Fernando Araújo

Analysis of a polymorphism in the promoter region of the tumor necrosis factor alpha gene in schizophrenia and bipolar disorder: further support for an association with schizophrenia

Sir – Activation of the inflammatory response system has been observed in the schizophrenia and affective disorders.1,2 Investigations of the role of the inflammatory response in these psychiatric disorders include analysis of the immune mediators at the gene level, so the genetic polymorphism of specific cytokine loci has been investigated in psychiatric disorders.3,4 Recently, Boin et al5 investigated a biallelic variant (-G308A) of the TNF- gene directly related to increased production of these cytokines, and found a significant association with schizophrenia. Interestingly, the TNF- gene is located in the region 6p21.1–21.3, near the HLA region, where linkage and association studies have suggested a locus of susceptibility to schizophrenia.6

Lipidic profile of individuals without cardiopathy with overweight and obesity

OBJECTIVE To assess the lipidic profile of overweight and obese individuals submitted to cardiologic assessment and who did not show evidences of cardiopathy. METHODS Sample with 684 individuals, 389 (56.9%) women and 295 (43.1%) men, with age ranging from 14 to 74 (average of 40.6) years old, without evidences of cardiopathy after clinical assessment and analysis of electrocardiogram, thorax radiography, ergometric test on treadmill and two-dimensional Doppler echocardiogram. The serum profile of lipids and glucose regarding sex and ranges of body mass index (BMI) -- eutrophic up to 24.9 Kg/m2, overweight 25-29.9 Kg/m2 and obese > 30 Kg/m2, was studied. RESULTS The following means showed a significant statistic difference between the sexes: glucose (mg/dL) in women 90.21+/-23.13 and men 95.28+/-28.64 (p < 0.001); triglycerides (mg/dL) in women 97.27+/-55.24 and men 141.47+/-57.06 (p < 0.001) and HDL-C (mg/dL) in women 52.63+/-13.92 and men 43+/-10.88 (p < 0.001). The average BMI in women was 26.15 and in men 26.33 (p = ns). In the analysis through BMI ranges there was a significant difference between the sexes (p = 0.037). In the categories of overweight and obesity, only the means of triglycerides in women showed a significant statistic difference: overweight women with 102.25+/-60.68 mg/dL and obese 121.64+/-63.57 mg/dL (p = 0.034). CONCLUSION Women without cardiopathy showed serum levels of glucose, triglycerides and HDL-cholesterol lower than mens. In both sexes, the means are lower in the comparison with eutrophic and overweight, and only the triglycerides average of women with overweight and obesity showed significant statistic difference.

Diferenças relacionadas ao sexo nos volumes ventriculares e na fração de ejeção do ventrículo esquerdo estimados por cintilografia de perfusão miocárdica: comparação entre os programas Quantitative Gated SPECT (QGS) e Segami

OBJECTIVES To test for gender differences in the measurements obtained by Segami and Quantitative Gated SPECT (QGS) software programs. METHODS 181 asymptomatic individuals without heart disease were submitted to myocardial perfusion imaging. End-diastolic volumes (EDV), end-systolic volumes (ESV) and left ventricular ejection fraction (LVEF) were measured by QGS and Segami software programs to evaluate the influence of gender, age, weight, height, heart rate, systolic blood pressure, diastolic blood pressure, body mass index and body surface area. RESULTS The means in the QGS method were: EDV (women= 68 ml; men= 95 ml; p<0.001), LVEF (women= 66.24%; men= 58, 7%) and Segami: EDV (women= 137 ml; men= 174 ml), LVEF (women= 62.67%; men= 58, 52%). There were significant differences between men and women in the EDV (p<0.001), ESV (p<0.001) and LVEF (p=0.001) that persisted after adjusting for body surface area. CONCLUSION Ventricular volumes were significantly lower and LVEF was significantly higher in women, estimated by QGS or Segami software programs.

Aumento do índice de massa corporal em relação a variáveis clínicas e laboratoriais quanto ao sexo em indivíduos sem evidências de cardiopatia

BACKGROUND In clinical practice, the patients we care for display a wide range of body mass indices, from lean to obese. This finding may be the sole apparent clinical abnormality. OBJECTIVE To evaluate clinical and laboratory variables that might be associated with increased body mass index in asymptomatic men and women with no evidence of heart disease, to provide data to substantiate medical recommendations in a study sample from our everyday practice. METHODS The subjects aged 14 to 74 years (mean 40.6 years), 295 men (43.1%) and 389 women (56.9%) The associations between body mass index stratified by gender and clinical and laboratory variables were analyzed using the Spearman correlation coefficient and multiple linear regression. RESULTS The mean body mass index (BMI) did not differ significantly between women (26.15 Kg/m(2)) and men (26.33 Kg/m(2)). In the multiple linear regression model, the ratios of total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) (beta = 1.1320; p < 0.001) and serum glucose (beta= 0.0233; p = 0.023) were independently correlated with body mass index in women. In men, the variables independently correlated with BMI were the TC/HDL-C (beta = 0.793; p < 0.001) and age (beta = 0.0464; p = 0.030). CONCLUSION In men and women with no evidence of heart disease, TC/HDL-C increased with body mass index in both genders. Other indices associated with BMI included serum glucose in women and age in men. Clinical and laboratory variables associated with body mass index may differ in relation to gender.

