Phenotypic heterogeneity of hereditary diffuse gastric cancer: report of a family with early-onset disease

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Assessment of Myocardial Ischemia in Obese Individuals Undergoing Physical Stress Echocardiography (PSE)

Background

Physical stress echocardiography is an established methodology for diagnosis and risk stratification of coronary artery disease in patients with physical capacity. In obese (body mass index ≥ 30 kg/m²) the usefulness of pharmacological stress echocardiography has been demonstrated; however, has not been reported the use of physical stress echocardiography in this growing population group.

Objective

To assess the frequency of myocardial ischemia in obese and non-obese patients undergoing physical stress echocardiography and compare their clinical and echocardiographic differences.

Methods

4,050 patients who underwent treadmill physical stress echocardiography were studied according to the Bruce protocol, divided into two groups: obese (n = 945; 23.3%) and non-obese (n = 3,105; 76.6%).

Results

There was no difference regarding gender. Obese patients were younger (55.4 ± 10.9 vs. 57.56 ± 11.67) and had a higher frequency of hypertension (75.2% vs. 57, 2%; p < 0.0001), diabetis mellitus (15.2% vs. 10.9%; p < 0.0001), dyslipidemia (59.5% vs 51.9%; p < 0.0001), family history of coronary artery disease (59.3% vs. 55.1%; p = 0.023) and physical inactivity (71.4% vs. 52.9%, p < 0.0001). The obese had greater aortic dimensions (3.27 vs. 3.14 cm; p < 0.0001), left atrium (3.97 vs. 3.72 cm; p < 0.0001) and the relative thickness of the ventricule (33.7 vs. 32.8 cm; p < 0.0001). Regarding the presence of myocardial ischemia, there was no difference between groups (19% vs. 17.9%; p = 0.41). In adjusted logistic regression, the presence of myocardial ischemia remained independently associated with age, female gender, diabetes and hypertension.

Conclusion

Obesity did not behave as a predictor of the presence of ischemia and the physical stress echocardiography. The application of this assessment tool in large scale sample demonstrates the feasibility of the methodology, also in obese.     

Immune response in the adipose tissue of lean mice infected with the protozoan parasite Neospora caninum

The adipose tissue can make important contributions to immune function. Nevertheless, only a limited number of reports have investigated in lean hosts the immune response elicited in this tissue upon infection. Previous studies suggested that the intracellular protozoan Neospora caninum might affect adipose tissue physiology. Therefore, we investigated in mice challenged with this protozoan if immune cell populations within adipose tissue of different anatomical locations could be differently affected. Early in infection, parasites were detected in the adipose tissue and by 7 days of infection increased numbers of macrophages, regulatory T (Treg) cells and T‐bet⁺ cells were observed in gonadal, mesenteric, omental and subcutaneous adipose tissue. Increased expression of interferon‐γ was also detected in gonadal adipose tissue of infected mice. Two months after infection, parasite DNA was no longer detected in these tissues, but T helper type 1 (Th1) cell numbers remained above control levels in the infected mice. Moreover, the Th1/Treg cell ratio was higher than that of controls in the mesenteric and subcutaneous adipose tissue. Interestingly, chronically infected mice presented a marked increase of serum leptin, a molecule that plays a role in energy balance regulation as well as in promoting Th1‐type immune responses. Altogether, we show that an apicomplexa parasitic infection influences immune cellular composition of adipose tissue throughout the body as well as adipokine production, still noticed at a chronic phase of infection when parasites were already cleared from that particular tissue. This strengthens the emerging view that infections can have long‐term consequences for the physiology of adipose tissue.     

Stress Echocardiography and Major Cardiac Events in Patients with Normal Exercise Test

Background

Exercise test (ET) is the preferred initial noninvasive test for the diagnosis and risk stratification of coronary artery disease (CAD), however, its lower sensitivity may fail to identify patients at greater risk of adverse events.

Objective

To assess the value of stress echocardiography (SE) for predicting all-cause mortality and major cardiac events (MACE) in patients with intermediate pretest probability of CAD and a normal ET.

Methods

397 patients with intermediate CAD pretest probability, estimated by the Morise score, and normal ET who underwent SE were studied. The patients were divided into two groups according to the absence (G1) or presence (G2) of myocardial ischemia on SE .End points evaluated were all-cause mortality and MACE, defined as cardiac death and nonfatal acute myocardial infarction (AMI).

Results

G1 group was comprised of 329 (82.8%) patients. The mean age of the patients was 57.37 ± 11 years and 44.1% were male. During a mean follow-up of 75.94 ± 17.24 months, 13 patients died, three of them due to cardiac causes, and 13 patients suffered nonfatal AMI. Myocardial ischemia remained an independent predictor of MACE (HR 2.49; [CI] 95% 1.74-3.58). The independent predictors for all-cause mortality were male gender (HR 9.83; [CI] 95% 2.15-44.97) and age over 60 years (HR 4.57; [CI] 95% 1.39-15.23).

