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To estimate the prevalence of polypharmacy (≥5 drugs) among adults and to analyze related factors. Cross-sectional study with 1,159 interviewees distributed across 104 cities and 253 primary healthcare services delivered through the Brazilian Unified Health System. Polypharmacy-related factors were identified using logistic regression model. 949 (81.8%) interviewees were using at least one medication and were included in this analysis. The prevalence of polypharmacy among them was 13.7% (95%CI:11.7–16.0%) in the general population and 33.3%(95%CI:26.1–41.4%) in older adults(≥65 years). Polypharmacy was positively associated with age (45 to 64 years, OR=2.02; 95%CI:1.03–3.94; ≥65 years, OR=4.17; 95%CI:1.92–9.17) and the following chronic diseases: stroke (OR=4.20; 95%CI:1.53–11.55); diabetes mellitus (OR=4.03; 95%CI:2.43–6.68); heart disease (OR=3.18; 95%CI:1.92–5.29); depression (OR=2.85; 95%CI:1.80–4.53); hypertension (OR=2.13; 95%CI:1.17–3.86); and dyslipidemia (OR=1.73; 95%CI:1.07–2.80). This study revealed that polypharmacy is a real concern in primary health care and affects older and middle-aged adults alike. Groups of patients that are more likely to experience polypharmacy were identified. Our findings emphasize the relevance of an appropriate approach to polypharmacy driven by aging and multimorbidity. [ABSTRACT FROM AUTHOR]

Adding tannins to the dietary protein source will cause complexation between the tannin and protein, which may increase dietary ruminal undegraded protein. Thus, this study aimed to evaluate the effects of replacing soybean meal (SM) with soybean meal treated with tannin (SMT) on the intake, partial and total nutrient digestibility, and protein dietary efficiency of young cattle fed a high-concentrate diet. Five Nellore bulls with bodyweights of 290 ± 11.2 kg were fitted with ruminal and abomasal cannulas and were used in the study. The experimental diets included 7.5% SM, with a proportion of that SM (0%, 33%, 66% or 100%) replaced with SMT. Another treatment (SMT+urea) with only 2.5% SM treated with tannins was tested. The intake of ether extract and the intake of neutral detergent fibre ash and protein were the only parameters related to feed intake that were affected by the replacement of SM with SMT. Ruminal and intestinal digestibility each showed a linear effect on crude protein, which decreased with ruminal digestibility and increased with intestinal digestibility. The intake of ruminal undegraded protein and metabolisable protein showed a positive linear correlation with the amount of SMT in the diet. SMT substitution showed no effect on methane emission. The replacement of traditional SM with SM treated with 2.5% tannins (85% condensed tannins and 15% hydrolysable tannins) for cattle that were fed high-concentrate diets showed increased amounts of metabolisable protein and decreased nitrogen loss per unit of crude protein, without changing the methane emission. Tannins provide an increase in the amount of protein used by the animal with no increase in the total amount of dietary protein. This occurs due to the capacity of tannin to bind protein through hydrogen bonds forming a tannin–protein complex, which is stable in the rumen (pH, 5.0–7.0) and resistant to microbial degradation. This approach can provide two important benefits: an increase in the amount of protein absorbed and deposited in the animal's tissue and a decrease in feed costs due to the removal of protein source ingredients, such as soybean meal. [ABSTRACT FROM AUTHOR]

Objective: Describe outcomes of open fetal surgery for myelomeningocele (MMC) repair in two Brazilian hospitals and the impact of surgical experience on outcome.Design: Retrospective cohort study.Setting: Sao Paulo, Brazil.Population: 237 pregnant women carrying a fetus with an open spinal defect.Methods: Surgical details, and maternal and fetal outcomes collected from all patients.Main Outcome Measures: Analysis of surgical and perinatal outcome parameters.Results: Total surgical time was 119 ± 7.6 minutes. Preterm labour occurred in 24.2%, premature rupture of membranes in 26.7%, placental abruption in 0.8%, need for a blood transfusion at delivery in 2.1%, and dehiscence at the repair site in 2.5%. Reversal of hindbrain herniation at birth occurred in 71.4%. There were no maternal deaths or severe maternal morbidities. The failure rate with the patient anaesthetised was 0.42% and perinatal mortality was 2.1% (three intrauterine demises and two neonatal deaths). Comparing results from our study in the first 3 years with the last 3 years demonstrated improvement in the total surgical time (121.2 ± 6.4 versus 118.5 ± 8.2 minutes, P = 0.005) and an increase in reversal of hindbrain herniation at birth (64.0 versus 77.1%, P = 0.042).Conclusion: Our open fetal surgical approach for MMC was effective and results were comparable to past studies. Improvements in surgical performance and perinatal outcome increased as the surgical team became more familiar with the procedure.Funding: The study was funded solely by institutional funds.Tweetable Abstract: Brazilian experience of in utero open surgery for myelomeningocele repair. [ABSTRACT FROM AUTHOR]

