Spirometry reference values in the Brazilian population

The aim of the present study was to provide new spirometry reference equations in a sample of the Brazilian population for the following parameters: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), FEV₁/FVC ratio, peak of expiratory flow (PEF), forced expiratory flow at 50% (FEF_50%)_, 75% average vital capacity (FEF_25-75%), and average forced expiratory flow time (FEFT). This was a prospective study using results from chest radiographs, electrocardiograms, and questionnaires to investigate the participants' respiratory symptoms, sedentarism, and comorbidities (Charlson comorbidity index). From December 2010 to July 2014, individuals were randomly selected from various locations in the state of Rio de Janeiro. All individuals were examined by a single technician in the morning at the laboratory, and performed the spirometry with the same spirometer. Spirometry values were tabulated for the creation of three equation models: linear regression, logarithmic regression, and logarithms through a method that incorporates the lambda, median, and coefficient of variation (LMS method). Initially, 7003 individuals from both genders were contacted, and 454 were recruited. The data from the new equations were compared with one Brazilian and eight international equations, resulting in a high correlation (r>0.9). The values derived from the LMS method and linear regression were very similar (P>0.5), and both could be used to acquire the reference values for Brazilian spirometry. Data derived from the equations of this study were different from the current Brazilian equation, which could be justified by the different method used.

Ventilation distribution and small airway function in patients with systemic sclerosis

BACKGROUND

Despite the importance of traditional pulmonary function tests (PFTs) in managing systemic sclerosis (SSc), many patients with pulmonary disease diagnosed by computed tomography (CT) present with normal PFTs.

OBJECTIVE

To evaluate the efficacy of the nitrogen single-breath washout (N₂SBW) test in diagnosing SSc and to correlate N₂SBW parameters with the PFT indexes used in the follow-up of these patients, clinical data, and CT findings.

METHODS

Cross-sectional study in which 52 consecutive SSc patients were subjected to spirometry, body plethysmography, analysis of the diffusing capacity for carbon monoxide (DLCO), analysis of respiratory muscle strength, N₂SBW testing, and CT analysis.

RESULTS

Twenty-eight patients had a forced vital capacity (FVC) that was <70% of the predicted value. In the N₂SBW test, 44 patients had a phase III slope (Phase III slope_N2SBW) that was >120% of the predicted value, while 15 patients had a closing volume/vital capacity (CV/VC) that was >120% of the predicted value. A significant difference in Phase III slope_N2SBW was observed when the patients with predominant traction bronchiectasis and honeycombing were compared to the patients with other CT patterns (p<0.0001). The Phase III slope_N2SBW was correlated with FVC (r_s=-0.845, p<0.0001) and DLCO (r_s=-0.600, p<0.0001), and the CV/VC was correlated with FVC (r_s=-0.460, p=0.0006) and residual volume/total lung capacity (r_s=0.328, p=0.017).

CONCLUSION

Ventilation heterogeneity is a frequent finding in SSc patients that is associated with restrictive damage, changes in pulmonary diffusion, and CT patterns. In addition, approximately one-third of the patients presented with findings that were compatible with small airway disease.

QBC for the diagnosis of human and canine american visceral leishmaniasis: preliminary data

"Quantitative Buffy Coat" (QBC) is a direct and fast fluorescent method used for the identification of blood parasites. Since Leishmania chagasi circulates in blood, we decided to test it in American visceral leishmaniasis (AVL). Bone marrow (BM) and peripheral blood (PB) of 49 persons and PB of 31 dogs were analyzed. QBC was positive in BM of 11/11 patients with AVL and in 1/6 patients with other diseases. Amastigotes were identified in PB of 18/22 patients with AVL and in none without AVL. The test was positive in 30 out of the 31 seropositive dogs and in 28/28 dogs with Leishmania identified in other tissues. QBC is a promising method for diagnosis of human AVL, and possibly for the exam of PB of patients with AVL/AIDS, for the control of the cure and for the identification of asymptomatic carriers. Because it is fast and easy to collect and execute, QBC should be evaluated for programs of reservoir control.