Conclusion

Positive SE for myocardial ischemia is a predictor of MACE in the studied sample, which helps to identify a subgroup of patients at higher risk of events despite having normal ET.     

High- or low-salt diet from weaning to adulthood: effect on body weight, food intake and energy balance in rats

OBJECTIVE: To get some additional insight on the mechanisms of the effect of salt intake on body weight. DESIGN AND METHODS: Rats were fed a low (LSD), normal (NSD), or high (HSD) salt diet. In a first set, body weight, tail-cuff blood pressure, fasting plasma thyroid-stimulating hormone, triiodothyronine, L-thyroxine, glucose, insulin, and angiotensin II were measured. Angiotensin II content was determined in white and brown adipose tissues. Uncoupling protein 1 expression was measured in brown adipose tissue. In a second set, body weight, food intake, energy balance, and plasma leptin were determined. In a third set of rats, motor activity and body weight were evaluated. RESULTS: Blood pressure increased on HSD. Body weight was similar among groups at weaning, but during adulthood it was lower on HSD and higher on LSD. Food intake, L-thyroxine concentration, uncoupling protein 1 expression and energy expenditure were higher in HSD rats, while non-fasting leptin concentration was lower in these groups compared to NSD and LSD animals. Plasma thyroid-stimulating hormone decreased on both HSD and LSD while plasma glucose and insulin were elevated only on LSD. A decrease in plasma angiotensin II was observed in HSD rats. On LSD, an increase in brown adipose tissue angiotensin II content was associated to decreased uncoupling protein 1 expression and energy expenditure. In this group, a low angiotensin II content in white adipose tissue was also found. Motor activity was not influenced by the dietary salt content. CONCLUSIONS: Chronic alteration in salt intake is associated with changes in body weight, food intake, hormonal profile, and energy expenditure and tissue angiotensin II content.     

Quality assessment in a travel clinic: a study of travelers' knowledge about malaria

BACKGROUND: Quality in health care delivery is considered essential and should be expected for all who deliver health care. We were not able to identify in Portugal any previous studies that assessed the quality of travel medicine consultations. The aims of this study was to assess the impact of travel health advice on travelers' knowledge and the quality of the outcome of the travel consultations at the Institute of Hygiene and Tropical Medicine, Portugal. METHOD: We selected the quasi-experimental model "separate-sample pretest-posttest design." Two random samples were obtained (control and experimental groups). An anonymous self-administered questionnaire was applied during the second half of 2002, until we had received about 200 questionnaires for each group. The questions assessed travelers' knowledge of malaria, its transmission, prevention, and clinical features. RESULTS: There was a significant improvement of travelers' knowledge in the postconsultation group, with 98.5% of individuals understanding that malaria is transmitted by mosquito bite (p= 0.005), 91.5% that malaria may be prevented by appropriate prophylactic medication (p= 0.007), and 93% knowing that malaria is prevented by avoiding mosquito bites (p= 0.003). However, almost half of the postconsultation group did not realize that there was no vaccine available for preventing malaria (p < 0.001) or that avoiding unsafe food and drink did not prevent malaria (p= 0.006). About 53% gave correct answers about malaria incubation periods (p < 0.001), and 91.1% were able to identify the initial symptoms of malaria (p < 0.001). CONCLUSIONS: Travel medicine consultations increase the knowledge base of travelers but do not achieve 100% correct answers. Our results suggest that during a travel health consultation, critical information is assimilated about the prevention of malaria, but myths and misunderstandings that are held by travelers are not completely dispelled.     

Nutritional guidance during prenatal care in public health services in Ribeirão Preto: discourse and care practice

This study aimed to verify if pregnant women attended in prenatal care services at Basic Health Units in Ribeir?o Preto-SP, Brazil, received nutritional guidance and if this guidance was pertinent to their nutritional status. Ninety-one pregnant women participated. The pregnant women were classified according to their nutritional condition, using a weight, height and pregnancy stage table established by the Brazilian Health Ministry's technical prenatal care manual. We found pregnant women with weight under (13.19%) and exceeding normal levels (37.36%). Independently of their nutritional condition, most of them (60.43%) declared they did not receive nutrition guidance. The mean number of prenatal visits did not influence the nutritional status. The results reveal deficiencies in the contents and quality of nutritional care. This suggests the need for care changes so as to turn discourse into practice.     

Care indicators for the body that procreates: nursing actions before, during and after delivery -- a contribution to obstetrical nursing practice

This study results from dynamics seen as Scenes of Esthetical Production, which were accomplished with 28 nursing teaching and service professionals to answer the question: what is generated about the body in labor when we take care of it before, during and after delivery? A qualitative study was realized, which aimed to identify and discuss the actions accomplished at these moments during which the woman's body gives rise to another life. Three categories emerged: 1) The care of the body in labor: the (un)due invasion and concealed violence; 2) the (lack of) care for the body that (ex)pulses another body: the invasion and the expressed violence; 3) the (lack of) care for the empty body: "fatigue and solitude" "the violence of the abandonment". These categories indicated that there are forms of delivering care to this clientele's health, which should avoid violence against the woman's body in labor.