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Increasing prevalence of obesity in children and adolescents might represent an emerging public health issue. Pathogenesis of obesity is multifactorial and involves a complex interplay of genetic and environmental factors. Adolescent obesity has been seen as a cosmetic problem only; nevertheless, a significant increase in cardiovascular risk, probably due to obesity-related metabolic disarrangement has been observed. Consequently, discussion on strategies for treating childhood and adolescent obesity has been promoted worldwide. The proposed treatment triad is life style modification, pharmacological, and surgical treatment. Although lacking definitive data, drug therapy has emerged as an efficacious tool, at least in adolescent obesity. Therefore, sibutramine and orlistat may be good therapeutic options when life style modifications alone do not work.

Objective: The elderly constitute a population with their own features and frequent admissions in intensive care units. This study has the objective to evaluate the ability to predict the survival of these patients through the APACHE II, UNICAMP II, SAPS II and SAPS 3 indexes, global and Central America/South equations., Methods: Elderly patients admitted from 01/01/2006 to 12/3/2006, defined as age > 60 years, were included in this study. Those who were readmitted were excluded. The rate of lethality standardized, calibration and discrimination for each index in the remaining patients were analysed. The outcome were death or hospital discharge., Results: Three hundred eighty six elderly patients were included in this study, being 36 excluded by readmission, remaining 350 for analysis. The rate of lethality standardized came near to the unit in all indexes, except the SAPS II (TLP=1.5455) which underestimated the lethality. The calibration, via Hosmer-Lemeshow tests was inadequate (p < 0.05), except for the UNICAMP II (p > 0.5). On the calibration curve, the models have distanced themselves from the pattern line. All of them presented an excellent discrimination via receiver operating characteristics curves (> 0.8)., Conclusions: In the studied population, the models presented an excellent discrimination and inadequate calibration. SAPS II underestimated the lethality.

The aim of this study was to investigate the agreement between diagnoses of calcified atheroma seen on panoramic radiographs and color Doppler images. Our interest stems from the fact that panoramic images can show the presence of atheroma regardless of the level of obstruction detected by color Doppler images. Panoramic and color Doppler images of 16 patients obtained from the archives of the Health Department of the city of Valença, RJ, Brazil, were analyzed in this study. Both sides of each patient were observed on the images, with a total of 32 analyzed cervical regions. The level of agreement between diagnoses was analyzed using the Kappa statistics. There was a high level of agreement, with a Kappa value of 0.78. In conclusion, panoramic radiographs can help detecting calcifications in the cervical region of patients susceptible to vascular diseases predisposing to myocardial infarction and cerebrovascular accidents. If properly trained and informed, dentists can refer their patients to a physician for a cardiovascular evaluation in order to receive proper and timely medical treatment.

Cicatricial pemphygoid (mucous membrane cicatricial pemphygoid) is a chronic autoimmune inflammatory disease characterized by subepithelial bubbles in mucous membranes and, occasionally on the skin. It may affect the mouth, the nose, pharynx, larynx, the eyes, esophagus, anus, genitals and skin; especially affecting patients between fifty and sixty years of life. Treatment includes systemic steroids and immunosuppressive agents. In the present paper we describe two cases with the active disease, and one of them had sepsis because of using immunosuppressive agents and another that presented supraglottic stenosis requiring tracheostomy.

To talk about spirituality is a difficult subject. It is subjective and the definition it is not consensual. About children knowledge is still scarce and very limited with many issues yet to be revealed. That's why it is so difficult to work this area with doctors, nurses and other health staff This article reveals some of the existent knowledge. In it we shall discuss spirituality in children and its development through life cycle. Afterwards we link spirituality in chronic condition to the role of Nursing Care.

In order to evaluate the effect of polymorphism in the PPARgamma2 and beta2-adrenergic genes and diet lipids on body composition, energy expenditure and eating behavior of obese women, 60 subjects were submitted to anthropometric, biochemical, dietary, molecular, basal and postprandial metabolism (indirect calorimetry) and eating behavior (visual analog scale) evaluation. Fat and saturated fatty acid (SFA) high diet was used to assess postprandial metabolism. The frequency of Pro12Pro/Gln27Gln, Pro12Pro/Gln27Glu, Pro12Pro/Glu27Glu and Pro12Ala/Gln27Glu genotypes was 35.71%, 30.37%, 23.21% and 10.71%, respectively. These values were not significant (p>0.05) for the dietary, anthropometric, biochemical and metabolic parameters. The Pro12Ala/Gln27Glu group was found to present greater energy used in postprandial period (EUPP). The presence of the PPARgamma2 gene variant, independent of beta2-adrenergic gene polymorphism, resulted in fat oxidation increase. Also, this group presented higher satiety, compared to the Pro12Pro/Gln27Gln group. The presence of the variant alleles in the PPARgamma2 gene suggests benefits in food intake control.