THE EFFECT OF MONOSIALOGANGLYOSIDE (GM-1) ADMINISTRATION IN SPINAL CORD INJURY

ABSTRACT Objective: To evaluate the effect of monosialoganglioside (GM-1) in spinal cord trauma patients seen in our service who have not been treated with methylprednisolone. Methods: Thirty patients with acute spinal cord trauma were randomly divided into two groups. In Group 1, patients received 200 mg GM-1 in the initial assessment and thereafter received 100 mg intravenous per day for 30 days and Group 2 (control) received saline. Patients were evaluated periodically (at 6 weeks, 6 months, one year and two years), using a standardized neurological assessment of the American Spinal Injury Association / International Spinal Cord Society. Results: The comparative statistical analysis of motor indices, sensitive indices for pain and touch according to the standardization of ASIA / ISCOS showed that the assessments at 6 weeks, 6 months and 2 years, GM-Group 1 patients had higher rates than the control group regarding sensitivity to pain and touch, with no statistically significant difference from the motor index. Conclusion: The functional assessment showed improvement in the sensitive indices of patients treated with GM1 after post-traumatic spinal cord injury compared to patients who received placebo. Level of Evidence IV, Prospective Case Studies Series.

Exercise-Induced Muscle Vasodilatation and Treadmill Exercise Test Responses in Individuals without Overt Heart Disease

Background: The beneficial effects of exercise on cardiovascular health may be related to the improvement in several physiologic pathways, including peripheral vascular function. The aim of this study was to evaluate the relationship between cardiovascular responses during the treadmill exercise test and exercise-induced muscle vasodilatation in individuals without overt heart disease. Methods: The study included 796 asymptomatic subjects (431 females and 365 males) without overt heart disease. We evaluated the heart rate (chronotropic reserve and heart rate recovery), blood pressure (maximum systolic and diastolic blood pressure as well as systolic blood pressure recovery) and exercise capacity during symptom-limited treadmill exercise testing. Exercise-induced muscle vasodilatation was studied with venous occlusion plethysmography and estimated by forearm blood flow and vascular conductance responses during a 3-min handgrip maneuver. Results: Forearm blood flow increase during the handgrip exercise was positively associated with heart rate recovery during treadmill exercise testing (p < 0.001). Forearm vascular conductance increase during the handgrip exercise was inversely associated with exercise diastolic blood pressure during exercise treadmill testing (p = 0.038). No significant association was found between exercise capacity and exercise-induced muscle vasodilation. Conclusion: In a sample of individuals without overt heart disease, exercise-induced muscle vasodilatation was associated with heart rate and blood pressure responses during treadmill exercise testing, but was not associated with exercise capacity. These findings suggest that favorable hemodynamic and chronotropic responses are associated with better vasodilator capacity, but exercise capacity does not predict muscle vasodilatation.

Epidemiology of cauda equina syndrome. What changed until 2015

Objective The primary objective of this study was to analyze the characteristics and outcomes of cases admitted to hospital with cauda equina syndrome (CES) at the Institute of Orthopedics and Traumatology (IOT) from 2005 to 2015. Secondly, this article is a continuation of the epidemiological work of the same base published in 2013, and will be important for other comparative studies to a greater understanding of the disease and its epidemiology. Methods This was a retrospective study of the medical records of admissions due to CES at IOT in the period 2005–2015 with diagnosis of CES and neuropathic bladder. The following variables were analyzed: gender, age, etiology of the disease, topographic level of the injury, time interval between injury and diagnosis, presence of neurogenic bladder, time interval between diagnosis of the CES and surgery, and reversal of the deficit or of the neurogenic bladder. Results Since this is a rare disease, with a low global incidence, it was not possible, just with the current study to establish statistically significant correlations between the variables and outcomes of the disease. However, this study demonstrates the shortcomings of the Brazilian public health system, both with the initial management of these patients and the need for urgent surgical treatment. Conclusion The study shows that despite well-defined basis for the conduct of CES, a higher number of sequelae caused by the pathology is observed in Brazil. The delay in diagnosis and, therefore, for definitive treatment, remains as the major cause for the high number of sequelae. Level of evidence: 4, case series.