Coronary artery calcification and aortic pulse wave velocity in chronic kidney disease patients

BACKGROUND: Patients with end-stage renal disease (ESRD) are at increased risk of cardiovascular mortality and morbidity. Many complications arise in ESRD patients as a result of the twin arterial pathologies of atherosclerosis and arteriosclerosis. Part of this latter process is calcification of the arterial media, which is thought significantly to increase vascular stiffness. The aim of our study was to explore the relationship between measures of arterial stiffness-pulse wave velocity (PWV)-and the extent of calcification in the coronary arteries (CAC). METHODS: Over a period of 2 years 82 patients from our renal unit were invited to participate in our study. Sixty-two patients agreed to undergo electron beam computerized tomography (EBCT), and in 55 (38 males and 17 females), PWV measurements were made. EBCT and PWV measurements were done according to previously described protocols. RESULTS: The mean age of the 55 patients was 56.4 years. The mean duration of dialysis was 65.4 months, and the mean CAC score was 2551. The mean PWV was 9.13 m/s. PWV strongly correlated with total CAC even after correction for age, dialysis duration, and time averaged C-reactive protein (CRP) (P= 0.0001). CAC scores were significantly different when compared according to PWV tertiles (P= 0.0001). CONCLUSION: We have demonstrated that PWV is strongly related to the degree of EBCT-derived coronary artery calcium score in chronic kidney disease patients.     

Lateral shelf acetabuloplasty in the early stage of Legg-Calvé-Perthes disease with special emphasis on the remaining growth of the acetabulum: a preliminary report

This study reports on the preliminary results in 43 patients with an early stage of unilateral Legg-Calvé-Perthes disease, treated with a shelf acetabuloplasty. The mean postoperative follow-up was 3.7 years (1.3-6.2 years). The results suggest an improved outcome in children older than 5 years of age at onset. According to the Stulberg classification, 16 hips were classified as Stulberg 2, 19 hips as Stulberg 3 and eight hips as Stulberg 4. The acetabular size, which is a measurement of the length of the acetabulum relative to the size of the shelf, increased from 48.86 to 69.13%. This reflects an incorporation of the shelf-graft into the pelvis as a result of continued growth of the lateral acetabular structures. The coverage of the femoral head by the bony acetabulum increased from 68.51 to 73.83%. The acetabular cover increases in children younger than 8 years of age and decreases in patients older than 8 years. We suggest that shelf acetabuloplasty can be considered as an appropriate surgical treatment for children older than 5 years of age, with severe Legg-Calvé-Perthes disease.     

Are lethal audiogenic seizures a missing link to the sudden infant death syndrome?

The pathogenesis of human seizure disorders has largely been derived from rodent models. A number of rodent and chick strains exhibit a genetic predisposition for lethal audiogenic seizures (AGSs) in the first year of life. Consideration is warranted that this disorder may be linked to the sudden infant death syndrome (SIDS). Factors that carry a strong association with SIDS such as hyperthermia and the prone sleeping position would conceivably play a significant role in a human AGS syndrome. Importantly, there is data to support the likelihood that motor seizure activity may be absent in infants with an AGS syndrome. Rodent AGSs may hold important clues to unraveling the mystery of SIDS.     

Psychoactive drug use in school age adolescents, Brazil

To quantify psychoactive drug use and investigate use-related variables among students of Assis, Brazil, a questionnaire was administered to collect sociodemographic data and identify the pattern of non-medical use of psychoactive drugs in 20% of public and private school students. The largest consumption indexes for lifetime use were seen for alcohol (68.9%) and tobacco (22.7%). Drugs most often used were: solvents (10.0%); marijuana (6.6%); benzodiazepines (3.8%); amphetamines (2.6%); cocaine (1.6%); and anticholinergics (1.0%).     

Investigation into the effect of household triatomine infestation on awareness among inhabitants of settlements and re-settlements in areas infested with Triatoma sordida in São Paulo State, Brazil

This study aims to analyze the effect of domiciliary infestation by triatomine bugs on the degree to which inhabitants are aware of potential vector transmission of Chagas disease. Such recently constructed dwellings comprise housing groups classified as settlements and re-settlements, selected respectively in the municipalities of Euclides da Cunha Paulista and Paulicéia, S?o Paulo State, Brazil. Both municipalities are under the jurisdiction of the Presidente Prudente Health Administrative Region. Of the 319 residents, some 100 (76.0% of whom were re-settlement residents) knew about triatomine bugs. Housing units infested with triatomines were inhabited by 93 people. In 79.2% of the infested houses, 26.8% of the residents knew about Chagas disease and its vectors, but in 50.0% of the households, some people did not know what to do in case of triatomine infestation. Population samples from settlements and re-settlements, regardless of sex, age, and the State of origin, showed no difference in attitudes towards the prevention of Chagas disease or knowledge of the disease vector.     

Ocular manifestations in Dengue fever

PURPOSE: To report a case of Dengue fever resulting in permanent visual loss in both eyes due to retinal capillary occlusion. METHODS: Case report. RESULTS: Severe permanent visual loss occurred in a patient with Dengue fever. Dilated fundus exam showed vascular sheathing with associated retinal hemorrhages at the equator and cotton wool spots in the maculae of both eyes. Fluorescein angiography revealed areas of capillary nonperfusion at the equator and in the macula. The diagnosis of Dengue fever was confirmed by serology detecting IgM antibodies to the Dengue virus. CONCLUSION: Ocular abnormalities may be seen in patients with Dengue fever, therefore ophthalmoscopy should be performed in patients presenting with severe forms of the disease.     

