Aerobic exercise prevents cardiomyocyte damage caused by oxidative stress in early cardiovascular disease by increasing vascularity while L-arginine supplementation prevents it by increasing activation of the enzyme nitric oxide synthase

L-Arginine and chronic exercise reduce oxidative stress. However, it is unclear how they affect cardiomyocytes during cardiovascular disease (CVD) development. The aim of this research was to investigate the possible effects of L-arginine supplementation and aerobic training on systemic oxidative stress and their consequences on cardiomyocytes during cardiometabolic disease onset caused by excess fructose. Wistar rats were allocated into four groups: control (C), fructose (F, 10% fructose in water), fructose training (FT; moderate running, 50-70% of the maximal velocity), and fructose arginine (FA; 880 mg/kg/day). Fructose was given for two weeks and fructose plus treatments for the subsequent eight weeks. Body composition, blood glucose, insulin, lipid profile, lipid peroxidation, nitrite, metalloproteinase-2 (MMP-2) activity, left ventricle histological changes, microRNA-126, -195, and -146, eNOS, p-eNOS, and TNF-α expressions were analyzed. Higher abdominal fat mass, triacylglycerol level, and insulin level were observed in the F group, and both treatments reversed these alterations. Myocardial vascularization was impaired in fructose-fed groups, except in FT. Cardiomyocyte hypertrophy was observed in all fructose-fed groups. TNF-α levels were higher in fructose-fed groups than in the C group, and p-eNOS levels were higher in the FA than in the C and F groups. Lipid peroxidation was higher in the F group than in the FT and C groups. During CVD onset, moderate aerobic exercise reduced lipid peroxidation, and both training and L-arginine prevented metabolic changes caused by excessive fructose. Myocardial vascularization was impaired by fructose, and cardiomyocyte hypertrophy appeared to be influenced by pro-inflammatory and oxidative environments.

Population density impact on COVID-19 mortality rate: A multifractal analysis using French data

The current COVID-19 pandemic caught everyone off guard and is an excellent case study to investigate the real impact of population density on emerging highly contagious infectious diseases. The relationship between the threat of COVID-19 and population density has been widely debated not only in scientific articles, but also in magazines and reports around the world. It appeared both in the columns of experts and in the speeches of politicians, yet without reaching any consensus. In this study, using COVID-19 data from France, we try to shed light on this debate. An alternative density measure, weighted by population, is used. This novel density measure clearly outperforms the commonly used density in terms of relationship with COVID-19 deaths and proved to be competitive with some of the best known predictors, including population. A multifractal analysis, characterizing different space distributions of population in France, is used to further understand the relation between density and COVID-19 mortality rate.

P2550The influence of tonic-clonic seizures on heart rate variability in patients with refractory epilepsy

Background

Heart Rate Variability (HRV) is an increasing area of interest in patients with epilepsy. The effects of epilepsy on the autonomic control of the heart are not completely understood and that autonomic dysfunction has been implicated in some cases of Sudden Unexpected Death in Epilepsy (SUDEP).

Objective

To study the influence of generalized tonic-clonic seizures (GTCS) on HRV of patients with focal refractory epilepsy.

Method

We prospectively evaluated (January 2015 to July 2018) 121 patients admitted to our institution's Epilepsy Monitoring Unit. All patients performed a 48-hour Holter recording. Patients who had GTCS during the recording were included and we selected the first GTCS as the index seizure. HRV (AVNN, SDNN, RMSSD, pNN50, and LF/HF) was evaluated by analyzing 5-min-ECG epochs during inter-ictal and post-ictal periods: baseline, pre-ictal (5 min before the GTCS seizure), post-ictal (5 min after the seizure), and late post-ictal (>5 hours after the seizure). We compared HRV data from these patients with normative values for a healthy population (controlling age and gender). The study was approved by our Institution Ethics Committee and all patients gave informed consent.

Results

Twenty three patients were included (mean age: 38.61±11.58; 70% Female). Thirty percent presented cardiovascular risk factors without known cardiac disease. We found significant differences between the analyzed periods for all but one (LF/HF) HRV metrics (using Friedman test, p<0.05, two-tailed). Specifically during the post-ictal period, we found a significant reduction for AVNN, SDNN, RMSSD and pNN50 (Wilcoxon test, p<0.05; two-tailed). LF/HF was increased during this period, but changes were not statistically significant. There was also a tendency for a reduction of AVNN, SDNN, RMSSD and pNN50 and an increase of LF/HF in our patients during all the analyzed periods when compared to normative healthy population values.

