Assessment of Clinical and Laboratory Limits between Hashitoxicosis and Graves’ Disease

BACKGROUND: Determine the clinical and laboratory features of Hashitoxicosis (Htx) and set standards that will help perform a differential diagnosis with Graves’Disease (GD). SUBJECTS & METHODS: we evaluated 45 patients with Htx (Hashi-group) diagnosed between January/1995 and July/2019 with autoimmune hyperthyroidism and cytology compatible with Hashimoto’s Thyroiditis (HT). The control group consisted of 51 patients with GD (Graves-group). RESULTS: clinical hyperthyroidism, free T4 (FT4), thyroid volume and need for antithyroid drugs were higher in the Graves-Group. Values of anti-thyroid antibodies and TSH were higher in the Hashi-Group. The definitive diagnostic criterion was cytology. Regarding the clinical course, 95% of the Hashi-Group had hyperthyroidism of short duration, while 84.3% of Graves-Group required radioactive iodine (RAI). CONCLUSION: hyperthyroidism due to HT was milder than that associated with GD. In most citology was able to distinguish HT from GD and predict spontaneous resolution preventing unnecessary RAI.

Phosphorylation and sulfation share a common biosynthetic pathway, but extend biochemical and evolutionary diversity of biological macromolecules in distinct ways

Phosphate and sulfate groups are integral to energy metabolism and introduce negative charges into biological macromolecules. One purpose of such modifications is to elicit precise binding/activation of protein partners. The physico-chemical properties of the two groups, while superficially similar, differ in one important respect—the valency of the central (phosphorus or sulfur) atom. This dictates the distinct properties of their respective esters, di-esters and hence their charges, interactions with metal ions and their solubility. These, in turn, determine the contrasting roles for which each group has evolved in biological systems. Biosynthetic links exist between the two modifications; the sulfate donor 3′-phosphoadenosine-5′-phosphosulfate being formed from adenosine triphosphate (ATP) and adenosine phosphosulfate, while the latter is generated from sulfate anions and ATP. Furthermore, phosphorylation, by a xylosyl kinase (Fam20B, glycosaminoglycan xylosylkinase) of the xylose residue of the tetrasaccharide linker region that connects nascent glycosaminoglycan (GAG) chains to their parent proteoglycans, substantially accelerates their biosynthesis. Following observations that GAG chains can enter the cell nucleus, it is hypothesized that sulfated GAGs could influence events in the nucleus, which would complete a feedback loop uniting the complementary anionic modifications of phosphorylation and sulfation through complex, inter-connected signalling networks and warrants further exploration.

In vitro and in silico assessment of antitumor properties and biomolecular binding studies for two new complexes based on NiII bearing k2N,S-donor ligands

This work deals with two new molecule-based materials, namely Ni^II-complexes of general formulae [Ni(L1)₂] (Ni1) and [Ni(L2)₂] (Ni2), where L1 = trans-cinnamaldehyde-N(4)-methyl thiosemicarbazone and L2 = trans-cinnamaldehyde-N(4)-ethyl thiosemicarbazone, as potential antitumor agents. Both compounds were characterized by elemental analysis, molar conductivity and spectroscopic techniques (FTIR and NMR). Their molecular structures were obtained by single-crystal X-ray diffraction analysis. Each one crystallizes in a monoclinic space group P 2₁/c, also the asymmetric unit comprises of one Ni^II ion located on an inversion centre and one anionic ligand, which acts as a κ²N,S-donor affording a five-membered metallaring. The compounds were screened against two selected tumour cell lines (MCF-7 and A549) and non-tumour fibroblasts cell line (MRC-5) via MTT assays. In both tumour cells, all compounds exhibited higher cytotoxicity than the control drug (cisplatin). The IC₅₀ values ranges of 3.70 - 41.37 μM and 1.06 - 14.91 μM were found for MCF-7 and A549, respectively. Importantly, all of them were less toxicity than cisplatin in MRC-5 with SI values ranged at 11.80 - 86.60. The red blood cell (RBC) assay revealed Ni2 as non-toxic due to its reduced haemolytic effect (0--9% at 1--10 μM). The DNA binding was investigated through a combination of spectrophotometric absorption and emission titrations, electrophoresis, and circular dichroism experiments. As a result, these metal complexes were not able to strongly binding to DNA (K_b values ~10⁴ mol L^--1) but suggesting groove-binding interactions. The scavenging ability of them towards 2,2-diphenyl-1-picrylhydrazyl (DPPH) free-radical was also evaluated in this work, but no important antioxidant behaviour was detected. Further, the interaction of Ni1 and Ni2 to human serum albumin (HSA) was explored by quenching of tryptophan emission, warfarin competitive assay, and molecular docking protocols. The HSA binding analyses indicated good affinity of both complexes to Sudlow site I (K_b values ⁓10³ mol L^-1).

