Alcohol in Cerebrospinal Fluid (CSF) and Alcoholism

Alcohol levels were measured in 15 cerebrospinal fluid (CSF) samples and 14 blood samples from grade III and IV male alcoholic patients with signs of nervous system involvement, and compared with levels detected in 11 CSF samples and 11 blood samples from abstemious patients or patients with grade I or II alcoholism whose CSF had been found to be normal by routine analysis (controls). Among the alcoholic patients, alcohol levels were lower in the CSF than in blood, whereas the opposite was true for the controls. The possible mechanisms underlying this difference are discussed and the need for further study of this topic is emphasized.

Antithrombotic effect of Lonomia obliqua caterpillar bristle extract on experimental venous thrombosis

The venom of Lonomia obliqua caterpillar may induce a hemorrhagic syndrome in humans, and blood incoagulability by afibrinogenemia when intravenously injected in laboratory animals. The possible antithrombotic and thrombolytic activities of L. obliqua caterpillar bristle extract (LOCBE) were evaluated in this study. The minimal intravenous dose of the extract necessary to induce afibrinogenemia and anticoagulation was 3.0 and 10.0 microg protein/kg body weight for rabbits and rats, respectively. In rabbits, this dose induced total blood incoagulability for at least 10 h and did not reduce the weight of preformed venous thrombi, in contrast to streptokinase (30,000 IU/kg). In rats, pretreatment with 5.0 and 10.0 microg/kg LOCBE prevented the formation of thrombi induced by venous stasis or by injury to the venous endothelium. The dose of 5.0 microg/kg LOCBE did not modify blood coagulation assay parameters but increased bleeding time and decreased plasma factor XIII concentration. When the extract was administered to rats at the dose of 10.0 microg/kg, the blood was totally incoagulable for 6 h. These data show that LOCBE was effective in preventing experimental venous thrombosis in rats, justifying further studies using purified fractions of the extract to clarify the mechanisms of this effect.

Morphological, histochemical and morphometric study of the myotomal muscle tissue of the pacu (Piaractus mesopotamicus Holmberg 1887: Serrasalminae, Characidae, Teleostei)

Histochemical, ultrastructural and morphometric methods were used to study growth patterns of red, pink and white muscle fibres and their relation to body weight and total length in the fast-growing freshwater fish Piaractus mesopotamicus Holmberg. The correlations amongst body weight, body length and diameter of red, pink and white fibres were low. From 10-15 to 40-50 cm, body weight increased 102.7 times, while the diameter of each type of fibre increased by factors of 0.94, 0.74 and 0.70, respectively. Muscle fibres revealed different morphological and histochemical stages of maturation. The frequencies of < 20 microns fibres of red, pink and white muscle tissue in the youngest and oldest classes were 64.5 and 11.0, 38.2 and 7.7 and 24.0 and 1.4%, respectively. In 30-40 cm fish, the frequency of < 20 microns fibres in the red and pink tissue was 24.5 and 25.5%, while in the white tissue it was 11.5%. During sexual maturity (40-50 cm), the recruitment of < 20 microns fibres in white muscle was 1.4%. Muscle fibres of this species showed continuous growth by both hyperplastic and hypertrophic mechanisms, and hyperplasia was particularly active in the juvenile phase.

Histochemical study of the extensor digitorum longus and soleus muscles in alcoholic rats

The extensor digitorum longus (EDL) and soleus (SOL) muscle fibres from albino rats submitted to experimental chronic alcoholism were evaluated in accordance with their metabolic and morphometric profiles. Twenty-seven male animals aged 4 months and weighing approximately 400 g were used. The animals were divided into three groups: control, isocaloric and alcoholic and sacrifices were carried out after 5, 10 and 15 months. The muscles were dissected, removed, cross-sectioned in a cryostat and submitted to the NADH (nicotinamide adenine dinucleotide) reaction. The SO (slow-twitch-oxidative), FG (fast-twitch-glycolytic) and FOG (fast-twitch-oxidative-glycolytic) muscle fibre types exhibited a polygonal, triangular or rounded shape and did not present noteworthy modifications in either muscles during the study. The cross-sectional areas of the fibres from the studied muscles did not present significant differences during the observations. Fibre area behaved similarly in the alcoholic animals up to the 10th month, i.e. it was decreased, as also observed in the other groups. At 15 months, however, all fibres were increased, with a predominance of FG fibres in the SOL muscle. Changes in fibre population were observed mainly in the SOL muscle of alcoholic animals: SO fibres were initially increased in number but decreased after the 10th month, and the opposite was observed for the population of FG fibres. FOG fibres increased linearly in number throughout the experiment. The statistical analysis showed nevertheless that the fibre population and cross-sectional area changes were not significant. In the alcoholic animals quantitative variations of muscle fibres were more evident in the SOL muscle, suggesting that the SOL muscle is more sensitive to the toxic action of ethanol. The results concerning the increased fibre diameter in alcoholic animals would be associated with muscle oedema induced directly or indirectly by the ethanol.

Effect of the bacillus of Calmette-Guérin, Propionibacter acnes and avridine as immunomodulators in antirabies vaccination of mice using the Fuenzalida-Palacios mouse brain vaccine

Using the laboratory mice, Fuenzalida-Palacios mouse brain human rabies vaccine was administered in groups of animals previously inoculated with rabies virus and then submitted to treatments with the immunomodulators onco-BCG, avridine and Propionibacterium acnes. Humoral and cellular immune responses were evaluated through the macrophage inhibition factor (MIF), intra-pad inoculation (IPI) and serum neutralization (SN) tests and by the detection of gamma-interferon (IFN-gamma). The IPI test was not effective in detecting the response of delayed-type hypersensitivity, contrary to MIF, which showed the immune cellular response. Higher levels of IFN-gamma were observed in the groups of mice vaccinated and treated with avridine and P. acnes. Although immunomodulating activities have been detected, the use of adjuvants with the Fuenzalida-Palacios type vaccine in mice did not reveal any encouraging results.