Objectives: Investigate the prediction of birth acidemia in pregnancies with placental insufficiency using two newly created venous-arterial Doppler ratios: pulsatility index (PI) of the ductus venosus (DV) over PI of the middle cerebral artery (MCA) and PI of the DV over PI of the umbilical artery and establish cut-off values for this prediction. Methods: This was a prospective cross-sectional study involving 47 patients with placental insufficiency managed in two Brazilian hospitals. All pregnancies were singleton, over 26 weeks of age and without structural or chromosome anomalies. A ROC curve was calculated for the venous-arterial ratios (independent variable) and acidemia (dependent variable). Results: The DV/AU PI ratio was not a good predictor of acidemia at birth. The DV/MCA PI ratio was related to fetal acidemia (area under the ROC curve 0.785, p = 0.004). The cut-off value was 0.582, sensibility 66.7%, specificity 77.1% and accuracy 74.5%. Conclusions: The DV/MCA PI ratio is adequate for the diagnosis of acidemia at birth in pregnancies with placental insufficiency. The cut-off value was 0.582. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux is very common in chilhood. If conservative procedures fail to relieve it, the use of a potent antiemetic agent that facilitates gastric motility and emptying, such as domperidone, is justified. We report a 4-month-old child who presented with QT interval prolongation after the oral use of domperidone, which normalized after the drug was discontinued. [ABSTRACT FROM AUTHOR]

Background: Laryngeal carcinoma involving anterior vocal commissure (AVC) represents a great challenge for staging and treatment. Objectives: To compare laryngoscopy and computed tomography (CT) scan efficiency in staging tumors extending to the AVC. We also analyzed the helicoidal axial CT scan accuracy in recognizing this larynx subregion invasion. Material And Methods: Fifty-two glottic and supraglottic laryngeal squamous cell carcinoma patients with tumoral extension to the AVC were prospectively studied from August 2001 to August 2003 at the National Cancer Institute (Rio de Janeiro, Brazil). All patients underwent videolaryngoscopic examination and direct laryngoscopy for lesion extension analysis and biopsy. After AVC helicoidal axial CT scan with sagittal and coronal 1.0 mm thick reconstruction, patients were submitted to surgical treatment. The same pathologist analyzed all surgical specimens. Results: When compared with pathologic stage, clinical endoscopic classification was correct in 40.38% of cases (40% for T1, 29.41% for T2, 46.43% for T3, and 50% in T4). Helicoidal axial CT scan accuracy for AVC tumors was 75% ( P = .0001), being more important for T2 (62.50%), T3 (73.91%), and T4 (88.24%) lesions. Identification of radiologic signs described as gross radiologic anterior commissure involvement (GRACI) increased radiologic image staging accuracy to over 96%. Conclusions: Endoscopic evaluation understaged tumors in all clinical stages but really T1. Helicoidal axial CT scan reformatted to 1.0 mm thick played an important role in correctly staging more advanced AVC laryngeal tumors. Radiologic signs, here identified as GRACI, may be very helpful for tomographic staging and patient treatment. [ABSTRACT FROM AUTHOR]

The assessment of fetal well-being by venous Doppler velocimetry, especially in cases of intrauterine growth restriction, has been growing in importance as a number of researchers have been improving their studies 1 - 5 as well as a consequence of better technologies in ultrasound equipment. Since different authors have studied the fetal blood circulation with color Doppler, initially focusing their attention on the arterial system 6 - 12 , many questions and doubts have remained without a reasonable answer, especially concerning the optimal time at which to deliver these fetuses. Among these authors, some have expressed the opinion that all biophysical methods, including the cardiotocogram, should be used before the decision of fetus delivery should be made 13 , 14 . It is possible, nowadays, to study several venous vessels, such as the ductus venosus, inferior vena cava, umbilical vein, portal vein, hepatic veins 15 , and, more recently 1 , 2 , the cerebral transverse sinus. The purpose of this review is to describe the fetal circulation, the technique and rationale behind measuring venous Dopplers and to assess the clinical applications of venous Doppler velocimetry. [ABSTRACT FROM AUTHOR]