Coupling of vinculin to F-actin demands Syndecan-4 proteoglycan

Syndecans are heparan sulfate proteoglycans characterized as transmembrane receptors that act cooperatively with the cell surface and extracellular matrix proteins. Syn4 knockdown was performed in order to address its role in endothelial cells (EC) behavior. Normal EC and shRNA-Syn4-EC cells were studied comparatively using complementary confocal, super-resolution and non-linear microscopic techniques. Confocal and super-resolution microscopy revealed that Syn4 knockdown alters the level and arrangement of essential proteins for focal adhesion, evidenced by the decoupling of vinculin from F-actin filaments. Furthermore, Syn4 knockdown alters the actin network leading to filopodial protrusions connected by VE-cadherin-rich junction. shRNA-Syn4-EC showed reduced adhesion and increased migration. Also, Syn4 silencing alters cell cycle as well as cell proliferation. Moreover, the ability of EC to form tube-like structures in matrigel is reduced when Syn4 is silenced. Together, the results suggest a mechanism in which Syndecan-4 acts as a central mediator that bridges fibronectin, integrin and intracellular components (actin and vinculin) and once silenced, the cytoskeleton protein network is disrupted. Ultimately, the results highlight Syn4 relevance for balanced cell behavior.

Potential impact of a 9-valent HPV vaccine in HPV-related cervical disease in 4 emerging countries (Brazil, Mexico, India and China)

BACKGROUND

We estimated the potential impact of an investigational 9-valent human papillomavirus (HPV) vaccine (HPVs 6/11/16/18/31/33/45/52/58) in HPV-related cervical disease in Brazil, Mexico, India and China, to help to formulate recommendations on cervical cancer prevention and control.

METHODS

Estimations for invasive cervical cancer (ICC) were based on an international study including 1356 HPV-positive cases for the four countries altogether, and estimations for precancerous cervical lesions were extracted from a published meta-analysis including 6 025 HPV-positive women from the four mentioned countries. Globocan 2012 and 2012 World Population Prospects were used to estimate current and future projections of new ICC cases.

RESULTS

Combined proportions of the 9 HPV types in ICC were 88.6% (95%CI: 85.2-91.3) in Brazil, 85.7% (82.3-88.8) in Mexico, 92.2% (87.9-95.3) in India and 97.3% (93.9-99.1) in China. The additional HPV 31/33/45/52/58 proportions were 18.8% (15.3-22.7) in Brazil, 17.6% (14.2-21.2) in Mexico, 11.3% (7.5-16.1) in India and 11.9% (7.5-17.2) in China. HPV6 and 11 single types were not identified in any of the samples. Proportion of the individual 7 high risk HPV types included in the vaccine varied by cytological and histological grades of HPV-positive precancerous cervical lesions. HPV 16 was the dominant type in all lesions, with contributions in low grade lesions ranging from 16.6%(14.3-19.2) in Mexico to 39.8% (30.0-50.2) in India, and contributions in high grade lesions ranging from 43.8% (36.3-51.4) in Mexico to 64.1% (60.6-67.5) in Brazil. After HPV 16, variations in other majors HPV types were observed by country, with an under representation of HPV 18 and 45 compared to ICC.