Effect of bacillus of Calmette-Guérin, avridine and Propionibacterium acnes as immunomodulators on rabies in mice

The cellular and humoral immune responses of mice inoculated with rabies virus and treated with the Bacillus of Calmette-Guérin, Avridine and Propionibacterium acnes were evaluated in this paper. There was a higher percentage of surviving mice in groups submitted to P. acnes treatment. Lower levels of interferon-gamma (IFN-gamma) were found in infected mice. The intra-pad inoculation test (IPI) was not effective to detect cellular immune response, contrary to the results found in MIF reaction. The survival of mice did not present correlation with the levels of antirabies serum neutralizing (SN) antibodies titers, IFN-gamma concentration and MIF response.

Effect of vaccination and the immunomodulators "bacillus of Calmette-Guérin, avridine and Propionibacterium acnes" on rabies in mice

Responses of vaccination and treatment to immunomodulators against rabies in mice were evaluated through macrophage inhibition factor (MIF), intra-pad inoculation (IPI) and serum neutralization (SN) tests and by the detection of gamma-interferon (IFN-gamma). Onco-BCG, Avridine and Propionibacterium acnes were administered to groups of mice. Higher survival rates were found in animals treated with P. acnes. Lower levels of IFN-gamma were observed in the groups of infected and vaccinated mice. The IPI was not effective on detecting the response of delayed-type hypersensitivity. Vaccine induced in the infected animals a more intense response to MIF reaction.

Serial Mitsuda tests for identification of reactional tuberculoid and reactional borderline leprosy forms

The authors studied the Mitsuda reaction in 37 leprosy patients (18 reactional tuberculoid, 19 reactional borderline cases) and compared the results with clinical findings, histopathology and bacilloscopy. Evaluation of the Mitsuda reaction was carried out on days 30, 60, 90 and 120. Most of the reactional tuberculoid patients showed a Mitsuda reaction of +3 in opposition to the reactional borderline patients who showed only +. Bacilloscopic analysis revealed that in 75% of the reactional tuberculoid cases there were rare or no bacilli; bacilli were present in 95% of the reactional borderline cases. The authors conclude that reactional tuberculoid cases have a greater ability to clear bacilli than reactional borderline cases, and that the Mitsuda reaction is a useful tool for the differentiation between these two types of leprosy.

The use of glucan as immunostimulant in the treatment of paracoccidioidomycosis

A group of 10 patients, nine of them seriously infected with Paracoccidioides brasiliensis (G1), received glucan (beta-1,3 polyglucose) as an immunostimulant intravenously once a week for one month, followed by monthly doses (10 mg) over an 11-month period, together with a specific anti-fungal agent as an immunostimulant. A second group of eight moderately infected patients (G2) was treated with only the anti-fungal agent. Among the patients in G1, there was only one case of relapse compared with five in G2. Values for the erythrocyte sedimentation rate (ESR) showed a significant difference (P < 0.001) post-treatment in G1 patients, when compared with the pretreatment levels. There was also a significant reduction (P < 0.001) in the level of serum antibodies to P. brasiliensis in the G1 patients in post-treatment examinations. The phytohemagglutinin (PHA) skin test showed a positive reaction among the patients in G1 (P < 0.01) post-treatment and there was a tendency towards an increase in the number of CD4+ T lymphocytes in both groups after treatment. The serum level of tumor necrosis factor (TNF) proved to be significantly higher (P < 0.02) in the G1 patients during treatment. In the G1 patients, the correlation between ESR and TNF tended to be negative whereas that between ESR and serum antibodies was positive. The present results indicate that the patients who received glucan, in spite of being more seriously ill, had a stronger and more favorable response to therapy.

[Relations among arm, arm muscle, arm fat areas and menarche in adolescents in the municipality of Botucatu]

The authors show the relations among arm circumference, arm muscle and arm fat areas with or without menarche, by carrying out an anthropometric study in 717 adolescents in the municipality of Botucatu. It must be emphasized that those adolescents who had already menstruated presented significantly higher nutritional indicators than those who had not menstruated yet. There was an increase in fat tissue and lean body mass in those adolescents who had already menstruated. Body changes might be expressed by calculating muscle and arm fat areas using triceps skinfold and arm circumference.

[Sodium diclofenac effect, after interruption of the stercoraceous peritonitis, on the rat colon. Study of mechanical resistance and collagen concentration]

The objective of the present study was to investigate changes in colon wall in rats with fecal peritonitis (Per) associated with sodium diclofenac (SD) by studying breaking strength and tissue collagen concentration. The rats were divided into the following experimental groups: GROUP 1-SD: 60 animals injected intramuscularly with sodium diclofenac at the dose of 2 mg/kg body weight; GROUP 2-Per: 60 animals injected intraperitoneally with a suspension of human feces. Peritonitis was interrupted after six hours of evolution; GROUP 3-Per+SD: 60 animals injected intraperitoneally with a suspension of human feces and receiving SD according to the schedule used for Groups 1 and 2;

CONTROL GROUP

12 animals injected intramuscularly with physiological saline. The animals of Group 1, 2 and 3 were successively sacrificed 2, 4, 7, 14 and 21 days after interruption of peritonitis an/or the beginning of treatment. Under conditions of the experimental model and of the methods used, we conclude that sodium diclofenac, peritonitis and the peritonitis-sodium diclofenac association decrease the breaking strength and the concentration of tissue collagen in the colon segment.