Conclusion

Our work shows reduced HRV after a GTCS in patients with focal resistant epilepsy, both in inter-ictal and post-ictal periods, when compared to normative healthy population values. These results might reflect long term structural changes in autonomic centers. The HRV changes were significant particularly during the post-ictal period, and should prompt further investigation, giving this period is critical for SUDEP.

P5346The effect of seizure type on ictal and early post-ictal Heart Rate Variability in patients with focal resistant epilepsy

Background

Seizures commonly affect the heart rate and its variability. The increased interest in this area of research is related to the possible connection with sudden unexpected death in epilepsy (SUDEP). Generalized tonic-clonic seizures (GTCS) are reported as the most consistent risk factor for SUDEP. However, the general risk of seizures (and their type) on cardiac function still remains uncertain.

Purpose

To evaluate the influence of seizure type (GTCS vs non-GTCS) on ictal and early post-ictal Heart Rate Variability (HRV) in patients with refractory epilepsy.

Methods

From January 2015 to July 2018, we prospectively evaluated 121 patients admitted to our institution's Epilepsy Monitoring Unit with focal resistant epilepsy. All patients underwent a 48-hour Holter recording. We included only patients who had both GTCS and non-GTCS during the recording and selected the first seizure of each type to analyze. HRV (AVNN, SDNN, RMSSD, pNN50, and LF/HF) was evaluated by analyzing 5-min-ECG epochs, starting with the seizure onset (ictal and early post-ictal period). The study was approved by our Institution Ethics Committee and all patients gave informed consent.

Results

Fourteen patients were included (7 Females, 4 patients with Temporal Lobe Epilepsy). The median age was 39 years (min-max, 18–57). Thirty-six percent presented cardiovascular risk factors without known cardiac disease.

A significant statistical reduction was found for AVNN (p=0.013), RMSSD (p=0.008), pNN50 (p=0.005) and HF (p=0.003), during GTCS when compared with non-GTCS (Wilcoxon test, p<0.05; two tailed).

Conclusion

Our study shows a significant reduced vagal tone during GTCS when compared with non-GTCS. Hence, GTCS had a more pronounced impact on HRV changes than other seizure types, which can be associated with higher SUDEP risk after GTCS.

Paradoxical effects of vitamin C in Chagas disease

Trypanosoma cruzi infection stimulates inflammatory mediators which cause oxidative stress, and the use of antioxidants can minimize the sequelae of Chagas disease. In order to evaluate the efficacy of vitamin C in minimizing oxidative damage in Chagas disease, we orally administered ascorbic acid to Swiss mice infected with 5.0 × 10⁴ trypomastigote forms of T. cruzi QM2 strain. These animals were treated for 60 days to investigate the acute phase and 180 days for the chronic phase. During the acute phase, the animals in the infected and treated groups demonstrated lower parasitemia and inflammatory processes were seen in more mice in these groups, probably due to the higher concentration of nitric oxide, which led to the formation of peroxynitrite. The decrease in reduced glutathione concentration in this group showed a circulating oxidant state, and this antioxidant was used to regenerate vitamin C. During the chronic phase, the animals in the infected and treated group showed a decrease in ferric reducing ability of plasma and uric acid concentrations as well as mobilization of bilirubin (which had higher plasma concentration), demonstrating cooperation between endogenous non-enzymatic antioxidants to combat increased oxidative stress. However, lower ferrous oxidation in xylenol orange concentrations was found in the infected and treated group, suggesting that vitamin C provided biological protection by clearing the peroxynitrite, attenuating the chronic inflammatory process in the tissues and favoring greater survival in these animals. Complex interactions were observed between the antioxidant systems of the host and parasite, with paradoxical actions of vitamin C.

Cognitive impairment and magnetic resonance imaging correlates in primary progressive multiple sclerosis

OBJECTIVES

To characterize cognitive impairment in primary progressive multiple sclerosis (PPMS) and to correlate the pattern of cognitive deficits with brain magnetic resonance imaging (MRI) volumetric data.

MATERIALS AND METHODS

In a multicenter cross-sectional study, we recruited consecutive patients with PPMS as well as age, sex, and education level-matched healthy controls (HC). All participants underwent neuropsychological (NP) assessment, and brain MRI was performed in patients with PPMS for analysis of lesion load, subcortical GM volumes, and regional cortical volumes.