Mannan-binding lectin enhances susceptibility to visceral leishmaniasis

Levels of the serum opsonin mannan-binding lectin (MBL) were directly correlated with the probability of developing visceral leishmaniasis. Monocytes infected with MBL-opsonized Leishmania chagasi promastigotes secreted higher levels of tumor necrosis factor alpha and interleukin-6 than cells infected with nonopsonized parasites. Our findings indicate that MBL can modulate the clinical outcome of infection with L. chagasi and the function of infected macrophages.

Definition of the surface in the thyroid hormone receptor ligand binding domain for association as homodimers and heterodimers with retinoid X receptor

Thyroid hormone receptors (TRs) bind as homodimers or heterodimers with retinoid X receptors (RXRs) to DNA elements with diverse orientations of AGGTCA half-sites. We performed a comprehensive x-ray crystal structure-guided mutation analysis of the TR ligand binding domain (TR LBD) surface to map the functional interface for TR homodimers and heterodimers with RXR in the absence and/or in the presence of DNA. We also identified the molecular contacts in TR LBDs crystallized as dimers. The results show that crystal dimer contacts differ from those found in the functional studies. We found that identical TR LBD residues found in helices 10 and 11 are involved in TR homodimerization and heterodimerization with RXR. Moreover, the same TR LBD surface is operative for dimerization with direct repeats spaced by 4 base pairs (DR-4) and with the inverted palindrome spaced by 6 base pairs (F2), but not with TREpal (unspaced palindrome), where homodimers appear to be simply two monomers binding independently to DNA. We also demonstrate that interactions between the TR and RXR DNA binding domains stabilize TR-RXR heterodimers on DR-4. The dimer interface can be functional in the cell, because disruption of key residues impairs transcriptional activity of TRs mediated through association with RXR LBD linked to GAL4 DNA-binding domain.

Competence of the human host as a reservoir for Leishmania chagasi

The failure of control programs for visceral leishmaniasis (VL) that depend on elimination of infected dogs suggests that other reservoir hosts may participate in the transmission cycle. To determine whether persons infected with Leishmania chagasi can infect the vector sand fly, laboratory-reared Lutzomyia longipalpis were allowed to feed on Brazilian subjects with active, cured, and asymptomatic VL and on asymptomatic residents of houses of persons with active VL. Of 3747 insects that had fed, 26 acquired infection from 11 of the 44 persons with active VL, but none acquired infection from the 137 asymptomatic persons. Among persons <4 years old with active VL, a history of diarrhea and higher peripheral blood neutrophil counts were independent predictors of infectivity. Further experiments using larger numbers of insects are necessary to evaluate the reservoir competence of persons with asymptomatic infections, who represent a large segment of the population of several Brazilian cities.

Vitamin D-dependent suppression of human atrial natriuretic peptide gene promoter activity requires heterodimer assembly

Crystallographic structures of the ligand-binding domains for the retinoid X (RXR) and estrogen receptors have identified conserved surface residues that participate in dimer formation. Homologous regions have been identified in the human vitamin D receptor (hVDR). Mutating Lys-386 to Ala (K386A) in hVDR significantly reduced binding to glutathione S-transferase-RXRalpha in solution, whereas binding of an I384R/Q385R VDR mutant was almost undetectable. The K386A mutant formed heterodimers with RXRalpha on DR-3 (a direct repeat of AGGTCA spaced by three nucleotides), whereas the I384R/Q385R mutant completely eliminated heterodimer formation. Wild type hVDR effected a 3-fold induction of DR-3-dependent thymidine kinase-luciferase activity in cultured neonatal rat atrial myocytes, an effect that was increased to 8-9-fold by cotransfected hRXRalpha. Induction by K386A, in the presence or absence of RXRalpha, was only slightly lower than that seen with wild type VDR. On the other hand, I384R/Q385R alone displayed no stimulatory activity and less than 2-fold induction in the presence of hRXRalpha. Qualitatively similar findings were observed with the negative regulation of the human atrial natriuretic peptide gene promoter by these mutants. Collectively, these studies identify specific amino acids in hVDR that play a critical role in heterodimer formation and subsequent modulation of gene transcription.