CONCLUSION

The addition of HPVs 31/33/45/52/58 to HPV types included in current vaccines could increase the ICC preventable fraction in a range of 12 to 19% across the four countries, accounting the 9-types altogether 90% of ICC cases. Assuming the same degree of efficacy of current vaccines, the implementation of the 9-valent HPV vaccine in Brazil, Mexico, India and China would substantially impact on the reduction of the world cervical cancer burden.

Clinical outcome of long-term survivors of progressive multifocal leukoencephalopathy

Progressive Multifocal Leukoencephalopathy (PML) is a demyelinating disease of the brain caused by the polyomavirus JC (JCV) in immunosuppressed people. There is no cure for PML but 1-year survival has increased from 10% to 50% in HIV-infected individuals treated with highly active antiretroviral therapy. We describe herein the clinical outcome of 24 PML patients whose survival exceeded 5 years, with a mean follow-up of 94.2 months (range, 60-188 months). Of all patients, only two were females including one who had non-Hodgkin's lymphoma and was HIV negative. All 23 HIV-positive patients received highly active antiretroviral therapy, and additional experimental therapies were not associated with a better clinical outcome. Marked neurological improvement occurred in 4/24 (17%) of patients, while 11/24 (46%) had partial improvement and 9/24 (37%) remained stable. By the end of the period of observation, 8/24 (33%) of patients had no significant disability despite persistent symptoms (modified Rankin disability scale (MRDS) =1), 6/24 (25%) had slight disability and were living independently (MRDS=2), 5/24 (21%) were moderately disabled, requiring some help during activities of daily living (MRDS=3) and 5/24 (21%) had moderately severe disability, requiring constant help or institutionalisation (MRDS=4). Patients with cerebellar lesions tended to have a worse clinical outcome. MRI showed leukomalacia with ventricular enlargement secondary to destruction of the white matter at the site of previous PML lesions, and focal areas of subcortical atrophy with preservation of the cortical ribbon. Of 20 patients tested, 19(95%) had detectable CD8+ cytotoxic T-lymphocytes against JCV in their blood. In absence of a specific treatment, immunotherapies aiming at boosting the cellular immune response against JCV may improve the prognosis of PML.

Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study

BACKGROUND

Knowledge about the distribution of human papillomavirus (HPV) genotypes in invasive cervical cancer is crucial to guide the introduction of prophylactic vaccines. We aimed to provide novel and comprehensive data about the worldwide genotype distribution in patients with invasive cervical cancer.

METHODS

Paraffin-embedded samples of histologically confirmed cases of invasive cervical cancer were collected from 38 countries in Europe, North America, central South America, Africa, Asia, and Oceania. Inclusion criteria were a pathological confirmation of a primary invasive cervical cancer of epithelial origin in the tissue sample selected for analysis of HPV DNA, and information about the year of diagnosis. HPV detection was done by use of PCR with SPF-10 broad-spectrum primers followed by DNA enzyme immunoassay and genotyping with a reverse hybridisation line probe assay. Sequence analysis was done to characterise HPV-positive samples with unknown HPV types. Data analyses included algorithms of multiple infections to estimate type-specific relative contributions.

FINDINGS

22,661 paraffin-embedded samples were obtained from 14,249 women. 10,575 cases of invasive cervical cancer were included in the study, and 8977 (85%) of these were positive for HPV DNA. The most common HPV types were 16, 18, 31, 33, 35, 45, 52, and 58 with a combined worldwide relative contribution of 8196 of 8977 (91%, 95% CI 90-92). HPV types 16 and 18 were detected in 6357 of 8977 of cases (71%, 70-72) of invasive cervical cancer. HPV types 16, 18, and 45 were detected in 443 of 470 cases (94%, 92-96) of cervical adenocarcinomas. Unknown HPV types that were identified with sequence analysis were 26, 30, 61, 67, 69, 82, and 91 in 103 (1%) of 8977 cases of invasive cervical cancer. Women with invasive cervical cancers related to HPV types 16, 18, or 45 presented at a younger mean age than did those with other HPV types (50·0 years [49·6-50·4], 48·2 years [47·3-49·2], 46·8 years [46·6-48·1], and 55·5 years [54·9-56·1], respectively).