Although cognitive dysfunction is a common finding in patients with acquired immunodeficiency syndrome (AIDS) its pathogenesis remains controversial. Given the involvement of the hippocampal formation in the processing of cognitive information and the scarcity of quantitative studies in this brain region, we have examined, using stereological methods, the hippocampal formations of AIDS patients. The study was performed in ten AIDS patients and ten age-matched controls. All cases were male. The Principle of Cavalieri was applied to estimate the volume of the layers of the dentate gyrus and of the CA3 and CA1 hippocampal fields. The fractionator and the nucleator were used as estimators of the total number, and mean somatic and nuclear volumes of the neurons in the cell-containing layers of all hippocampal subdivisions. No cell death was detected in AIDS patients but the global volume of their hippocampal formations was significantly decreased due to the reduced volume of its layers, mainly the cell-containing layers. Furthermore, the somatic and nuclear volumes of the neurons in the hippocampal formation were significantly decreased in AIDS patients. No correlation was found between the estimates obtained and the presence or absence of neurological involvement. Our results show that neurons in the hippocampal formation of AIDS patients display marked morphological changes, despite the maintenance of their total number. These alterations are likely to lead to dysfunction of the hippocampal circuitries and, thus, might contribute to explaining the demential features which occur in this condition. [ABSTRACT FROM AUTHOR]

Past work showed that chronic alcohol consumption induces massive degeneration in the rat cerebellar cortex. In order to provide details of these effects, the cortical cell numbers and the cerebellar layer volumes were studied in adult rats fed alcohol for 1, 3, 6, 12, and 18 months and compared with respective age-matched controls. Significant decreases of granular and molecular layer volumes were found after 3 and 6 months of alcohol feeding, respectively. No significant differences were found in the Purkinje cell layer volume. Neuron countings showed that granule cells and molecular layer interneurons were the earliest and most severely affected populations. A decrease in the number of Purkinje cells was observed only after 18 months of alcohol consumption and Golgi cells were not significantly reduced. Thus, we concluded that cerebellar neurons have a selective vulnerability to alcohol which might alter the balance between excitatory and inhibitory limbs of the cerebellar circuitry. [ABSTRACT FROM AUTHOR]

Whorled multiplanal inclusions up to 1.5 μm in diameter were observed in dendrites of the cerebellar Goigi cells after 6 months of alcohol treatment, increasing in number with time. Inclusions are formed by apposed cytomembranes stacked parallel or In a twisted arrangement The paired membranes merged into a dense, finely textured material. A close relationship with dendritic smooth endoplasmic reticulum is apparent A correlation between chronic alcohol intake and the development of these inclusions is shown although, in common with many other types of neuronal cytoplasmic inclusions, their genesis and function remains to be determined. [ABSTRACT FROM AUTHOR]

The increased number of lipofuscin granules in Purklnje cells from chronic alcohol-fed rats was studied by morphometric methods. These granules were autofluorescent and had marked acid phos-phatase activity. No significant changes were found in the mean nuclear and perikaryon volumes when alcohol-fed and control groups were compared. The number of lipofuscin granules per unit of surface area of cell cytoplasm (Na) and their volumetric density (V), were significantly greater in alcohol-fed groups than in controls. These values were also significantly different when the 6- and 12-month control groups were compared. Na and V, values in alcohol-fed groups increased progressively. The increased number is probably related to disturbances in neuronal cell metabolism. The importance of age and malnutrition in the formation of these granules was also considered. [ABSTRACT FROM AUTHOR]

There is a growing body of evidence indicating that chronic alcohol consumption induces morphological changes in the central nervous system (CNS) similar to those observed during brain senescence, including an increased formation of lipofuscin. In addition, it was also found that alcohol withdrawal does not reverse these changes. On the contrary, most of the alterations observed during alcohol consumption worsen as happens with the increased lipofuscin formation. Thus, using our model of alcohol feeding and withdrawal, we decided to examine the effects of different drugs said to offer neuronal protection during CNS degenerative processes. The action of piracetam, a cyclic derivate of GABA and commonly used as a nootropic agent, was tested by studying the lipofuscin accumulation on the cerebellar Purkinje and hippocampal CA3 pyramidal cells in alcohol-treated and withdrawn rats. Piracetam was found to markedly decrease the formation of neuronal lipofuscin. Whatever the functional implications of this pigment, its reduction in piracetam-treated animals might be related either to a protective effect on the intraneuronal membranous system or to an antioxydant property of this molecule. [ABSTRACT FROM AUTHOR]