Ultrastructural localization of anionic sites and lectin-binding sites in sarcoid human alveolar macrophages during interaction with T-lymphocytes

Sarcoidosis alveolitis is caused by an unknown stimulus activating alveolar macrophages (AM) and T-lymphocytes. During antigen presentation, the complex HLA class II molecule/processed peptide, on the surface of sarcoid AM, induces the T-lymphocyte to proliferate. Altered glycosylation patterns of cell surface glycoproteins such as class II molecules in inflammatory states, may enhance the antigen-presenting capability of AM. In order to know if anionic sites and lectin-binding sites take part in the process of antigen presentation by alveolar macrophages, cells obtained from bronchoalveolar lavage of patients with pulmonary sarcoidosis were incubated with cationized ferritin (CF) and colloidal gold complexed lectins (BSL-I-A4; RCA-I; RCA-II; WGA) for 30 min at 4 degrees C. After incubation, the cells were fixed with 4% paraformaldehyde, 2% glutaraldehyde, postfixed, and Epon embedded. The CF particles were uniformly distributed over the entire cell surface of the lymphocyte, and formed clusters on the surface of the macrophage mainly at the adhesion region between the AM and the lymphocytes. We found enhanced binding of BSL-I-A4 by AM, while WGA and RCA were poorly taken up by these cells. Gold-BSL-I-A4 was distributed randomly on the plasma membrane of the AM, and clustered in the adhesion region with lymphocytes. These results suggest that anionic sites and alpha-D-N-acetyl-galactosamine residues labeled with gold-BSL-I-A4 may be involved in the process of antigen presentation by sarcoid alveolar macrophages.

Role of resident mast cells and macrophages in the neutrophil migration induced by LTB4, fMLP and C5a des arg

In the present study, we have investigated the participation of resident peritoneal cells (macrophages and mast cells) in the neutrophil migration induced in rats by the intraperitoneal administration of LTB4, fMLP or C5a des arg. The intraperitoneal injection of LTB4 (10 nmol), fMLP (10 nmol) and C5a des arg (zymosan-activated plasma, 1 ml) caused an intense neutrophil migration compared to the saline control (1,000, 1,500 and 2,000%, respectively). An 83% depletion in the number of resident cells following peritoneal lavage reduced the LTB4-stimulated neutrophil migration by 73.6% without affecting that caused by fMLP and C5a des arg. Increasing the peritoneal macrophage population (236%) by pretreating the cavities with thioglycollate enhanced the neutrophil migration induced by LTB4 (129%), but did not alter that induced by fMLP and C5a des arg. Similarly, reducing the population of peritoneal mast cells containing toluidine-blue-staining granules by subchronically pretreating the cavities with compound 48/80 diminished the LTB4-induced NM by 69% but had no effect on the responses to fMLP and C5a des arg. Pretreating the animals with dexamethasone strongly inhibited (70%) the neutrophil migration induced by the intraperitoneal injection of LTB4, fMLP and C5a des arg. Indomethacin, BW A4C and NDGA had no such effect. The incubating medium from peritoneal macrophages and mast cells stimulated with LTB4 induced neutrophil migration when injected into the peritoneal cavity of rats. This migration was strongly reduced (70%) by treating the cells with dexamethasone. In contrast, stimulating the cells with fMLP or C5a des arg did not result in the release of any promigratory activity into the incubating fluid. Our results suggest that LTB4 induces neutrophil migration via a mechanism dependent on resident mast cells and macrophages while that induced by C5a des arg and fMLP seems to be independent of such cellular involvement. The neutrophil migration induced by LTB4 is apparently mediated by factor(s) whose release is blocked by dexamethasone. fMLP and C5a appear to cause in vivo migration by the formation of a concentration gradient and by a glucocorticoid-sensitive mechanism different from that stimulated by LTB4.