INTERPRETATION

To our knowledge, this study is the largest assessment of HPV genotypes to date. HPV types 16, 18, 31, 33, 35, 45, 52, and 58 should be given priority when the cross-protective effects of current vaccines are assessed, and for formulation of recommendations for the use of second-generation polyvalent HPV vaccines. Our results also suggest that type-specific high-risk HPV-DNA-based screening tests and protocols should focus on HPV types 16, 18, and 45.

A heparin mimetic isolated from a marine shrimp suppresses neovascularization

BACKGROUND

 Choroidal neovascularization (CNV) is the main cause of severe visual loss in age-related macular degeneration (AMD). Heparin/heparan sulfate are known to play important roles in neovascularization due to their abilities to bind and modulate angiogenic growth factors and cytokines. Previously, we have isolated from marine shrimp a heparin-like compound with striking anti-inflammatory action and negligible anticoagulant and hemorrhagic activities.

OBJECTIVES

 To investigate the role of this novel heparin-like compound in angiogenic processes.

METHODS AND RESULTS

 The anti-angiogenic effect of this heparinoid in laser-induced CNV and in vitro models is reported. The compound binds to growth factors (FGF-2, EGF and VEGF), blocks endothelial cell proliferation and shows no cytotoxic effect. The decrease in proliferation is not related to cell death either by apoptosis or secondary necrosis. The results also showed that the heparinoid modified the 2-D network organization in capillary-like structures of endothelial cells in Matrigel and reduced the CNV area. The effect on CNV area correlates with decreases in the levels of VEGF and TGF-β1 in the choroidal tissue. The low content of 2-O-sulfate groups in this heparinoid may explain its potent anti-angiogenic effect.

CONCLUSIONS

 The properties of the shrimp heparinoid, such as potent anti-angiogenic and anti-inflammatory activities but insignificant anticoagulant or hemorrhagic actions, point to this compound as a compelling drug candidate for treating neovascular AMD and other angioproliferative diseases. A mechanism for the anti-angiogenic effect of the heparinoid is proposed.

Alcoolização de nódulo tiroidiano em região endêmica de bócio colóide

A doença nodular tiroidiana é problema clínico comum, principalmente em regiões com carência de iodo. Esse estudo avaliou a eficácia da injeção percutânea de etanol (IPE) no tratamento de nódulos tiroidianos únicos, múltiplos, sólidos, císticos, de diferentes tamanhos com ou sem disfunção glandular, em região endêmica de bócio. Quarenta e dois pacientes com diagnóstico de bócio colóide ou hiperplasia nodular colóide, na punção biópsia aspirativa por agulha fina (PBAAF), foram selecionados para análise após terem sido submetidos a pelo menos duas IPEs. Os nódulos tiroidianos eram múltiplos (sólidos e ou císticos) em 52,4% dos pacientes, únicos e sólidos ou mistos em 35,7% e únicos e císticos em 11,9%. A redução média dos nódulos após injeção de etanol foi de 58,2% para os únicos e 60,8% nos císticos. Nos nódulos múltiplos, avaliou-se a redução de todo o lobo tiroidiano, alcançando 52,4% de redução. Os efeitos colaterais registrados foram decorrentes apenas do desconforto na aplicação. Este estudo indica que a injeção percutânea de etanol (IPE), alcançando reduções médias de volume que variam de 49 a 60%, é método seguro, eficaz e simples para o tratamento de nódulos tiroidianos benignos.