RESULTS

We recruited 55 patients with PPMS and 36 HC. Thirty-six patients were included in the MRI analysis. Patients with PPMS performed significantly worse than HC in all NP tests. Subcortical GM volume was significantly correlated with all NP tests, except for Stroop Test, with the largest effect for the thalamus (r=-.516 [BVMT-R DR, P=.016 FDR-corrected] to r=.664 [SDMT, P<.001 FDR-corrected]). In the stepwise linear regression model, thalamic volume was the only predictor of performance in all NP tests.

CONCLUSION

Cognitive impairment is common in PPMS and affects all evaluated cognitive domains. Subcortical GM volume, particularly of the thalamus, is a strong predictor of cognitive performance, suggesting it has a central role in the pathophysiology of PPMS-related cognitive dysfunction.

Molecular picture of cobalamin C/D defects before and after newborn screening era

Objective

Birth prevalence of Cobalamin (Cbl) C or D defects in Portugal is an estimated 1:85,000, one of the highest worldwide. We compared the genotype/phenotype of patients identified with CblC or CblD before and after the implementation of expanded newborn screening.

Methods

Twenty-five Portuguese CblC/D patients, 14 symptomatic and 11 identified through screening, were diagnosed using gas chromatography or tandem mass spectrometry. Molecular characterization was performed through the study of MMACHC and MMADHC genes.

Results

The most common MMACHC mutation, c.271dupA, was present in 100% of MMACHC alleles of all CblC screened patients, in contrast with the 61% identified before expanded newborn screening. All studied cases (except one, who presented a CblD deficiency) presented a CblC defect. More CblC late-onset patients were diagnosed before the introduction of newborn screening than in the post newborn screening era, probably because some early onset patients died without a definitive diagnosis.

Conclusion

The molecular data found in this cohort contribute to the improvement of screening and diagnosis of Cbl defects and would enable a confirmatory diagnosis of these patients, reducing the need for complex, costly, laborious, and time-consuming biochemical/enzymatic tests.

Endoscopic ultrasonography-fine-needle aspiration of solid pancreatic lesions: A prospective, randomized, single-blinded, comparative study using the 22 Gauge EchoTip® ProCoreTM HD (A) and the 22 Gauge EchoTip® Ultra HD (B) endoscopic ultrasound needles

INTRODUCTION

In order to improve diagnostic efficacy of pancreatic masses, a new endoscopic ultrasonography-fine-needle aspiration (EUS-FNA) needle was developed (EchoTip(®) ProCore™ HD). Very few studies have compared these two needles and none could avoid selection biases.

AIMS

The present study intends to compare the results obtained by these two needles when performing EUS-FNA of pancreatic solid lesions.

PATIENTS AND METHODS

This was a prospective, single-blinded, randomized, controlled trial conducted at a tertiary care referral center. Thirty consecutive patients with solid pancreatic lesions were enrolled to have EUS-FNA performed with two different types of needle. All patients were punctured with the two needles and were randomized regarding the order of the needle to be used.

RESULTS

After collecting data, we used the Fisher's exact test in order to compare the results P <0.05. There was no difference (P = 1.0) regarding introduction, exposition and removal of the needles. The values of sensitivity (92% for needles A and B), specificity (100% × 80%), positive predictive value (100% × 95.8%), negative predictive value (71.4% × 66.6%) and accuracy (93.3% for needle A and 90% for needle B) were not statistically different. The duration of the procedure was the only analyzed parameter, in which we observed a difference between the needles. For needle A, the average time was 2 min 26 s (1 min 30 s-4 min 0 s) and for needle B the average time was 11 min 7 s (6 min 0 s-17 min 0 s).

CONCLUSION

Even though, the 22 gauge EchoTip(®) ProCore™ HD and the 22 gauge EchoTip(®) Ultra HD endoscopic ultrasound needles had similar overall results, the ProCore™ needle allowed a much quicker procedure.

Characterization of mitochondrial proteome in a severe case of ETF-QO deficiency

Multiple acyl-CoA dehydrogenase deficiency (MADD) is a mitochondrial fatty acid oxidation disorder caused by mutations that affect electron transfer flavoprotein (ETF) or ETF:ubiquinone oxidoreductase (ETF-QO) or even due to unidentified disturbances of riboflavin metabolism. Besides all the available data on the molecular basis of FAO disorders, including MADD, the pathophysiological mechanisms underlying clinical phenotype development, namely at the mitochondrial level, are poorly understood. In order to contribute to the elucidation of these mechanisms, we isolated mitochondria from cultured fibroblasts, from a patient with a severe MADD presentation due to ETF-QO deficiency, characterize its mitochondrial proteome and compare it with normal controls. The used approach (2-DE-MS/MS) allowed the positive identification of 287 proteins in both patient and controls, presenting 35 of the significant differences in their relative abundance. Among the differentially expressed are proteins associated to binding/folding functions, mitochondrial antioxidant enzymes as well as proteins associated to apoptotic events. The overexpression of chaperones like Hsp60 or mitochondrial Grp75, antioxidant enzymes and apoptotic proteins reflects the mitochondrial response to a complete absence of ETF-QO. Our study provides a global perspective of the mitochondrial proteome plasticity in a severe case of MADD and highlights the main molecular pathways involved in its pathogenesis.