Reactive oxygen generation by azomethine H: a new antimalarial drug

Superoxide radical (O2-) is a free radical that may be involved in various toxic processes. Cu-Zn superoxide dismutase catalyzes the dismutation of the superoxide free radical and protects cells from oxidative damage. A rat bioassay validated for the identification of the toxic effects of azomethine H revealed increased serum activities of amylase, alanine transaminase, and alkaline phosphatase. The lipoperoxide and bilirubin concentrations were also increased in animals that received azomethine H (1 g/kg) from ascorbic or hydrochloric acid solutions. Azomethine H increased Cu-Zn superoxide dismutase activity. This elevation of Cu-Zn superoxide dismutase activity was highest on the 7th day and was at levels comparable with those of control rats from day 60 onwards. Superoxide is an important intermediate in the action and toxicity of azomethine H.

Liver dysfunction in patients bitten by Crotalus Durissus terrificus (Laurenti, 1768) snakes in Botucatu (State of São Paulo, Brazil)

Thirty-two patients bitten by venomous snakes sixteen by Bothrops spp. and sixteen by Crotalus durissus terrificus were studied. The group comprised thirty males and two females, aged eight to sixty-three years (mean 33 +/- 15). Bromsulphalein tests were increased in the majority of patients bitten by Crotalus durissus terrificus. The correlation coefficient of Spearman was positive between bromsulphalein tests and alanine aminotransferase levels, and between alanine aminotransferase and aspartate aminotransferase levels only in the Crotalus group. The only patient who died was bitten by Crotalus durissus terrificus and showed hydropic degeneration and mitochondrial injury in the liver. It was concluded that the hepatic damage might have been caused by at least two possible mechanisms: venom effect on liver mitochondria and cytokine effects on hepatocyte, specially interleukin-6.

The malarial impact on the nutritional status of Amazonian adult subjects

The anthropometric (body weight, height, upper arm circumference, triceps and subescapular skinfolds; Quetelet index and arm muscle circumference) and blood biochemistry (proteins and lipids) parameters were evaluated in 93 males and 27 females, 17-72 years old voluntaries living in the malarial endemic area of Humaita city (southwest Amazon). According to their malarial history they were assembled in four different groups: G1--controls without malarial history (n:30); G2--controls with malarial history but without actual manifestation of the disease (n:40); G3--patients with Plasmodium vivax (n:19) and G4--patients with Plasmodium falciparum (n:31). The malarial status was stablished by clinical and laboratory findings. The overall data of anthropometry and blood biochemistry discriminated the groups differently. The anthropometric data were low sensitive and contrasted only the two extremes (G1 > G4) whereas the biochemistry differentiated two big groups, the healthy (G1 + G2) and the patients (G3 + G4). The nutritional status of the P. falciparum patients was highly depressed for most of the studied indices but none was sensitive enough to differentiate this group from the P. vivax group (G3). On the other hand the two healthy groups could be differentiated through the levels of ceruloplasmin (G1 < G2) and alpha nitrogen (G1 > G2). Thus it seems that the malaria-malnourishment state exists and the results could be framed either as a consequence of nutrient sink and/or the infection stress both motivated by the parasite.

Cell and humoral immunity in endemic pemphigus foliaceus

A study was conducted on 16 patients with pemphigus foliaceus, ten of them with the localized form (group G1) and six with the disseminated form (group G2). These patients were submitted to full blood counts, quantitation of mononuclear cell subpopulations by monoclonal antibodies, study of blastic lymphocyte transformation, and quantitation of circulating antibodies by the indirect immunofluorescence test, in order to correlate their clinical signs and symptoms and laboratory data with their immunological profile, and to determine the relationship between circulating autoantibody titers and lesion intensity and course of lesions under treatment. Leucocytosis was observed especially in group G2. All patients showed decreased relative CD3+ and CD4+ values and a tendency to decreased relative values of the CD8+ subpopulation. Blastic lymphocyte transformation indices in the presence of phytohemagglutinin were higher in patients (group G1 + G2) than in controls. The indirect immunofluorescence test was positive in 100% of G2 patients and in 80% of G1 patients. The median value for the titers was higher in group G2 than in group G1. Analysis of the results as a whole permits us to conclude that cell immunity was preserved and that there was a relationship between antibody titers detected by the direct immunofluorescence test and extent of skin lesions.

Evaluation of nutritional status in patients with endemic pemphigus foliaceus

Sixteen patients with endemic pemphigus foliaceus were submitted to nutritional evaluation. Ten had the localized form of the disease (Group G1) and six the disseminated form (Group G2). The patients were submitted to anthropometric measurements (weight, height, Quetelét index, tricipital skin fold, subscapular skin fold, arm circumference, arm muscle circumference, arm area, arm muscle area, and arm adipose area) and to laboratory evaluation by protein electrophoresis. Arm circumference, arm area and arm muscle area showed lower values in G2 than in G1. Weight and arm muscle circumference tended to the lower in G2 than in G1. Protein electrophoresis showed decreased albumin levels in both groups, with lower values in G2. Overall analysis of the results permits us to conclude that patients with endemic pemphigus foliaceus present signs and symptoms of protein, but not calorie, malnutrition and that this malnutrition is more marked in patients with disseminated pemphigus foliaceus.