Remission of progressive multifocal leukoencephalopathy and primary central nervous system lymphoma in an HIV-infected patient

The coexistence of progressive multifocal leukoencephalopathy (PML) and primary central nervous system lymphoma (PCNSL) is a rare event, usually associated with a fatal outcome. We report the case of a human immunodeficiency virus (HIV)-infected individual presenting with both PML and PCNSL who made a remarkable recovery after highly active anti retroviral therapy (HAART) and radiation therapy, and discuss diagnostic and therapeutic aspects of both conditions.

Ovarian clear cell carcinoma associated with endometriosis: a case report with immunohistochemical study

Endometriosis is a frequent benign gynecological disease; nonetheless, it can demonstrate some aspects that resemble malignant disease. Malignant transformation of endometriosis occurs mainly in the ovary. A rare case of transition between typical endometriosis and clear cell carcinoma with immunohistochemical study is presented. The patient, a 30-year-old Caucasian woman (para 0), was diagnosed with endometriosis ten years before. Six months later she developed a left cystic ovarian tumor (58 cm3) that persisted after two ultrasounds in a four-month period. Tumor markers were normal (CA125, CA 15.3, CA 19.9, alpha-fetoprotein, carcinoembrionary antigen A1). There was no ascites. The left ovarian mass was removed by laparotomy and endometriosis in continuity with carcinoma positive for cytokeratin 7 and estrogen receptor was revealed. CD10 was positive in the stromal cells of the endometriosis. Clear cell carcinoma grade 3 was diagnosed. In conclusion, although a rare event, the association of typical endometriosis and clear cell carcinoma of the ovary should be kept in mind, mainly in patients with a persistent ovarian cyst.

Interstitial cells of Cajal in patients with chagasic megacolon originating from a region of old endemicity

Megacolon is the second most frequent and most important digestive manifestation of Chagas' disease. It is characterized by motor disorders and dilatation of the distal segments of the colon. Several theories have been presented to explain the physiopathology of chagasic megacolon, e.g. the plexus theory.

OBJECTIVE

In the present study the distribution of interstitial cells of Cajal (ICC) was evaluated in colon biopsies from chronic chagasic patients originating from a region of old endemicity for Trypanosoma cruzi and for comparison in subjects with other colon disorders. The chagasic patients had been submitted to colectomy for the investigation of other possible mechanisms underlying the physiopathogenesis of megacolons.

DESIGN STUDY

Twenty-two colon biopsies (15 from chagasic patients and 7 from nonchagasic patients) were examined. ICC were identified by immunohistochemistry by using the anti-CD117 antibody. The number of ICC was determined in longitudinal and circular muscle layers and in the myenteric plexus, and the results were analyzed by the Kruskal-Wallis and Student t-tests.

RESULTS

A reduced number of ICC was observed in all layers and in the myenteric plexus of patients with chagasic megacolon (P<0.05).

CONCLUSIONS

We conclude that the physiopathological manifestations observed in the large bowel of chagasic patients originate from alterations that occur in the ICC, which play an important role in the control of gut motility.

Nódulo pulmonar esquistossomótico simulando neoplasia: relato de caso

Paciente sadio em que, ao exame de rotina, foi detectado nódulo pulmonar esquistossomótico com verme adulto, 25 anos após o tratamento específico com oxamniquine® e distante da região endêmica. O nódulo simulava clinicamente neoplasia.

[The nursing space in public health at the municipal health network of Porto Alegre]

Based on the author's experience at the municipal basic health network of Porto Alegre, this article presents a small historical retrospective of nursing work evolution on public health field, at Municipal Health Office of Porto Alegre (R.S., Brazil), characterizing the nurse's practice.

Hepatocyte metaplasia in experimental chagasic pancreatitis: preliminary report

Beginning the study of chronic pathologic changes in pancreas of hamsters experimentally infected with Trypanosoma cruzi Vic strain, hepatocyte metaplasia was observed in one animal from infected group. This is the first report of oncocytes in Chagas' disease, which could be due to aberrant regenerative response to pancreas inflammatory process.