Anatomy of the septomarginal trabecula in Landrace pig hearts

The limitations on the availability of organs for transplantation have aroused interest in research on xenotransplantation of whole organs or certain parts of them. Thus, studies that confirm or reject similarities between the organs of different animals have started to have important clinical applications. In the present study, we investigated the septomarginal trabecula in 34 hearts from Landrace pigs with the aim of observing their similarities with the septomarginal trabecula in humans. In pigs, the muscle bundle of the septomarginal trabecula and the right branch of the stimulating complex are dissociated. The right branch is a narrow bridge that, after going out from the upper part of the interventricular septum, is attached to the upper part of the anterior papillary muscle. On the other hand, the muscle bundle of the septomarginal trabecula is generally a resistant crest that goes from the lower part of the septum to the lower part of the anterior papillary muscle. The septomarginal trabecula presents marked anatomical differences between humans and pigs.

Cyclophosphamide in the treatment of focal segmental glomerulosclerosis

Prednisone is the initial treatment of primary focal segmental glomerulosclerosis. However, when immunosuppressive agents in combination with steroids are used in the treatment of prednisone-dependent and prednisone-resistant patients the remission rate is variable. We report a long-term trial using cyclophosphamide (2.0 to 3.0 mg/kg body weight for 12 weeks) in combination with prednisone (1.0 to 2.0 mg/kg body weight), as compared with prednisone alone for the treatment of prednisone-resistant and frequently relapsing nephrotic syndrome and focal segmental glomerulosclerosis. Fifty-four patients (34 males and 20 females) with a diagnosis of idiopathic nephrotic syndrome and focal segmental glomerulosclerosis, followed-up for an average of 86.1 +/- 82.4 months, were evaluated. Complete remission occurred in 20.4% and partial remission in 14.8% of the patients treated with steroids and in 26.7 and 20.0% of the patients treated with cyclophosphamide + prednisone, respectively. Of the 24 prednisone-resistant patients treated with steroids in combination with cyclophosphamide, 33.3% obtained a complete/partial response. At the time of final evaluation, 25% of the patients treated with prednisone and 10.0% of those treated with prednisone in combination with cyclophosphamide had reached end-stage renal disease. Persistent nephrotic syndrome and progressive renal insufficiency were more frequently observed among the patients treated with prednisone alone (50.0 vs 33.3% and 33.3 vs 16.7%, respectively). The treatments were well tolerated and no patient experienced adverse reactions requiring discontinuation of medications. Although open-label and non-randomized, the present trial showed that cyclophosphamide is a reasonable choice for the treatment of primary focal segmental glomerulosclerosis and prednisone-resistant nephrotic syndrome.

Distribution and genetic diversity of tomato-infecting begomoviruses in Brazil

Tomato-infecting begomoviruses have been reported throughout Brazil since the introduction of the B biotype of Bemisia tabaci. Here, we report a large scale survey on the distribution and genetic diversity of tomato-infecting begomoviruses. Tomato samples with typical begomovirus symptoms were collected in seven different states, comprising the major tomato growing areas of the country. Viruses were detected by polymerase chain reaction (PCR) using universal primers for the genus Begomovirus. PCR-amplified fragments were cloned and sequenced. Based on sequence comparisons and phylogenetic analyses, at least seven previously undescribed species of begomoviruses were found. Four of the new viruses were found exclusively in the Southeastern states, two exclusively in the Northeastern states, and one was found in both regions. Sequence comparisons reveal strong evidence of recombination among the Brazilian begomoviruses. Together, the results indicate the existence of a high degree of pre-existing genetic diversity among tomato-infecting begomoviruses in Brazil and suggest that these viruses have emerged after being transferred from natural hosts to tomatoes, due to the introduction into Brazil of a novel polyfagous biotype of the whitefly vector.