The effects of long-term alcohol consumption and withdrawal upon the structure of the rat hippocampal formation were studied by applying morphometric methods to material processed for light and electron microscopy. The somatostatinergic neurons of the hilus were also studied. Groups of 6 rats were treated as follows: (a) given alcohol for 6, 12 and 18 months; (b) paired controls; and (c) rats switched to a normal diet in the 6 months after 6 and 12 months of alcohol intake. A progressive loss of hippocampal neurons after chronic alcohol consumption was found. The loss was aggravated during withdrawal from alcohol, with the exception of the hilar cells. The dendrites of granule cells from the alcohol-treated rats displayed signs of regrowing, but they did not do so in rats withdrawn from alcohol. The synapses between mossy fibre terminals and CA3 dendrites appear to be rather resistant to alcohol insult, and evidence of morphological plasticity was found in withdrawn rats. If an homology can be established between humans and rodents then the changes observed in alcohol-fed rats can be regarded as underpinning some of the functional and behavioural alterations depicted under these circumstances. The peculiar changes found in some nerve cell populations after withdrawal of alcohol could be related to the deficient or incomplete functional recovery often seen after abstinence from alcohol. [ABSTRACT FROM AUTHOR]

We have recently shown in the supraoptic nucleus (SON) of the rat that prolonged ethanol consumption induces cell degeneration and enlargement of the surviving neurons and of their subcellular organelles. We analyzed the SON of withdrawn rats to evaluate whether it displays any evidence of morphological reorganization following abstinence from ethanol, inasmuch as in this condition the ethanol-Induced changes in the plasma levels of neurohormones and plasma osmolality are no longer detectable. A group of 18 month-old withdrawn rats was compared with age-matched, pair-fed control and ethanol-treated rats. To differentiate between the effects of withdrawal and the effects of rehydration, a group of 18-month-old rehydrated rats was also included in this study and compared with age-matched, pair-fed control and dehydrated rats. We estimated the volume of SON, and the total number and mean volume of its neurons. The cross-sectional areas of the vasopressinergic and oxytocinergic populations were also evaluated. At the ultra-structural level, we determined the volumes and surface areas of the rough endoplasmic reticulum and Golgi apparatus, and the volumes of neurosecretory granules and nucleoli. In withdrawn animals, the total number of SON neurons was smaller than in controls, although the neuronal volume was greater. The number of SON neurons did not differ between withdrawn and ethanol-treated rats, despite the reduced volume of SON the former animals. The decrease of SON volume correlated with and was caused by a reduction in the volume of SON neurons and in the size of the organelles involved in neuro-hormone synthesis. Thus, withdrawal from ethanol stops the ethanol-Induced neuronal degeneration of the SON and partially reverses the ethanol-induced enlargement of SON neurons and their organelles. We suggest that the larger volume of SON neurons in with dawn animals relative to controls represents a compensatory mechanism, triggered by the reduced number of neurons, to allow the maintenance of adequate levels of circulating neurohormones. [ABSTRACT FROM AUTHOR]

We have demonstrated that, in the rat hippocampal formation, withdrawal from chronic alcohol consumption aggravates the ethanol-induced loss of pyramidal neurons and dentate granule cells. We have also shown that intracerebral grafting and piracetam could have a protective effect in these conditions. In this study we utilized immunocytochemical methods to investigate whether γ-aminobutyric acid (GABA)ergic dentate gyms cells, which are known to be inhibitory, were also affected by withdrawal from alcohol and, if so, whether putative neuroprotective agents could ameliorate the alterations found. Rats were alcohol-fed for 6 months and further divided into several groups: (1) alcohol-fed for an extra 6 months; (2) withdrawn from alcohol for 6 months; (3) withdrawn and grafted with newborn rat hippocampal tissue; (4) withdrawn and orally treated with piracetam for 6 months; (5) withdrawn and treated systemically with monosialoganglioside GM1 for 6 months; (6) withdrawn and treated with the vehicle used to dissolve the GM1. Control animals were pair-fed. All animals were killed 12 months after the beginning of the experiment and processed for GABA immunocytochemistry. GABA-immunoreactive (IR) neurons in the dentate gyrus were quantified and we found that alcohol-fed animals had a significant reduction in the numerical profile density of GABA-IR neurons in the dentate gyrus as a whole and in the hilus and in the granular layer of the suprapyramidal limb. Withdrawal from alcohol aggravated the GABAergic neuronal loss. Of the treatments used, only piracetam had a striking beneficial effect. Data gathered from the present work and from our previous studies indicate that the neuronal loss following chronic alcohol consumption and withdrawal affects both excitatory and inhibitory neurons in the dentate gyrus and that piracetam may have a useful protective role in this condition. [ABSTRACT FROM PUBLISHER]