[Nurses' concepts on their work in the clinical model of health care]

The aim of this study was to know the nurses' conception about the emphasis of the activities that they develop in the work process, in the clinic model assistance. This study is a qualitative research, with dialetic approach. To form the sample one nurse was chosen in each of the 17 units of a university hospital in Porto Alegre/RS. The data were collected through semi-structured interview. To analyze the data the material was classified in relevant structures, from which nine categories were established. The results showed that, although there is a prevalence of management activities of the care concerning the assistance activities, the nurses considered that these dimensions are indissociable in their work. It was concluded that the relation between assisting and managing are not excluding and that the management is one of the dimensions of nursing care.

[Opinions of nursing assistants about shift reports]

It approaches the nursing assistants' opinion about the importance of shift report in the continuity of nursing assistance. It aims to find subsidies that can contribute to a better development of this activity in the nursing practice. It is a descriptive research that uses an opinion poll with 15 nursing assistants of one clinical unit of a university hospital in Porto Alegre/RS. The data were collected through a questionnaire with closed questions and one open question. The data analysis of the closed questions was done by a manual tabulation of the obtained answers, and they were grouped by regularity and repetition. The data treatment of the opened question was through the thematic analysis with categories construction and contents quantification. It was possible to verify that the study subjects are interested in changing aspects related to the activity. It was emphasized the need to greater objectivity in the information transmission and in the time reduction.

[Critical thinking: a focus in nursing education]

In this study we identify and analyse articles published in national and international journals, that used the term "critical thinking" in the title or summary. The aim of the analysis was to seek answers to educators' queries as to how to improve teaching-learning the process in nursing. We analysed 52 articles published in the indexes Comprehensive Medline, Lilacs and Cinahl, in the last five years, from July, 1992 to July, 1997. Data analysis showed that critical thinking should be implemented in nursing education, what demands syllabus planning and teaching-learning strategies that will favour active participation by both educators and learners.

[The work of nursing in the production of health care in a clinical model]

The subject of this research study is the technological and social organization of health work in hospital, considering the position of nursing practice within production of care. The aim is to analyze the work process at a University Hospital to apprehend the configuration of practices, knowledges, social relations and technologies that are operated by agents in intervention on the body of an ill person. Using a dialectical approach, empirical data were collected by direct observation of the work process in a medical in-patient unit and by semi-structured interviews with professionals. It was found that the production of care is developed based on collective work, that is structured by the division in parts and fragmentation of the actions of the different agents, in order to produce a diagnosis and therapy. The agents articulate their actions around the medical act which takes up a central position in the production of care. The importance of broadening the clinical model to contemplate the social and subjective dimension of the health/disease process is pointed out in a therapeutical project shared by different health care team professionals. It is proposed to change the work process associated with the construction of new management models in health care institutions.

[Use of participating observation and semi-structured interviews in nursing research]

An experience report of the researchers in the development of a qualitative research is presented. The limits and the possibilities found in the realization of the field work are described, while adopting participant observation and semi-structured interview as techniques for data collection. The importance of the involvement level of the researcher with the subjects and some aspects that may interfere in the results to be achieved are emphasized.

Quantitative analysis of C cells in Hashimoto's thyroiditis

The objective of the present investigation was to study quantitatively C cells in Hashimoto's thyroiditis (HT) by analyzing 22 thyroids obtained at autopsy or thyroidectomy from 16 patients with thyroiditis and from 6 normal subjects. Six different areas were sampled on average and labeled with a monoclonal anticalcitonin antibody by immunohistochemistry using the avidin-biotin-peroxidase complex. Normal thyroids from adult patients with no thyroid disease were used as control. C cells were counted in 1 cm2 fields and the mean number of cells per field was calculated. Data were analyzed statistically by the Mann-Whitney test. The inflammatory process detected in cases of HT was usually moderate (50%) and the number of C cells ranged from 0 to 12.2 per 1 cm2 field. The number of C cells in normal thyroids ranged from 20 to 148 per 1 cm2 field, with a median of 35.2 cells per field. The results demonstrate a significant decrease in C cell number in HT compared with normal thyroids, indicating that the inflammatory process causes destruction of both follicular and C cells, which are replaced by fibrosis.