Race and glomerulonephritis in patients with and without hepatosplenic Schistosomiasis mansoni

BACKGROUND/AIMS

United States investigators have shown evidence of higher susceptibility to focal segmental glomerulosclerosis (FSGS) in blacks than in whites. This association between race and FSGS has not been assessed outside the US. The present study assesses the association between race and type of glomerulonephritis in a sample of Brazilian patients, taking into account the presence of the hepatosplenic form of Schistosomiasis mansoni (HSM).

METHODS

Eighty patients with focal segmental glomerulosclerosis (FSGS) were compared to 50 with membranoproliferative glomerulonephritis (MPGN). The association between race (i.e. black versus white) and type of glomerulonephritis was adjusted for age, gender and HSM by logistic regression.

RESULTS

Blacks were more likely than whites to have FSGS (as compared to MPGN), both among patients with HSM (odds ratio (OR) = 2.67; 95% confidence interval (CI) = 0.81 - 8.81) and without HSM (OR = 2.19; 95% CI = 0.79 - 6.05). After adjustment for age, gender and HSM, the odds of FSGS remained significantly greater for blacks (OR = 2.49; 95% CI = 1.05 - 5.95).

CONCLUSION

The increased likelihood of FSGS in Brazilian blacks is consistent with findings from US patients. The association between race and type of glomerulonephritis was similar between patients with and without HSM. Future investigations should focus on the mediators factors that might explain these findings.

Primary focal segmental glomerulosclerosis in children: prognostic factors

To study the clinical course and the predictors of outcome in children and adolescents, 39 patients with nephrotic syndrome and primary focal segmental glomerulosclerosis (FSGS) were followed for a mean of 84.6 months. Thirty-six patients were treated with prednisone, either alone or in conjunction with cyclophosphamide. The clinical course was one of sustained remission in 4 patients, frequent relapse in 13, persistent nonnephrotic proteinuria in 5, and persistent nephrotic syndrome in 17; 2 patients had stable renal failure and 8 had progressive renal failure, 5 of them evolving to end-stage renal failure (ESRF). Resistance to prednisone was recorded in 76.6% of patients. The use of cyclophosphamide plus prednisone was of benefit in 42.8% of patients; 22.2% of the prednisone-resistant patients achieved remission of the nephrotic syndrome. A Kaplan-Meier analysis revealed a survival rate of 92% after 5 years, 86% after 10 years, and 76% after 15 years. Using both univariate and multivariate analysis, persistent nephrotic syndrome was associated with progression to ESRF and the remission of proteinuria with maintenance of renal function. As the outcome of the nephrotic syndrome in FSGS is significantly improved by remission of proteinuria, it is conceivable that immunosuppressive medication may be used in conjunction with prednisone in patients with steroid resistance.

Community acquired pneumonia among pediatric outpatients in Salvador, Northeast Brazil, with emphasis on the role of pneumococcus

Pneumonia is one of the leading causes of hospitalization and death among children in developing countries, and mortality due to pneumonia has been associated with S. pneumoniae infection. This investigation was designed to describe the antimicrobial susceptibility and serotype patterns of pneumococcal strains recovered from the blood of children with community-acquired pneumonia (CAP) and to assess the clinical findings of pneumococcal bacteremic patients with pneumonia. In a 26 month prospective study, blood cultures were obtained as often as possible from children (<16 years of age) diagnosed with CAP in two emergency rooms. Antimicrobial drug susceptibility tests and serotyping were performed when pneumococcus was identified. We studied 3,431 cases and cultured blood samples from 65.5% of those. Pneumococcus was recovered from 0.8% of the blood samples. The differences in age, somnolence, wheezing and hospitalization among children with and without pneumococcal bacteremia were statistically significant. Pneumococcal bacteremia was age-related (mean 1.63 +/- 1.55; median 0.92) and associated with somnolence and hospitalization among children with CAP. One strain was recovered from pleural fluid. Penicillin resistance was detected in 21.0% (4/19) of the strains at an intermediate level, whereas 63.0% of the strains were resistant to trimethoprim-sulfamethoxazole. The most common serotypes were 14 and 6B, and these serotypes included the resistant strains. Eight of our 18 isolates from blood were of types included in the heptavalent conjugate pneumococcal vaccine, recently licensed in the USA.

Transcanal labyrinthectomy in childhood: report of a case

Vertigo in children is caused by several factors. One such factor is viruses (e.g., mumps, measles, and rubeola) afflicting the inner ear by various mechanisms. In the majority of cases, affected patients improve with clinical therapy and vestibular rehabilitation. We present the case of a child with vertigo as a sequela of mumps virus infection that did not improve with clinical treatment and vestibular rehabilitation. Consequently, the child was submitted to a transcanal labyrinthectomy followed by vestibular rehabilitation, with significant postprocedure improvement of symptoms. We discuss surgical indications, the technique used in this case, and the importance of vestibular rehabilitation in the postoperative period.