The effects of the aqueous crude extract (5%) of Eugenia punicifolia on cholinergic nicotinic neurotransmission were investigated. Actions of aqueous crude extract over the inhibitory effect of the cholinergic nicotinic antagonists gallamine or pancuronium, on contractions induced by electrical stimulation of phrenic nerve of rat diaphragm, were studied. Tissues were mounted as for isotonic contractions and stimulation was delivered at submaximal voltage. Addition of Eugenia punicifolia did not alter the amplitude of twitch contraction. Gallamine (IC(50): 28.8+/-0.51 microM) or pancuronium (IC(50): 3.16+/-0.11 microM) completely inhibited twitch contractions. After the maximum effect of the antagonists was achieved, addition of the aqueous crude extract (0.5-1.0 mL) totally recovered the responses to electrical stimulation. Neostigmine, a reversible acethylcholinesterase inhibitor, partially recovered responses (49.70+/-6.90% at 1 microM). In another series of experiments, previous incubation of the extract (0.5 mL) shifted to the right inhibitory concentration-response curves for the antagonists gallamine (IC(50) before E. punicifolia: 35.8+/-1.61 microM; IC(50), after E. punicifolia: 2.24+/-0.04 mM) and pancuronium (IC(50), before E. punicifolia: 3.55+/-0.13 microM; IC(50), after E. punicifolia: 0.39+/-0.01 mM). Our results show that the aqueous extract of E. punicifolia recovered the action of competitive nicotinic antagonists at the neuromuscular junction. A receptor-mediated mechanism or the possibilities of interactions of the extract with the enzyme acethylcholinesterase, however, remain to be investigated.

Objective: To evaluate the effect of diet and PPARgamma2 and beta2-adrenergic receptor genes on energy metabolism and body composition in obese women., Material and Methods: 60 obese women, aged 34.59 +/- 7.56 years were studied at the Department of Physiology and Nutrition at Navarra University. Anthropometric, biochemical, metabolic and molecular evaluations were carried out, and the women were submitted to short-term and long-term hypocaloric diets, varying the macronutrients. The groups were formed according to gene polymorphism, as follows: Pro12Pro(PPARgamma2)/Gln27Gln (beta2-adrenergic receptor genes) - A, Pro12Pro (PPARgamma2)/Gln27Glu (beta2-adrenergic receptor genes) - B, Pro12Pro (PPARgamma2)/ Glu27Glu (beta2-adrenergic receptor genes)-C and Pro1Ala (PPARgamma2)/Gln27Glu beta2-adrenergic receptor genes) - D., Results: In group A, fat oxidation was correlated positively with body mass index (BMI), but an increase in fat and saturated fatty acids (SFA) in the diet did not reflect in increased oxidation. In group B, total fat and SFA intake did not lead to fat oxidation increase. In group C, fat and complex carbohydrates (CHO) resulted in lower fat oxidation, and long-term increase of monounsaturated fatty acid (MUFA) intake resulted in increase of CHO oxidation and smaller weight loss. In group D, greater energy expenditure was obtained after diet high in SFA in a short-term, and fat basal and postprandial oxidation correlated positively with its intake. Hypocaloric diet high in polyunsaturated fatty acid (PUFA) resulted in increase of fat oxidation., Conclusions: Polymorphism in PPARgamma2 gene resulted in increased fat oxidation, regardless of genotype of beta2-adrenergic receptor gene. It is recommended control of the total intake of fats and SFA in Pro12Pro/Gln27Gln and Pro12Pro/Gln27Glu, and complex CHO and MUFA in Pro12Pro/Glu27Glu. In Pro12Ala/Gln27Glu, AGPI intake can result in greater body weight loss.

Presence of fungus in the conjunctiva is a constant threat to the eyes, because these microorganisms, defined as opportunistic, may provoke severe ocular infections, in situations as low organic resistance, use of immunosuppressants, antibiotics and epithelial alteration. Our goal here is to report a case of ocular aspergillosis in an immunosuppressed patient where paroxysmal nocturnal hemoglobinuria was diagnosed. A 51-year-old immunosuppressed, thrombocytopenic patient was hospitalized with a diagnosis of paroxysmal nocturnal hemoglobinuria. On examination, she had a visual acuity of 20/40 in the right eye (RE) and light perception in the left (LE). She presented hyposphagma, bilateral conjunctival edema on biomicroscopy and had some multiple and circumscribed conjunctival abscesses in both eyes; clear cornea in both eyes. Fundoscopy of the RE did show any particularity, in the LE there was a smear hemorrhage. Computed tomograph showed a fat periocular infiltration. Magnetic resonance lead to the same finding, compatible with orbital cellulitis. Hemoculture showed Aspergillus growth and direct smears of conjunctival material was negative. There was great improvement while treating her with amphotericin B, but there was complete remission after using 5% natamicyn eye drops. Orbital infections caused by Aspergillus are uncommon, usually appearing in immunosuppressed patients. Frequently they progress insidiously, and can be confounded with other orbital processes. Immunological impairment can inhibit the expression of local and systemic symptoms, resulting in diagnostic confusion. The diagnosis is established by laboratory tests, but culture can be negative in spite of the classical presentation, making the beginning of treatment difficult. In these cases management starts according to the symptoms.