Effect of different glycosaminoglycans in a guinea-pig carotid artery thrombosis model

Heparin is the most frequently used drug for the prevention and treatment of thrombosis. Its use, however, is restricted by its side-effects. To study the efficacy of other glycosaminoglycans that could substitute heparin in the management of arterial thrombosis, 60 guinea-pigs were randomly allocated into 6 groups: G1 = control, G2 = heparin (150 IU/kg), G3 = heparan sulfate from beef pancreas (2.5 mg/kg), G4 = heparan sulfate from beef lung (2.5 mg/kg), G5 = N-acetylated heparan from beef pancreas, G6 = dermatan sulfate from beef intestine (2.5 mg/kg). Ten minutes after intravenous injection of the drugs, thrombosis was induced by the injection of a 50% glucose solution into a segment of the right carotid artery isolated between 2 thread loops during 10 minutes. Three hours later the artery was re-exposed and if a thrombus was present it was measured, withdrawn and weighed. Thrombin time and activated partial thromboplastin time were measured in all animals. Thrombus developed in 90% of the animals in the control group, 0% in G2 and G3, 62.5% in G4, 87.5% in G5 and G6. Only in the animals treated with heparin the coagulation tests were prolonged. In conclusion, in the used dose only the heparan sulfate from beef pancreas presented an antithrombotic effect similar to heparin in this experimental model.

Chromosome aberrations in lymphocyte cultures from paracoccidioidomycosis patients

Blood cell lymphocyte chromosomes from untreated (UT) and clinically-cured (CC) patients with paracoccidioidomycosis and from healthy (control) people (CO) were studied. The frequency of aneuploid cells in the UT patients was higher than in the CC and CO individuals. The frequency of metaphase cells with premature centromere division was significantly higher in the UT than in the CC and CO group. No structural aberration and no statistically significant difference in the frequency of polyploidy was observed in the three groups studied. Our findings are indicative of an aneugenic (aneuploidy-inducing) action of infection by Paracoccidioides brasiliensis.

[Evaluation of the psychoaffective development of adolescents aged 15-18. A study on adolescents in the town of Botucatu, SP-aspects of sexuality]

The authors present data obtained from the analysis of a questionnaire regarding sexuality among 1,437 adolescent students in the Botucatu municipal district. The student's age varied from 15 to 19 years. The results demonstrate the evolving characteristics of the student's sexuality and suggest that sexual orientation and guidance should be part of the child and adolescent educational process. The authors pointed out that the members of Health care team should stimulate the discussion of sexuality while providing medical advice.

A critical evaluation of the expression of parasitemia in experimental Chagas' disease

This paper aims to study the best way to express the parasitemia of Trypanosoma cruzi's experimentally infected animals. Individual scores may have a great variability, not emphasized by the majority of the authors. A group of 50 rats infected with 1 x 10(6) trypomastigotes of T. cruzi Y strain was used and the parasitemia was estimated by BRENER's method. The results showed that the median can avoid false results due to very high or low parasitemias but it does not have the mathematic properties necessary for analysis of variance. The comparison of the means of the original and transformed data, with their respective coefficients of variability (CV), showed that the logarithmic mean (Mlog) have the minor value of CV. Therefore, the Mlog is the best way to express the parasitemia when the data show great variability. The number of the animal for group did not affect the variability of data when the Mlog and CV were used.

[Grouping of countries according to indicators of standard of living]

The position of 125 countries is studied on the basis of a collection of 26 basic, health, economic and educational indicators. Multivariate statistical methods were used, including Cluster Analysis, Principal Component Analysis and Multivariate Analysis of Variance. The most discriminating variables were life expectancy the child mortality rate, the mortality rate of children of less than five years of age, the birth and fertility rates and the high-school female matriculation rate. The first principal component was interpreted as a measure of the living standard which made it possible to place the countries in order. Five clusters of countries are suggested.

[Clinical characteristics and prognostic implications of renal involvement in multiple myeloma]

The renal involvement in patients with multiple myeloma has been described as a sign of poor prognosis. The influence of renal insufficiency in the clinical patterns and in the prognosis of patients with multiple myeloma was studied retrospectively in 45 patients. Patients with renal insufficiency, at first visit, more often presented weight loss, proteinuria, hypercalcemia. The means of uricemia, ESR, were higher and the hematocritic mean was lower in patients with renal insufficiency. There was no difference in edema, arterial hypertension, fractures and bone pain. The reversibility of renal insufficiency occurred in 47% of the cases, which happened more often in the first months of the follow up. The creatinine mean was lower in patients with reversible renal insufficiency. The median survival was: patients with renal insufficiency: 11 months; patients with normal renal function: 50 months. Among patients with renal insufficiency those with recuperation of renal function showed a higher median survival (24 months) than those with irreversible renal insufficiency (1 month). The renal involvement then is frequent and often reversible. Patients with impaired renal function showed a worse prognosis; normalization of the renal function was associated with a better outcome.

Alcohol levels in cerebrospinal fluid and blood samples from patients under pathological conditions

We measured alcohol levels by the Cordebard method in 148 CSF samples from individuals who had abstained from alcohol for at least 7 days prior to the beginning of the study. Each blood sample was accompanied by a CSF sample from the same patient. CSF samples found to be normal after analysis were used as controls. Mean alcohol concentration in blood did not differ significantly between the control group and the groups with altered CSF. The group with altered CSF had statistically higher alcohol levels in CSF than in blood. CSF lactate, glucose and protein levels were not correlated with alcohol level. The results suggest the presence of endogenous alcohol in the CSF, with levels increasing in the presence of pathological processes involving the nervous system.

[Captopril in mild and moderate hypertension resistant to diuretics: predictive value of the efficacy by captopril acute test]

PURPOSE

To evaluate if acute blood pressure response with captopril can be applied as a predictive test of treatment efficacy in hypertensive patients uncontrolled with large dose of diuretics.