[Association between race and incidence of end-stage renal disease secondary to glomerulonephritis: influence of the histologic type and presence of arterial hypertension]

OBJECTIVE

To assess, retrospectively, the association between race and incidence of end-stage renal disease (ESRD) in patients with glomerulonephritis in a University Hospital of Bahia, Brazil.

METHODS

The sample was comprised of 79 patients with focal segmental glomerulosclerosis (FSG), 50 with membranoproliferative glomerulonephritis (MPGN) and 49 with other types of glomerulonephritis (OTGN), followed-up between 1970 and 1996 for at least 6 months. It was not included patients with acute glomerulonephritis, minimal change disease, crescentic glomerulonephritis, connective tissue diseases or patients with serum creatinine level greater than or equal to 4.0 mg/dl. The patients were classified according to race as caucasian (white), mulatto or negro. For patients older than 18 yr, not taking antihypertensives drugs, hypertension was defined as a mean of three blood pressure measurements greater than or equal to 140 mmHg for systolic or 90 mmHg for diastolic; for ages </= 18 years. The definition was based on criteria recommended by the Task Force on Blood Pressure in Children.

RESULTS

In the normotensive group, the incidence of ESRD was 72% lower in mulattos and negroes (relative risk (RR)=0.28; 95% confidence interval (CI)=0.11-0.67). In the group with hypertension, the direction of association between race and ESRD was opposite to that observed in the normotensive group (RR=1.49; 95% CI= 0.68-4.34). The modification in the RR depending on the presence or the absence of hypertension was statistically significant (p=0.01). In the normotensive group the RR shifted toward the null hypothesis after the inclusion of histologic type in the Cox model.

CONCLUSIONS

Among normotensive patients with glomerulonephritis the incidence of ESRD was greater in caucasians (whites) than in negroes or mulattoes. By contrast among hypertensive patients there was a trend for a higher risk of ESRD in negroes. The study suggests that hypertension and the histologic type of glomerulonephritis influence the association between race and ESRD.

Missense mutation R1066C in the second transmembrane domain of CFTR causes a severe cystic fibrosis phenotype: study of 19 heterozygous and 2 homozygous patients

We report the clinical features of 21 unrelated cystic fibrosis (CF) patients from Portugal and Spain, who carry the mutation R1066C in the CFTR gene. The current age of the patients was higher in the R1066C/any mutation group (P < 0.01), as compared to the deltaF508/deltaF508 group. Poor values for lung radiological involvement (Chrispin-Norman) and general status (Shwachman-Kulcycki) were observed in the R1066C/any mutation group (P < 0.005 and P < 0.0004). A slightly, but not significantly worse lung function was found in the R1066C/any mutation group when compared with the deltaF508/deltaF508 patients. No significant differences were detected regarding the age at diagnosis, sweat Cl-values, or percentiles of height and weight between the two groups. Neither were significant differences observed regarding sex, meconium ileus (4.7% vs. 11.1%), dehydration (10.5% vs. 14.7%), or pancreatic insufficiency (PI) (100% vs. 97.8%). The proportion of patients with lung colonization by bacterial pathogens was slightly, but not significantly higher in the R1066C/any mutation group (70.0%), as compared with the deltaF508/deltaF508 group (57.5%). Other clinical complications were significantly more frequent in the R1066C/any mutation patients(P < 0.02) than in the deltaF508/deltaF508 group. The two homozygous R1066C/R1066C patients died at the ages of 3 months and 7 years. The data presented in this study clearly demonstrate that the R1066C mutation is responsible for a severe phenotype similar to that observed in homozygous deltaF508 patients. The poor clinical scores and complications of patients with the R1066C mutation are probably related to their slightly longer survival.

Mucosal leishmaniasis: quantitative nasal cytology as a marker of disease activity and indicator of healing

Mucosal leishmaniasis (ML) follow-up is based on subjective parameters. Using simplified quantitative cytology of nasal lavages (QNCs), we studied 20 ML patients, 10 patients with cutaneous leishmaniasis (CL), and 10 healthy subjects. Patients with ML were treated with antimony and followed up with otolaryngological examination plus QNCs for 6 months. At the first evaluation, the median total number of cells in ML patients (1,540,000) was greater than that in CL patients (215,000) or that in healthy subjects (250,000). Neutrophils were predominant in ML patients, in contrast to both sets of controls, in whom epithelial cells were more frequent. During treatment, we found a significant reduction in total nasal cell counts in ML patients who were cured, and encountered a switch in predominant cell type. The cytology of 2 patients who did not respond to antimony remained the same. It is therefore possible to detect nasal inflammation in ML patients through QNCs, which may indicate extension of mucosal involvement, providing an objective parameter to monitor therapy.