[Pseudo-tumoral schistosomiasis: case report]

The schistosomiasis is an endemic disease in Brazil. The most frequent forms are: intestinal, hepatosplenic and hepatointestinal. Rare forms also manifest such as pseudo-tumoral form. The objective of this paper is to report a 8 years-old boy, from Minas Gerais State, with pseudo-tumoral schistosomiasis. He was submitted an exploratory laparotomy and a biopsy from abdominal mass was made. The histologic studies showed a chronic inflammatory process, with a large number of S. mansoni eggs. The treatment was a single-dose of oxaminiquine (20 mg/kg), with a positive evolution, with non-sequel observed after two years of follow-up.

[Extraskeletal primary osteosarcoma of the frontal region]

BACKGROUND

Extraskeletal osteosarcoma (ESOS) in the head as a primary site has seldom been reported and none in the frontal region.

METHODS

A 78-year-old Italian man presented with one month history of a frontal soft tissue mass. A CT scan showed a mass of uneven density occupying the subcutaneous soft tissue and involving fascial planes. No primary bone tumor was found. The entire mass was excised. The mass was solid measuring 0.8 x 0.6 x 0.5 cm. Extraskeletal osteoblastic osteosarcoma was diagnosed by light microscopy. The tumor recurred four months after the diagnosis. The tumor was again ressected. The patient was also submitted to low penetration radiation therapy. Nine months after the first biopsy the patient had symptoms due to infiltration to the base of the cranium. He died 10 months after the first biopsy.

CONCLUSIONS

The first case with ESOS of the frontal region without a pre-existing condition or a history of irradiation is described.

[Daily circadian variations of deaths in a general hospital]

This work aims at determining the incidence of circadian daily variations of natural death at a general hospital.

METHODS

We have analyzed time of death in 502 individuals with natural death. Statistical analyses have been applied to determine the difference significance between proportions and averages. As a result, we have found out that the occurrence of natural death was similar in different periods of the day. However, values indicate an excess of lethality at 6 a.m. and from noon to 6 p.m. We have concluded that the observed results suggested that the natural death does not have a circadian pattern, despite the vespertine peak.

[Health education: some considerations and implications for nursing practice]

The article focuses on distincts approaches on Health Education, analyzing its implications for the nursing practice in the health work process. It emphasizes the importance of this theme for the health agents' education for a interdisciplinary work with social sciences. It also points out some implications of the social citizenship's developing approach for nursing practice and education.

Biologically active flavonoids and terpenoids from Egletes viscosa

The steam volatile components from the hexane extract of dried flower buds of Egletes viscosa were identified by gas chromatography-mass spectrometry as trans-carvyl acetate, cis-carvyl acetate, sabinyl acetate, verbenyl acetate, cyclopentaethylidene, geranyl acetate and 5-methylfuranone, and trans-pinocarvyl acetate (major component). From the non-volatile residue, centipedic acid and a novel clerodane diterpene, 12-acetoxy-hawtriwaic acid lactone, were isolated. From the ethanol extract, ternatin (4',5-dihidroxy-3,3',7,8-tetramethoxyflavone), was isolated. Ternatin showed anti-inflammatory, hepatoprotection and gastroprotection properties, and, according to the NCI protocols, it showed moderate activity against HIV. The diterpenes showed antispasmodic activity. Structure determination of these secondary metabolites was accomplished by spectrometric methods, including 2D NMR, chemical interconversion and X-ray crystallographic analysis.

[Nursing education and professional practice: what is the relationship?]