METHODS

Mild and moderate 120 uncontrolled hypertensive patients treated with hydrochlorothiazide 100 mg, were submitted to captopril (25 mg) test. The systolic (SBP) and diastolic (DBP) blood pressure acute and chronic responses were correlated and the linear discriminate function (LDF) and qui-square were applied to test the treatment efficacy. Previously two groups (G) patients were obtained as bad responders (G1) and good responders (G2) respectively, if the mean arterial pressure fall less or equal/more than 15% at the end of the associated treatment with diuretic and captopril.

RESULTS

Mean arterial pressure values during placebo were 168 +/- 2/109 +/- 1 mmHg. This values after diuretic and associated captopril treatment were, respectively, 151 +/- 1/101 +/- 1 and 137 +/- 1/90 +/- 1 mmHg, all significant different (p < 0.05). Blood pressure normalization was obtained in 58% of patients. The calculated LDF formula were: LDF = 7.92 - % SBP +/- 1.21 delta % DBP. The G1 LDF mean value was 192 and 361 to G2. The value 276 represents the separation medium point between both groups. As far the distance from the separation medium point for a calculated LDF for a calculated LDF for a problematic patient, as more will be the probability for this patient to belong to this group. LDF and qui-square classified correctly, respectively, 80% and 47% of patients in G1. To G2 good responders patients, LDF and qui-square agreed, respectively, in 72 and 77%.

CONCLUSION

The results obtained suggest that captopril test, could be useful as an auxiliary methodology to select hypertensive patients, uncontrolled with diuretic treatment, which might benefit with the association of converting enzyme inhibitors drugs.

Intratracheal injection of nickel chloride and copper-zinc superoxide dismutase activity in lung of rats

Superoxide radical (O2-) is a free radical that may be involved in various toxic processes. Cu--Zn superoxide dismutase catalyses the dismutation of the superoxide free radical and protects cells from oxidative damage, and it has been used clinically. The concentration of Ni2+ and Cu--Zn superoxide dismutase activity were measured in lungs of rats at time intervals of 5, 12, 19, 26, 33, and 40 days following an intratracheal injection of 127 nmol of NiCl2. Nickel chloride increased nickel content and resulted in a significant increase of Cu--Zn superoxide dismutase activity in lungs. This elevation of Cu--Zn superoxide dismutase activity was highest on the 12th day (approximately threefold) and is at levels comparable to controls rats on day 40 onwards. Since Cu--Zn superoxide dismutase activity was increased in lung throughout our experimental period without corresponding increases of Cu2+ and Zn2+, we speculate that the elevation of Cu--Zn superoxide dismutase activity might be due to an increased half-life of the enzyme, induced by nickel.

[Captopril in mild and moderate arterial hypertension resistant to diuretic therapy. A multicenter study]

PURPOSE

To evaluate the antihypertensive effect of captopril in mild and moderate hypertensive patients uncontrolled with diuretics.

METHODS

Low dose of captopril (25 to 50 mg) bid were associated during 9 weeks in 120 patients previously treated with 100 mg of hydrochlorothiazide. A subgroup of patients (74) were followed additionally for 3 weeks with the same dose of the drugs administered as a single dose. The patients were clinically evaluated after two weeks placebo, and each three weeks of active drugs. Blood pressure normalization were considered when diastolic arterial pressure was < or = 90 mmHg. Laboratory tests were measured before diuretic, before captopril and at the end of combined twelve weeks treatment.

RESULTS

After 15 days washout, the baseline supine arterial pressure, 168 +/- 2/ 109 +/- 1 mmHg decrease significantly with diuretic to 151 +/- 1/ 101 +/- 1 mmHg and the drop was further increased with captopril b.i.d., with a mean dose of 44 +/- 1 mg, to 137 +/- 1/ 90 +/- 1 mmHg. Blood pressure normalization was obtained in 58% patients with captopril b.i.d. and in 63% as single dose. Blood pressure normalization was achieved in 63% of non-white patients and in 56% patients over 45 years old. Plasmatic potassium decreased significantly with diuretic and did not recovered when captopril was associated.

CONCLUSION

Our results indicate that the addition of low dose of captopril twice or once a day may result in a marked additional blood pressure reduction in cases of insufficient control by the diuretic alone.

Modulation of parasitemia and antibody response to Trypanosoma cruzi by cyclophosphamide in Calomys callosus (Rodentia, Cricetidae)

Calomys callosus a wild rodent, previously described as harboring Trypanosoma cruzi, has a low susceptibility to infection by this protozoan. Experiments were designed to evaluate the contribution of the immune response to the resistance to T. cruzi infection exhibited by C. calossus. Animals were submitted to injections of high (200 mg/kg body weight) and low (20 mg/kg body weight) doses of cyclophosphamide on days -1 or -1 and +5, and inoculated with 4 x 10(3) T. cruzi on day O. Parasitemia, mortality and antibody response as measured by direct agglutination of trypomastigotes were observed. Two hundred mg doses of cyclophosphamide resulted in higher parasitemia and mortality as well as in suppression of the antibody response. A single dose of 20 mg enhanced antibody levels on the 20th day after infection, while an additional dose did not further increase antibody production. Parasitemia levels were not depressed, but rather increased in both these groups as compared to untreated controls. Passive transfer of hyperimmune C. callosus anti-T. cruzi serum to cyclophosphamide immunosuppressed animals resulted in lower parasitemia and mortality rates. These results indicate that the immune response plays an important role in the resistance of C. callossus to T. cruzi.