Clinical and molecular studies in three Portuguese mtDNA T8993G families

The T8993G mutation in the mitochondrial DNA adenosine triphosphatase 6 gene represents an important cause of maternally inherited Leigh's syndrome. Reported are the clinical findings and mutational loads in three Portuguese T8993G pedigrees. Polymerase chain reaction-restriction fragment length polymorphism analyses demonstrated the T8993G mutation in a high percentage of tissues from all patients (97% +/- 2.3%), but it was less abundant in the blood from 14 maternal relatives. The disease progressed severely in the probands but did not have the fatal course reported by others. To test whether this prolonged course was related to the presence of a specific, disease-associated haplogroup the origin of the mutational event in Portugal was traced. Haplotype investigation revealed an independent occurrence of the mutation in the three probands. These analyses represent the first molecular characterization of Portuguese patients with Leigh's syndrome.

Clonally related penicillin-nonsusceptible Streptococcus pneumoniae serotype 14 from cases of meningitis in Salvador, Brazil

Active hospital-based surveillance in the city of Salvador, Brazil, from December 1995 through October 1998, identified 221 patients with confirmed pneumococcal meningitis. Of these 221 patients, 29 (13%) had isolates with intermediate-level resistance to penicillin. Infection with these penicillin-nonsusceptible isolates was significantly associated with age of <2 years (P<.0019), previous antibiotic use (P<.0006), and coresistance to trimethoprim-sulfamethoxazole (P<.0000). Serotype 14 was the most prevalent serotype (55.2%) of penicillin-nonsusceptible isolates. Strain typing by repetitive element BOX polymerase chain reaction (PCR) analysis showed that penicillin-nonsusceptible serotype 14 isolates had closely related BOX PCR patterns, whereas penicillin-susceptible serotype 14 isolates each had distinct, unrelated patterns. Penicillin-nonsusceptible serotype 14 isolates from Salvador and other Brazilian cities had similar BOX PCR patterns. These observations indicate that in Brazil a large proportion of cases of penicillin-nonsusceptible pneumococcal meningitis appear to be caused by a closely related group of serotype 14 strains that may have disseminated to widely separate geographic areas.

[Racial differences between patients with focal segmental glomerulosclerosis and membranoproliferative glomerulonephritis from the State of Bahia]

OBJECTIVE

To assess the association between race and type of glomerulonephritis, taking into account age, gender and the presence of hepatosplenic schistosomiasis mansoni.

METHODS

Patients from the Renal Service of the Federal University of Bahia, Brazil, 80 with focal segmental glomerulosclerosis (FSG) and 50 with membranoproliferative glomerulonephritis (MPGN) were compared regarding the distribution of the racial types (black, mulatto, white). Patients with systemic lupus erythematosus or any kind of autoimmune disease were not included in the present analysis. Adjusted comparisons were performed using the Mantel-Haenszel method and a multivariate logistic regression model.

RESULTS

Race was significantly associated with histologic type; the odds of being classified as black or mulatto were approximately 2.4 times higher (odds ratio = 2.43; IC 95% = 1.09-5.45) in patients with FSG than in those with MPGN. The association between race and histologic type was not influenced by the potential effects of age, gender and hepatosplenic schistosomiasis. In the multivariate logistic regression model, race was significantly associated (p = 0.037) with type of glomerulonephritis (odds ratio = 2.54; IC 95% = 1.06-6.06).

CONCLUSION

A higher frequency of negroes and mulattoes in the FSG group (compared with MPGN) in this sample from the State of Bahia is consistent with findings of previous studies from the United States. The data support the possibility of a greater susceptibility to FSG among negroes and mulattoes, independently of age, gender and schistosomiasis. The identification of the mechanisms that determine this racial difference represents an important question for future investigations.

[Increase in the frequency of norfloxacin and ciprofloxacin resistance of bacteria isolated from urine culture]

OBJECTIVE

To assess time trends in the frequency of norfloxacin and ciprofloxacin resistance of bacteria isolated from urine culture.