Thyroid hormone activation of transcription is potentiated by activators of cAMP-dependent protein kinase

We characterized the cross-talk between activators of protein kinase A (PKA) and thyroid hormone (T3) in T3 receptor (TR)-mediated transcription. U937 cells were cotransfected with a plasmid expressing the TR and a reporter plasmid containing a T3 response element (TRE) oriented either as a direct repeat or as a palindrome upstream of the thymidine kinase promoter linked to the chloramphenicol acetyltransferase gene. T3 activated transcription by 10-fold. T3 response was potentiated 2.5-3-fold by activators of PKA, but an activator of protein kinase C or of guanylate kinase was ineffective. In the absence of T3, activators of PKA had no effect on transcription. TR heterodimerization with the retinoid X receptor may facilitate T3/PKA cross-talk because coexpression of the retinoid X receptor potentiated cross-talk. Synergy was not observed in JEG-3, F9, CV-1, HeLa, L929, and HTC cells, indicating that it may require cell-specific factors. Synergy required the DNA- and ligand-binding domains, but not the amino-terminal domain, indicating that T3- and TRE-induced conformational changes on the TR are essential for cross-talk. PKA phosphorylated the TR in vitro, suggesting that, like other nuclear receptors, the TR is a target for PKA. These results imply that PKA cross-talks with T3 at the level of the TRE-bound TR, enhancing its transcriptional activity in a cell-specific manner.

[Comparative effects of captopril and chlorthalidone on glucose tolerance and insulin levels essential hypertensives]

PURPOSE

To compare the effects of chlortalidone (CL) and captopril (Cp) upon glucose tolerance and serum insulin levels in essential hypertensive patients.

METHODS

Non obese essential hypertensive patients with normal glucose tolerance test (OGTT) and diastolic blood pressure (DBP) > 90 mmHg and < or = 115 mmHg in the seated position were treated, in a randomized fashion, with Cp or CL during 16 weeks, after 16 weeks of placebo. The OGTT was performed after placebo and after active therapy, with serum insulin levels determinations carried out before and 120 minutes after oral glucose load.

RESULTS

Twenty four patients in the CL group and 19 in the Cp concluded the study. Hypocalemia (serum potassium < 3.8mEq/L or serum potassium reductions > or = 0.9mEq/ L) occurred in nine patients of the CL group (CL H). In this group CL therapy induced increments in the area under the curve of glycemia during OGTT (582 vs 610mg/h/dL, p < 0.05) that were not observed in the normocalemic patients of the CL (CLN) or Cp groups. Serum insulin levels during OGTT did not change with active therapy in all three groups. The insulin sensitivity index, however, decreased significantly in the CLH (1.9 vs 1.4; p < 0.05) and CLN (10.1 vs 4.3, p < 0.05) but remained unchanged in the Cp group (3.1 vs 2.5; NS). The insulin response to glucose index increased in the Cp (0.28 vs 0.40; p < 0.05) group but not in the CLH (0.25 vs 0.42; NS) and CLN (0.07 vs 0.24).

CONCLUSION

The antihypertensive therapy with chlortalidone in essential hypertensive patients may result in reductions in the peripheral sensitivity to insulin that can be accompanied by increases in glycemic levels after oral glucose load, particularly in patients who develop hypocalemia. Our results indicate that Cp therapy induces increments in insulin response to glucose without detectable changes in peripheral insulin sensitivity.

Interleukin-12 restores interferon-gamma production and cytotoxic responses in visceral leishmaniasis

American visceral leishmaniasis (AVL) is associated with the absence of lymphocyte proliferative responses and interleukin (IL)-2 and interferon-gamma (IFN-gamma) production upon stimulation with Leishmania antigen. In contrast, cure of AVL is associated with restoration of these T cell functions. In the present study, the ability of IL-12, a cytokine that acts on NK and T cells to restore cellular immune responses in AVL, was evaluated. Participants of the study included 12 patients with AVL and 7 subjects cured of AVL. The [3H]thymidine uptake and IFN-gamma production in cultures of peripheral blood mononuclear cells (from AVL patients) stimulated with Leishmania chagasi antigen were 882 +/- 1393 cpm and zero, respectively. Addition of IL-12 enhanced the proliferative response to 5097 +/- 6429 cpm (P < .001) and IFN-gamma production to 305 +/- 325 pg/mL (P < .01). IL-12 also restored cytotoxic activity against the K562 cell line. These results indicate that IL-12 has an important role in the regulation of the cellular immune response in human leishmaniasis.