[Mortality due to neoplasms in Brazil (1980/1983/1985): grouping by states, behavior and trends]

Mortality caused by neoplasms in Brazil was examined by means of official Ministry of Health data covering 26 of the Federal Units and 13 different tumoral sites and referring to the years 1980, 1983 and 1985. Both cluster analyses and those of principal components have shown heterogeneous behaviour as between the different regions of the country in relation to the 13 variants studied. The main discriminatory elements are the trachea/bronchus/lung malign neoplasms followed by those of stomach, pancreas, colon and larynx. Complementary analyses have demonstrated a tendency to an increase in the mortality rate due to prostate malign neoplasms (17.74%), followed by those of trachea/bronchus/lung (15.22%), breast (11.32%), pancreas (10.23%), colon (8.08%), uterine colon (6.45%) and larynx (6.36). There has been a decrease of the mortality due to benign neoplasms/carcinoma "in situ"/others (27.37%), malign rectus neoplasms of the sigmoid/anus (7.67%), stomach (5.31%), of other non-specific locations in the uterus (2.56%), of leukaemia (0.70%) and malign neoplasms of the oesophagus (0.44%). Maling neoplasms of the stomach have been the main cause of cancer mortality in Brazil accounting for 21.27% of the mean total, followed by of the malign neoplasms trachea/bronchus/lung (17.52% of the general average). The mortality rates by esophageal malign neoplasms in Rio Grande do Sul is stressed.

Heparin, heparin plus ASA and dipyridamole, and arteriovenous fistula as adjuvant methods to prevent rethrombosis after venous thrombectomy. Experimental study in rabbits

Venous rethrombosis following thrombectomy is a common event. The aim of the present study was to verify the action of heparin, heparin plus acetyl salicylic acid (ASA) and dipyridamole, and of an arteriovenous fistula (AVF) in the prevention of this complication. Thrombosis was induced in 48 male rabbits by the injection of thrombin in a segment of the left jugular vein, in which the blood flow was arrested for 10 minutes. After 48 hours, the animals were randomly allocated into one of 4 groups of treatment: (1) control, (2) subcutaneous heparin (600 S.I. Units/kg--8/8 hours), (3) heparin, in the same dose, plus ASA (10 mg/kg/once a day), and dipyridamole (0.5 mg/kg thrice a day), (4) an AVF was surgically constructed between the left carotid artery and the left maxillar vein. After 30 minutes, thrombectomy was performed. The venous blood flow, the hematocrit, activated partial thromboplastin time and thrombin time tests were performed before, right after the thrombectomy and 48 hours after thrombectomy. Venography was performed after thrombectomy and at the end of the experiment. The animals were killed 48 hours after thrombectomy and the veins were examined macroscopically. Venous rethrombosis was significantly prevented only in the AVF group (9/12), when compared to control group (0/12), heparin group (1/12) and heparin plus antiaggregating agents group (2/12). These results validate further clinical and experimental investigations with the use of AVF to prevent rethrombosis after venous thrombectomy, when a reduction of venous flow is present.

Isoniazid acetylating phenotype in patients with paracoccidioidomycosis and its relationship with serum sulfadoxin levels, glucose-6-phosphate dehydrogenase and glutathione reductase activities

The authors evaluated the isoniazid acetylating phenotype and measured hematocrit, hemoglobin, glucose-6-phosphate dehydrogenase and glutathione reductase activities plus serum sulfadoxin levels in 39 patients with paracoccidioidomycosis (33 males and 6 females) aged 17 to 58 years. Twenty one (53.84%) of the patients presented a slow acetylating phenotype and 18(46.16%) a fast acetylating phenotype. Glucose-6-phosphate-dehydrogenase (G6PD) activity was decreased in 5(23.80%) slow acetylators and in 4(22.22%) fast acetylators. Glutathione reductase activity was decreased in 14(66.66%) slow acetylators and in 12(66.66%) fast acetylators. Serum levels of free and total sulfadoxin were higher in slow acetylator (p less than 0.02). Analysis of the results permitted us to conclude that serum sulfadoxin levels are related to the acetylator phenotype. Furthermore, sulfadoxin levels were always above 50 micrograms/ml, a value considered therapeutic. Glutathione reductase deficiency observed in 66% of patients may be related to the intestinal malabsorption of nutrients, among them riboflavin, a FAD precursor vitamin, in patients with paracoceidioidomycosis.

Interaction among zinc, glucose, and insulin in normal individuals during glucose and tolbutamid perfusion

Reports in the literature have shown that acute or chronic zinc administration may cause hyperglycemia, with a fall in serum or insular insulin occurring in experimental animals. On the other hand, under conditions of both acute and chronic hyperglycemia, an increase, a decrease, or a normal level of blood zinc has been observed in studies conducted on humans. Thus, the objective of the investigation described here was to determine the relationship existing among zinc, glucose, and insulin under acute conditions. Thirty-six subjects of both sexes (mean age, 23 yr) were tested at 7:00 A.M. after a 12-h fast. Two antecubital veins of both forearms were punctured and maintained with physiological saline. Three experiments were performed in which zinc was administered orally, and hypertonic glucose and tolbutamid were administered intravenously. Blood samples were then collected over a period ranging from 93 to 240 min after the basal times of -30 and 0 min. Hyperzincemia did not cause changes in plasma glucose or insulin either in the absence of or during perfusion of glucose. Hyperglycemia, hypoglycemia, and hyperinsulinemia did not modify serum zinc levels. These results demonstrate that acute zinc administration did not change carbohydrate metabolism and that sudden variations in glucose and insulin levels did not modify the serum profile of zinc.

