) eosinophil precursor responses to IL-5. Potentiation by dexamethasone was still detectable: (a) on low density, immature, nonadherent BALB/c bone-marrow cells, (b) on bone-marrow from other strains, and (c) on cells from allergic mice. Hydrocortisone and corticosterone had similar effects. Dexamethasone administered in vivo, 24 h before bone-marrow harvest, increased subsequent progenitor responses to GM-CSF (P = 0.001) and precursor responses to IL-5 (P<0.001). These effects were blocked by RU 486 (20 mg kg(-1), orally, 2 h before dexamethasone, or added in vitro at 10 microM, P<0.001). Glucocorticoids, acting in vivo or in vitro, through glucocorticoid receptors, enhance bone-marrow eosinopoiesis in naïve and allergic mice.

Effects of exercise training on peak performance and quality of life in congestive heart failure patients

BACKGROUND

Exercise programs for patients with heart failure have often enrolled and evaluated relatively healthy, young patients. They also have not measured the impact of exercise performance on daily activities and quality of life.

METHODS AND RESULTS

We investigated the impact of a 6-month supervised and graded exercise program in 33 elderly patients with moderate to severe heart failure randomized to usual care or an exercise program. Six of 17 patients did not tolerate the exercise program. Of those who did, peak oxygen consumption increased by 2.4 +/- 2.8 mL/kg/min (P < .05) and 6-minute walk increased by 194 ft (P < .05). However, outpatient energy expenditure did not increase, as measured by either the doubly labeled water technique or Caltrac accelerometer. Perceived quality of life also did not improve, as measured by the Medical Outcomes Study, Functional Status Assessment, or Minnesota Living With Heart Failure questionnaires.

CONCLUSION

Elderly patients with severe heart failure can safely exercise, with an improvement in peak exercise tolerance. However, not all patients will benefit, and daily energy expenditure and quality of life do not improve to the same extent as peak exercise.

Angiomatoid fibrous histiocytoma of the arm treated by radiotherapy for local recurrence--case report

The Angiomatoid Fibrous Histiocytoma is a rare tumor of soft tissues, which occurs mainly in children and young adults, with low malignancy grade. It has the capacity of local recurrence, but rarely metastizes. It is frequently difficult to differentiate this from vascular tumors, namely hemangioendotheliomas and angiosarcomas, or simply organized hematomas. The authors present a case of a patient with an angiomatoid fibrous histiocytoma of the arm, treated with radiotherapy after three postsurgical recurrences.

Use of salt bridge in rhythm analysis

Filling a catheter with electrolyte solution converts it to a conductor and allows the safe recording of an electrogram from near or within the right atrium. This technic is very useful in localizing the internal position of a cardiac catheter and particularly in rhythm analysis. Four cases are presented to review the value of this salt bridge technic.