Serum insulin levels, 24-hour blood pressure profile, and left ventricular mass in nonobese hypertensive patients

In essential hypertensive patients, considered to be insulin-resistant, a blunted decline in nocturnal blood pressure is associated with increased adrenergic tone and left ventricular mass. Since insulin stimulates the sympathetic system, we tested whether insulin resistance and insulinemia influence left ventricular mass and the 24-hour blood pressure profile. We studied 29 nonobese hypertensive patients with office diastolic pressure between 95 and 110 mm Hg and normal oral glucose tolerance test after a 4-month washout period. They were then assigned to M-mode echocardiographic evaluation and 24-hour ambulatory blood pressure monitoring. The glucose and insulin responses to a 75-g oral glucose load were compared with those obtained in 16 weight-matched normotensive control subjects. During the oral glucose tolerance test the hypertensive patients compared with control subjects presented higher levels of glucose at 60 minutes (138.7 +/- 30.3 versus 108.7 +/- 35.7 mg/dL; P < .05) and 90 minutes (114.0 +/- 23.8 versus 94.8 +/- 31.1 mg/dL; P < .05) and insulin at 60 minutes (287.1 +/- 259.4 versus 142.1 +/- 83.9 pmol/L; P < .05). However, peak insulin levels after glucose load did not correlate with ambulatory blood pressure values or left ventricular mass index. Left ventricular mass index showed significant correlation with mean sleeping systolic pressure (rs = 56, P < .05) and diurnal systolic pressure (rs = .37, P < .05) but not with mean diurnal or sleeping diastolic pressures. In conclusion, our results indicate that in nonobese hypertensive patients, insulin resistance does not have any influence on the 24-hour blood pressure profile or on left ventricular mass index.(ABSTRACT TRUNCATED AT 250 WORDS)

[Visceral leishmaniasis epidemic in the State of Piauí, Brazil, 1980-1986]

The kala-azar epidemic in the State of Piauí 1980-1986 is analyzed on the basis of the data collected by SUCAM Piauí. The outbreak began in towns of central and northern Piauí in 1980. In contrast what has happened in endemic periods in which the disease occurred in areas of higher altitude and semi-arid climate, the epidemic developed in humid tropical river valleys in rural zones. The epidemic was worst in the towns. The state capital, Teresina, hit in 1981, reached the epidemic peak in 1984 and accounted, for more than 60% of the 1,509 cases in the state. The epidemic was not substantial in those regions sprayed to combat malaria and Chagas' disease. While control in Teresina was attempted through intensive use of insecticides, the outbreak gave way spontaneously in rural areas. Neither the number of cases nor the phlebotomine population of Teresina presented significant seasonal variations but were moderately correlated. There was greater prevalence in children of 5 years of age or less, especially during the peak epidemic years, and much lesser prevalence in adults over 40 years of age. The geographical distribution of the epidemic process and its beginning, concomitant with a prolonged drought with its accompanying migration of people and domestic animals from endemic to epidemic regions, suggests that migration unleashed the epidemic. The fact that the epidemic process spontaneously relinquished its hold in areas where no control was attempted, indicates that the end of the epidemic cannot be attributed solely to measures of control. An analysis of the coefficients of specific incidence within age groups sparks the discussion about the possibility that progressive reduction of susceptibility (determined by the great number of asymptomatic infections as well as by long-lasting immunity) contributed to the extinction of the epidemic.

Skin reactions to bug bites as a result of xenodiagnosis

Cutaneous allergic reactions to bites of two bug species Triatoma infestans and Dipetalogaster maxima, were studied in an area where T. infestans is the local domestic vector. While more delayed skin reactions occurred with the indigenous vector, reactions also occurred with D. maxima. Repeated exposure to D. maxima produced more intense immediate skin reactions. First-stage D. maxima bugs produced a lower frequency and intensity of skin reaction. It is concluded that further work on this problem is necessary as it prejudices the use of xenodiagnosis in field surveys.