Bioassays were performed in order to detect the susceptibility of Aedes aegypti to the chemical insecticides temephos and cypermethrin. The results showed that this species is susceptible to temephos and presents resistance to cypermethrin.

FTY720 has shown potent immunomodulatory activity in a variety of animal organ transplant models. However, the in vivo immunosuppressive mechanism of FTY720 is still not fully understood. It has been suggested that the marked decrease in the number of peripheral blood lymphocytes during FTY720 administration could be responsible for its immunosuppressive effects. Our aims were: (1) to study the effects of FTY720 treatment on skin graft survival using a fully mismatched strain combination and (2) to evaluate lymphocyte numbers in different sites at 5 days after skin transplant. C57BL/6 mice and BALB/c mice were the donors and recipients respectively. BALB/c mice received FTY720 (1 mg/kg/d) orally for 4 consecutive days. Drug administration started 1 day before skin transplants. A small segment of tail skin was affixed on the right dorsal side of the mouse via sutures. The administration of FTY720 (4 mg/kg) prolonged skin graft survival from 12.6 +/- 2.2 days (no treatment) to 16.6 +/- 4.2 days. The histologic findings of rejection were similar for all groups. Five days after transplant, lymphocyte numbers were significantly increased in lymph nodes compared with nontransplanted or isogenic graft mice. FTY720 decreased lymphocyte numbers only in the spleen. In conclusion, FTY720 prolonged skin graft survival in a fully mismatched strain combination when administered for 4 days (day -1 to day +2) at a dose of 1 mg/kg/d. The decreased number of lymphocytes in the spleen suggests that the spleen may be a target of FTY720 activity, during the early posttransplant period.

Ninety-one Escherichia coli isolates obtained from diarrheic and normal feces of newborn piglets (0-11 days of age) from three states of Brazil were assessed for phenotypic and genotypic characteristics associated with pathogenic processes. These isolates expressed fimbriae F18ac and type 1, but not fimbriae K88, K99, 987P or F41. Genes for toxins (LT-I, STa, SLT-I, SLT-II, SLT-IIv) either individually or combined were found to be present in most of the diarrheic strains (65.7%) and in 42.8% of the non-diarrheic ones. The eaeA gene was present in 25.7% of the diarrheic isolates and in 9.5% of the non-diarrheic ones. Colicin, hemolysin and aerobactin were also found to be produced by some strains from both sources. Because of the great variety of biological characteristics associated with different illness processes, we suggest that, in Brazil, pigs may act as a reservoir for transmission of Escherichia coli strains to other animals.

We have studied the fusion activity of Sendai virus, a lipid-enveloped paramyxovirus, towards a line of adherent cells designated PC-12. Fusion was monitored by the dequenching of octadecyl-rhodamine, a fluorescent non-exchangeable probe. The results were analysed with a mass action kinetic model which could explain and predict the kinetics of virus-cell fusion. When the temperature was lowered from 37 degrees C to 25 degrees C, a sharp inhibition of the fusion process was observed, probably reflecting a constraint in the movement of viral glycoproteins at low temperatures. The rate constants of adhesion and fusion were reduced 3.5-fold and 7-fold, respectively, as the temperature was lowered from 37 degrees C to 25 degrees C. The fusion process seemed essentially pH-independent, unlike the case of liposomes and erythrocyte ghosts. Preincubation of the virus in the absence of target cell membranes at neutral and alkaline pH (37 degrees C, 30 min) did not affect the fusion process. However, a similar preincubation of the virus at pH = 5.0 resulted in marked, though slow, inhibition in fusion with the fusion rate constant being reduced 8-fold. Viral preincubation for 5 min in the same acidic conditions yielded a mild inhibition of fusogenic activity, while preincubation in the cold (4 degrees C, 30 min) did not alter viral fusion activity. These acid-induced inhibitory effects could not be fully reversed by further viral preincubation at pH = 7.4 (37 degrees C, 30 min). Changes in internal pH as well as endocytic activity of PC-12 cells had small effect on the fusion process, thus indicating that Sendai virus fuses primarily with the plasma membranes.