[Grouping of countries according to basic and economic indicators]

"Countries are grouped according to a collection of basic and economic indicators published by UNICEF, in 1990. Two multivariate statistical methods were used: Principal Component Analysis and Cluster Analysis. The study [covers] 36 countries of the Americas, Europe (including the USSR), the Middle East, Asia and the other continents; they were chosen to include countries having complete information (for the 16 variables used) and in the most varied stages of development. The first principal component was interpreted as a measure of the degree of development...with emphasis on the position occupied by Brazil (13th place among the 25 American countries). In general, the most discriminative variables were the mortality rates of infants and children under five, and life expectancy...." (SUMMARY IN ENG)

Characteristics of Staphylococcus aureus from subclinical bovine mastitis in Brazil

A total of 127 Staphylococcus aureus strains isolated from milk samples of cows with subclinical bovine mastitis was examined for biotype, phage pattern, in-vitro antibiotic susceptibilities and ability to produce enterotoxins. The majority of the strains showed features consistent with bovine rather than human origin. All strains were sensitive to the antibiotics tested, except penicillin and streptomycin. Enterotoxigenicity was observed in 6 (4.7%) strains and only enterotoxins A and C were produced.

Antimicrobial susceptibilities of Staphylococcus aureus isolated from animal and human sources in Brazil

The susceptibilities of 760 Staphylococcus aureus strains isolated from animal infections (400), human infections (300) and healthy human carriers (60) to seven antibiotics were determined by an agar dilution technique. The isolates from human infections were more resistant to a wider spectrum of antibiotics than were the strains from animal infections and healthy human carriers. Amikacin and gentamicin were the most active drugs against all groups of strains.

Interrelationships of zinc with glucose and insulin metabolism in humans

Hyperzincemia has been reported to cause alterations in the homeostasis of glycid metabolism. To determine this effect on plasma glucose and insulin levels, we studied 36 normal individuals of both sexes aged 22-26 y after a 12-h fast. The tests were initiated at 7:00 AM when an antecubital vein was punctured and a device for infusion was installed and maintained with physiological saline. Zinc was administered orally at 8:00 AM. Subjects were divided into an experimental group of 22 individuals who received doses of 25, 37.5, and 50 mg of zinc and a control group of 14 individuals. Blood samples were collected over a period of 240 min after the basal samples (-30 and 0 min). We did not detect any change in plasma glucose or insulin levels, a fact that we attribute either to the ineffectiveness of the 50 mg dose of zinc or to the lack of human response to the acute action of this trace element. The individuals who ingested zinc showed a significant fall in plasma cortisol, probably caused by the action of this trace element.

Measurement of glucose-6-phosphate dehydrogenase and glutathione reductase activity in patients with paracoccidioidomycosis treated with ketoconazole

Hemoglobin rates, hematocrit and glucose-6-phosphate dehydrogenase (G6PD) and glutathione reductase activities were measured in 38 patients with paracoccidioidomycosis treated with ketoconazole or sulfadoxin, and in 13 normal individuals. Ketoconazole-treated patients showed reduced G6PD and glutathione reductase activities. One of these patients was found to be G6PD-deficient and suffered a hemolytic episode during treatment, which, however, did not require interruption of therapy. The authors suggest that patients showing an erythrocyte enzyme defect should be monitored hematologically during treatment with ketoconazole. They also suggest that ketoconazole is an oxidant drug in addition to being a possible inhibitor of antioxidant erythrocyte enzymes.

Glucose-6-phosphate dehydrogenase and glutathione reductase activity in methemoglobin reduction by methylene blue and cystamine. Study on glucose-6-phosphate dehydrogenase-deficient individuals, on normal subjects and on riboflavin-treated subjects

The authors have standardized methods for evaluation of the activity of the glucose-6-phosphate dehydrogenase and of glutathione reductase. The general principle of the first method was based on methemoglobin formation by sodium nitrite followed by stimulation of the glucose-6-phosphate dehydrogenase with methylene blue. Forty six adults (23 males and 23 females) were studied. Subjects were not G6PD deficient and were aged 20 to 30 years. The results showed that methemoglobin reduction by methylene blue was 154.40 and 139.90 mg/min (p<0.05) for males and females, respectively, in whole blood, and 221.10 and 207.85 mg/min (n.s.), respectively, in washed red cells. These data showed that using washed red cells and 0.7g% sodium nitrite concentration produced no differences between sexes and also shortened reading time for the residual amount of methemoglobin to 90 minutes. Glutathione reductase activity was evaluated on the basis of the fact that cystamine (a thiol agent) binds to the SH groups of hemoglobin, forming complexes. These complexes are reversed by the action of glutathione reductase, with methemoglobin reduction occurring simultaneously with this reaction. Thirty two adults (16 males and 16 females) were studied. Subjects were not G6PD deficient and were aged 20 to 30 years. Methemoglobin reduction by cystamine was 81.27 and 91.13 mg/min (p<0.01) for males and females, respectively. These data showed that using washed red cells and 0.1 M cystamine concentration permits a reading of the residual amount of methemoglobin at 180 minutes of incubation. Glutathione reductase activity was evaluated by methemoglobin reduction by cystamine in 14 females before and after treatment with 10 mg riboflavin per day for 8 days. The results were 73.69 and 94.26 jug/min (p<0.01) before and after treatment, showing that riboflavin treatment increase glutathione reductase activity even in normal individuals. Three Black G6PD-deficient individuals (2 males and 1 female) were also studied. The G6PD and glutathione reductase were partially activated, the change being more intense in males. On the basis of race and of the laboratory characteristics observed, it is possible to suggest that the G6PD deficiency of these individuals is of the African type and that the female is heterozygous for this deficiency. Analysis of the results as a whole permitted us to conclude that the methods proposed here were efficient for evaluating the activity of the glucose-6-phosphate dehydrogenase and of glutathione reductase. The latter is dependent on the pentose pathway, which generates NADPH, and on riboflavin, a FAD precursor vitamin.