This paper focuses on the relation between nurse's education and professional practice, through the experiences of nurses that were graduated at the same School of Nursing and that were working in hospitals in Porto Alegre. The discussion of the aspects that are involved in the categories of analysis give elements for nursing education, emphasizing the fact that it is disconnected of the reality of the professional practice, which characterizes dissociation between theory and practice.

Limb-girdle syndrome: a genetic study of 22 large Brazilian families. Comparison with X-linked Duchenne and Becker dystrophies

The differential clinical diagnosis between the X-linked muscular dystrophies (DMD and BMD) and autosomal recessive limb-girdle muscular dystrophy (LGMD), which is extremely important for genetic counseling, may be very difficult. The aim of the present report is to describe clinical and laboratory findings in patients from large families, with AR inheritance, in an attempt to characterize better cases which have been diagnosed as LGMD compared with the X-linked forms. The main features analysed are: age of onset and of confinement to a wheelchair, reproductive performance, serum enzymes (CK and PK) and dystrophin assessment (through immunohistochemistry and Western blot). Twenty-two families, with 62 affected patients diagnosed as limb-girdle muscular dystrophy, were included in this report. In 19 families, the patients had a milder clinical course, while in the remaining 3, the progression of the disease was continuous and clinically similar to X-linked DMD ("DMD-like"). A high consanguinity rate was observed among the parents of the affected patients (77%). No major clinical difference was observed between the X-linked and the AR forms. However, muscle dystrophin was found qualitatively and quantitatively normal in the autosomal forms but absent or abnormal in the X-linked ones. The reproductive performance was significantly higher for male than female patients. In addition, a surprising finding was the significantly greater fitness estimated for male LGMD cases as compared with Becker patients of comparable age studied in our center. The implications of such findings are discussed.

[Program of quality control in gynecologic cytology at the Adolfo Lutz Institute: strategies and critical analysis of results of its pilot implementation]

The Quality Control in the Gynecological Cytology Program, Instituto Adolfo Lutz, was designed to assure a high-standard of laboratory analysis for the Gynecological Cancer Detection and Prevention System in the São Paulo State Public Health Service. This study presents strategies for intra-laboratorial quality control as well as preliminary results on 32,018 cases. The methods applied for the selection of cases to be reviewed were based on clinical and cytological conditions that could mean higher risk of development of neoplasia and/or conditions that might induce difficulties of interpretation. The classification and analysis of the discrepancies found in this initial experience are the highlight points of this Program. Out of the 492 cases submitted to review, 45 had received underscored initial interpretation, although none of them fit international criteria for "false-negative". Overscores were found in 51 cases, with only three cases fitting the criteria for "false-positive". Based on this initial experience, the Quality Control Program will be applied to the other laboratories of the Public Health Service. This intra-laboratory model of control will be coupled with external supervision by Instituto Adolfo Lutz.

Serum and pleural adenosine deaminase. Correlation with lymphocytic populations

This study attempts to correlate levels of ADA in tuberculous and neoplastic pleural exudates with the different immunologic cellular expressions that follow these clinical situations. Seventy-three patients with pleural effusion were studied in order to assess ADA activity (pleural and serum); in 25 of them, a study of delayed cellular immunity (pleural and sanguineous) was performed through B, CD3, CD4, and CD8 lymphocytic populations. The activity of ADA was determined, and the study of lymphocytic populations was made through the use of monoclonal antibodies. The data obtained showed the following: levels of ADA were significantly (p less than 0.0005) higher in the pleural fluid and the serum of tuberculous effusions compared to neoplastic effusions; percentages of CD3 and CD4 T-cells were significantly (p less than 0.05 and p less than 0.0005, respectively) greater in tuberculous effusions. The statistical study of the levels of ADA activity and the percentage of CD4 T-cells in pleural exudates produced a significant regression curve (r = 0.612 and p less than 0.0001) which showed a positive correlation between these two parameters. The pathogenic implications of these results suggest the possibility that ADA could be a new marker of cell-mediated immune activity.