METHODS

Results of all urine cultures with a bacterial growth of at least 10(5) colony-forming units per milliliter, performed at the Renal Service of the Federal University of Bahia, Brazil, from 1983 to 1994 were analyzed. The bacteria considered for this analysis were those most often isolated: Escherichia coli (n = 668), Klebsiella spp. (n = 286), Staphylococcus spp. (n = 186), Proteus spp. (n = 135) and Enterobacter spp. (n = 129).

RESULTS

The frequencies of norfloxacin resistance for the periods 1983-1986, 1987-1990 and 1991-1994 were 3.2%, 5.9% and 9.1%, respectively (p-value < 0.05). The most pronounced increases in the frequencies of norfloxacin-resistance were observed for Klebsiella spp. and Enterobacter spp. The frequency of ciprofloxacin resistance was 7.4% in the period 1985-1989 and 16.5% in the period 1990-1994 (p-value < 0.05). This time trend in ciprofloxacin resistance was more striking for Enterobacter spp. and Staphylococcus spp.

CONCLUSION

The results show a gradual increase in the frequency of norfloxacin and ciprofloxacin resistance of the bacteria most commonly isolated from urine cultures. The influence of previous treatment with quinolones and characteristics of the infecting bacteria on these findings are important questions to to be addressed in future investigations.

[Is glomerulopathy due to schistosomiasis mansoni disappearing?]

Hepatosplenic form of S. mansoni infection may be accompanied by a glomerulopathy in 12-15% of cases, manifested in the majority by a nephrotic. This type of renal involvement is becoming a rare occurrence in our University Hospital (Hospital Universitário Prof. Edgard Santos) a typical general hospital in an endemic state for this parasitic disease. To investigate this fact, autopsied cases with patients with hepatosplenic form of schistosomiasis mansoni during two decades in our Hospital-1960-70, (before a therapeutic intervention in endemic areas with oxamniquine) and 1980-1990 (after the intervention) were compared in reference to number of cases and the finding of glomerulonephritis by histological examination. Even though there was a striking decrease in number of patients with advanced forms of this disease (140 as compared to 31 autopsies in these two decades), the prevalence of glomerulonephritis diagnosed was 11.4 (16 cases) in the first and 12.9 (4 cases) in the second. As there was no change in pattern of attendance in this Hospital, the drastic decrease in number of severe forms of this parasitic infection following massive therapy of the endemic population with oxamniquine is the most likely explanation not only for the decrease in number of hepatosplenic cases but, also, and as a consequence, the scarcity of cases of the schistosomal glomerulopathy observed.

[Cell differentiation of cultured mammary epithelium]

The functional differentiation of mammary epithelial cells requires specific hormones, growth factors and chemical signals of the cellular environment. These signals consist in cell communication with the extracellular matrix and cell-cell interactions which through an intrincated mechanism lead to the events that trigger milk secretion. The mammary epithelial cells HC11 from the cellular line COMMA-1D were cultured in the presence of lactogenic hormones such as insulin, dexametazone and prolactin and further stimulated with the epidermal growth factor. In these conditions the cell differentiated, presenting quantitative changes in shape and volume on their organelle cell structure. These cells synthesize beta casein and the intermediary filaments of keratin demonstrated by immunoblotting as well as electronic micrographics.

Clinical effects of intermittent, intravenous cyclophosphamide in severe systemic lupus erythematosus

To evaluate the clinical effectiveness of intermittent intravenous cyclophosphamide in the treatment of severe systemic lupus erythematosus, 20 patients with systemic lupus erythematosus (SLE) and evidence of severe renal involvement or systemic vasculitis, consecutively admitted to the hospital were studied. Cyclophosphamide was administered intravenously at a dosage of 1.0 g/m2 monthly, during 6 months and maintained every 3 months during 12 additional months. Of 10 patients with active lupus nephritis, a reduction or disappearance of proteinuria and maintenance of normal renal function was recorded in 6. Improvement of renal function was observed in 4 out of 7 patients with renal insufficiency at initial evaluation; resolution of renal insufficiency was more frequently observed in patients with recent onset renal failure. At the end of the follow-up (18.0 +/- 14.5 months) disappearance or reduction of nephrotic range proteinuria was recorded in 6 out of 14 patients; there was progression toward renal failure in 4 patients (20%). Response to intravenous cyclophosphamide therapy was observed in 4 of 5 patients with severe extrarenal SLE. Side effects, recorded in 12 patients, were mild and transient and in no patient was the treatment discontinued. Four patients died during the follow-up, although in 2 of them the deaths were not attributable to therapy. Even though this was an open and uncontrolled study, intermittent, intravenous cyclophosphamide was an effective therapy for severe, steroid refractory SLE.