Immunological assessment and its predictive role in malnourished infants with diarrhoea and/or systemic infections

The Immune capacity of 47 marasmic 1–12 months old ill infants with weights below 75 per cent of Brazilian standards and of 12 well-nourished healthy controls was studied, by measuring: the absolute and relative T and B lymphocyte subpopulatioits, the blastogenic response to phytohaemagglutinin (PHA), expressed as stimulation index (SI), and the delayed hypersensitivity skin test with PHA. Eight (17 per cent) of the malnourished infants died and results were evaluated with respect to ultimate outcome. In addition a discriminant analysis was retrospectively applied to the immunological data of the two groups of malnourished infants. Both groups of malnourished infants presented significantly lower values than the control group for all measurements, although not very evident for B lymphocytes. The immunodepression was more intense for the infants who died than for those who survived, as shown by significantly lower values for the SI, the skin test, and by the discriminant analysis. The discriminant analysis led to a linear predictive model which accurately classified 85 per cent of the survivors and 100 per cent of those who died. It was con cluded that immunological parameters may be useful to select prospectively those infants who need a different therapeutic approach because of their high risk of mortality.

Is coronary sinus blood oxygen tension behavior determined by myocardial oxygen tension variation during cardiac reperfusion?

The relationship between coronary sinus blood oxygen tension (CSPO2) and myocardial oxygen tension (MPO2) variations during cardiac ischemia and reperfusion was studied in anesthetized open-chest dogs. Oxygen tension was measured by a polarographic method. Ischemia resulted in a slightly decreased CSPO2 and a more pronounced reduction of MPO2. After reperfusion the CSPO2 rose rapidly and transiently before it returned gradually to the control level. By contrast, during the recovery period, the MPO2 increased slowly, with recovery occurring long after the peak of CSPO2. These data suggest that during the reperfusion phase, the CSPO2 variation is probably due to opening of the myocardial arteriovenous shunts instead of an increase of flow through the myocardial capillary bed.

Lumbar sympathectomy and distal arteriovenous fistula as adjuncts to prevent arterial rethrombosis after thrombectomy: experimental study in dogs

The role of lumbar sympathectomy and distal arteriovenous fistula (AVF) in preventing rethrombosis of femoral arteries with intimal injury and poor run-off was studied in 21 dogs. Femoral artery thrombosis was induced by endothelial lesion in all animals (phase 1) and 24 hours later the arterial flow was restored by thrombectomy. The dogs were then randomly allocated into 3 experimental groups: control, sympathectomy, and AVF (phase 2). Critical stenosis of the popliteal artery was then created by a partially occluding ligature in all animals in order to simulate poor run-off. After 24 hours the femoral arteries were studied for the presence of rethrombosis (phase 3). At the end of phase 2 and during phase 3, femoral pressure and flow, fluorescein circulation time and paw temperature were measured, and arteriography was done. Arterial rethrombosis was significantly prevented in the AVF group (6/7) when compared to the control group (2/7) or the sympathectomy group (1/7). These data suggest an effective action of an adjuvant AVF, but not of sympathectomy in preventing rethrombosis after thrombectomy in arteries with poor run-off.

[Malaria in the municipality of Humaitá, State of Amazonas. XXI. Prevalence of glucose-6-phosphate dehydrogenase in a population sample and in patients with Plasmodium falciparum malaria]

Os autores estudaram a prevalência da deficiência de glicose-6-fosfato desidrogenase (G6PD), pelo método de BREWER et alii, em 141 indivíduos da população do município de Humaitá, Estado do Amazonas. Destes, 128 eram amazônides, 67 dos quais nunca tiveram malária, enquanto que 61 tinham tido ou estavam tendo a doença; os 13 restantes que estavam com malária não eram arnazônides. Os resultados revelaram que 7 arnazônides (4,96%), eram deficientes. Destes, 5 eram do sexo feminino e 2 do masculino. Em todos os indivíduos do sexo feminino o teste foi positivo com comportamento do tipo heterozigoto. Dos indivíduos deficientes, 4 nunca tinham tido malária; dos outros 3, 2 apresentavam a reação de hemaglutinação positiva com título 1/16 e o terceiro estava tendo malária causada pelo Plasmodium falciparum pela primeira vez. Este doente apresentou forma benigna de malária evoluindo para cura clínica e parasitológica no 3.° dia de tratamento com a clindamicina. Nenhum dos 13 doentes não arnazônides apresentava deficiência de G6PD. Dessa forma, não houve diferença na prevalência da deficiência de G6PD em arnazônides que nunca tiveram malária e em arnazônides que tinham tido ou estavam tendo a doença. Portanto, os indivíduos com deficiência de G6PD estão sujeitos a infecções por Plasmodium falciparum na mesma proporção que os não deficientes. Por outro lado, o aumento da prevalência da deficiência de G6PD, na amostra estudada, poderia estar relacionado com a pressão seletiva exercida pela malária em população submetida à homozigose.

Delayed results of treatment of paracoccidioidomycosis with amphotericin B plus sulfamides versus amphotericin B alone

A delayed evaluation of two groups of patients with paracoccidioidomycosis was carried out. Both groups were treated with amphotericin B, "but one of them was submitted to maintenance treatment with sulfonamides. Statistical analysis showed that treatment is more effective when patients are maintained with sulfonamide drugs.