Simultaneous repair of myelomeningocele and shunt insertion

Methods Simultaneous shunt placement and neural tube repair are described and compared with a concomitant series of patients with delayed shunting. Twenty-eight patients with a myelomeningocele underwent closure of neural tube defects at our Institution from 1998 to 2001. Eleven patients (Group 1) had concomitant surgery performed after birth. Group 2 (7 out of 28) included patients without hydrocephalus at birth, in Group 3 (4 out of 28) the children did not develop hydrocephalus, and Group 4 (6 out of 28) patients were born outside our hospital and referred for surgical care after birth.Discussion Simultaneous insertion of shunt and correction of a myelomeningocele do not pose an additional risk to the child and do have some advantages, facilitating healing of the back without CSF leakage and protecting the brain from the effects of progressive ventricular dilatation. Patients with a myelomeningocele born outside the hospital are prone to infectious complications.     

Shifting trends in in vitro antibiotic susceptibilities for common ocular isolates during a period of 15 years

PURPOSE: To assess the in vitro susceptibility of the most common ocular bacterial isolates to several antibiotics and verify changing trends in the antibiotic susceptibility in a 15-year period. DESIGN: Experimental study. METHODS: All cultures positive for Staphylococcus aureus, coagulase-negative Staphylococcus (CNS), Streptococcus sp, and Pseudomonas sp in conjunctival (n = 4,585) and corneal (n = 3,779) samples from patients seen at the Federal University of S?o Paulo from 1985 to 2000 were evaluated. Cultures were performed in liquid and solid media, and susceptibility tests were done to amikacin, gentamicin, neomycin, tobramycin, ciprofloxacin, norfloxacin, ofloxacin, cephalothin, and chloramphenicol. RESULTS: Amikacin and neomycin showed an improvement of their sensitivity during the study period (88%-95% and 50%-85%, respectively) for corneal and conjunctival samples. Gentamicin and tobramycin revealed a decrease of sensitivity in time, from 95% to less than 80% in corneal and conjunctival samples. Ciprofloxacin, norfloxacin, and ofloxacin had good sensitivity to all evaluated bacteria, better in conjunctiva (95%) than in cornea (90%). Sensitivity of S. aureus to cephalothin decreased during the study but was still 98% for CNS. Chloramphenicol had good sensitivity to S. aureus (85% in corneal and 92%in conjunctival samples), CNS (87% and 88.5%), and Streptococcus sp (95% and 96%). CONCLUSIONS: Gentamicin, tobramycin, and cephalothin decreased their in vitro susceptibility to all tested pathogens. The fluoroquinolones remained a good choice in the treatment of ocular infections, with high suscep-tibility to all pathogens tested. Chloramphenicol also revealed an increase in its susceptibility to all bacteria evaluated.     

Effect of chronic systemic use of trimethoprim-sulfamethoxazole in the conjunctival bacterial flora of patients with HIV infection

PURPOSE: To investigate the effect of orally administered trimethoprim-sulfamethoxazole (TMP-SMZ) on the prevalence, species distribution, and resistance of the conjunctival bacterial flora in adults with human immunodeficiency virus (HIV) infection. DESIGN: Cross-sectional study, with clinical and experimental laboratory investigation. METHODS: Samples from the inferior conjunctival fornix were collected and submitted for culture to evaluate aerobic flora. RESULTS: Sixty samples were collected. Negative cultures were found in 17 (56.7%) eyes of the TMP-SMZ group and in 10 (33%) of the control group (P = .036). All Staphylococcus species isolates in the TMP-SMZ group were resistant to the drug, whereas 50% of the control group presented this finding (P = .025). In the study group, all bacteria were resistant to TMP-SMZ, compared with only 47% of the microorganisms in the control group. CONCLUSION: Orally administered TMP-SMZ in patients with HIV infection seems to exert a selection pressure in the microorganisms present on the conjunctiva.     

C-reactive protein in type 1 diabetes and its relationship to coronary artery calcification

OBJECTIVE: In 196 type 1 diabetic subjects and 195 nondiabetic subjects aged 30-55 years, we examined whether C-reactive protein (CRP) is elevated in diabetes and whether CRP is associated with coronary artery calcification (CAC). RESEARCH DESIGN AND METHODS: CRP was measured with a highly sensitive immunoassay. CAC was measured using electron beam computed tomography. RESULTS: CRP was elevated in diabetic women compared with nondiabetic women (median 1.62 vs. 0.85 mg/l, P < 0.001) independently of other factors, but was similar in diabetic and nondiabetic men (median 0.82 vs. 0.81 mg/l). Insulin dose per day was positively correlated with CRP in diabetic women (Spearman's rho = 0.36, P = 0.0003) but much less so in men (rho = 0.16, P = 0.09). Being in the top tertile for CRP was associated with CAC in diabetic and nondiabetic men even after adjustment for other risk factors (adjusted odds ratio [OR] = 4.6 and 4.3, respectively, P = 0.02 for both). In nondiabetic women, being in the top tertile for CRP was associated with CAC (OR 3.1, P = 0.04), but not independently of BMI (OR = 1 after adjustment). Among diabetic women the association was not significant even before adjustment for BMI (OR = 2.6, P = 0.07). CONCLUSIONS: Elevated CRP in diabetic women might reflect a particular sensitivity to insulin levels or might reflect insulin resistance. In general, CRP is an important marker of subclinical atherosclerosis, but the clinical significance of elevated CRP in diabetic women needs to be addressed in prospective studies, since CRP was not clearly associated with CAC in this group.