Tercilio Luiz Turini

Fatores prognósticos da doença meningocócica: estudo relativo a 254 casos

Analisa-se, em relacao a 254 casos de doenca meningococica, a variacao da letalidade sob a influencia dos seguintes fatores que, segundo a literatura, agravam-lhe o prognostico: grupos de idade extrema, tempo curto de historia antes da admissao, presenca de purpuras e/ou petequias na admissao, ocorrencia de choque ou de coma, numero de leucocitos normal ou diminuido no sangue periferico na admissao, liquido cefalorraquidiano normal na admissao, numero de leucocitos normal ou diminuido no sangue periferico na admissao, numero de leucocitos menor que 100/mm³, proteinorraquia maior que 300 mg/dl, ou glicorraquia menor que 10 mg/dl, no liquido cefalorraquidiano colhido na admissao. Dentre esses fatores, aqueles para os quais se demonstrou influencia estatisticamente significativa sobre a letalidade foram: 1) idades extremas: maior letalidade em criancas com menos de um ano de idade e em adultos com mais de 40 anos; 2) tempo de historia, antes da admissao hospitalar, menor que 48 horas; 3) presenca de coma ou 4) choque na admissao; 5) numero de leucocitos, no sangue periferico colhido na admissao, igual ou menor que 10.000/mm³. A combinacao desses fatores evidenciou que, quanto maior o numero deles associados, mais alto o indice de letalidade.Two hundred and fifty-four cases of acute meningococcic meningitis at the hospital of the University of Londrina, Parana (Brazil), between 1972 and 1976, were analyzed to determine the lethality of nine prognostic factors, which, according to literature, are said to aggravate the prognosis, namely: age, the period of time the patient has had the disease before admission, petechial and purpuric lesions of the skin, shock, coma, reduced number of leucocytes in peripherical blood, normal cerebrospinal fluid (c.s.f.) on admission, leucocyte number in c.s.f. lower than 100/mm3, protein concentration in c.s.f. higher than 300 mg/dl and glucose concentration in c.s.f. lower than 10 mg/dl (all in c.s.f. obtained upon admission). The following prognostic factors significantly influenced the mortality rate for this disease: 1) extreme ages - greater lethality in children under one year of age and in adults older than 40; 2) if the patient showed signs of the disease less than 48 hours before admission; 3) patient in coma upon admission, or; 4) in a state of shock; 5) leucocytes numbering 10,000/mm3 or lower in peripherical blood obtained upon admission. The combination of these factors showed that the greater the number of associated factors, the higher the mortality rate.

Desnutrição e aproveitamento escolar: estudo entre escolares da primeira série do primeiro grau da zona urbana periférica de Londrina, PR, Brasil

Estudaram-se 450 escolares da periferia de Londrina, PR, Brasil, com o objetivo de demonstrar uma possivel associacao entre desnutricao e aproveitamento escolar. Destes 450 escolares, 227 eram do sexo masculino e 223 do feminino. A incidencia de desnutricao foi de 34,89%. Das criancas desnutridas, apenas 56,69% obtiveram rendimento satisfatorio, em comparacao aos 73,88% das criancas eutroficas, demonstrando uma relacao significativa entre desnuiricao e aproveitamento escolar. As criancas desnutridas provinham de familias com baixa renda mensal bruta per capita em maior proporcao que as eutroficas. O aproveitamento escolar mostrou estar mais relacionado ao gasto mensal per capita em alimentacao do que a renda mensal bruta per capita.Four hundred and fifty first graders from the peripheric urban area of Londrina were studied with the objective of demonstrating a possible association between malnutrition and school failure. In this series of 450 children, 227 were male and 223 were female. The incidence of malnutrition was 34,89%. Of the undernourished children, only 56,69% had a satisfactory outcome in comparison with 73,88% of the eutrophic children, thus demonstrating a significant relation between malnutrition and school failure. The undernourished children belonged to families with a low per capita gross monthly income, in a greater proportion than the eutrophic ones. School failure was shown to be more closely related to per capita month expenditures in food rather than with the per capita gross monthly income itself.

Características de carcaça e qualidade de carne de bovinos inteiros ou castrados da raça Nelore, suplementados ou não durante o primeiro inverno

This research was aimed at evaluating quantitative and qualitative characteristics of the carcass and meat from intact or castrated beef cattle, supplemented or not supplemented during the first winter. Forty Nellore males, intact or castrated, with initial weight and age of 300kg and 14 months, were submitted to the treatments: 1) SUP - Animals on pasture and supplemented (0.5% of the live body weight) with concentrated (25% of soybean meal and 75% of ground corn) during the first winter (06/01/2003 to 09/21/2003), and 2) NSU - Animals on pasture, without supplementation. At slaughter, on an average age of 28 months, the carcass characteristics were evaluated. Animals of the NSU treatment presented the largest (P 0.05) for fat thickness between castrated and intact animals (4.17 vs 2.20 mm, respectively), however, castrated animals presented greater (P<0.05) fat percentage in the carcass (16.68 vs 11.34%) and more tender meat (6.57 vs 7.50kgf) than the intact animals. Intact and non-supplemented animals presented backfat thickness lower than required by the industry.

Nimesulide-induced fatal acute liver failure in an elderly woman with metastatic biliary adenocarcinoma. A case report

CONTEXT Nimesulide is a selective inhibitor of the enzyme cyclooxygenase 2. Although considered to be a safe drug, cases of acute hepatitis and fulminant liver failure have been reported in Europe, the United States and South America, especially among elderly female patients. Until now, there had not been any reports in the literature relating to Brazilian subjects. CASE REPORT An 81-year old female who had been using nimesulide therapy for six days presented hematemesis and epistaxis two days before hospitalization. Clinical examination showed an extensive coagulation disorder, diffuse hematomas, hypotension and tachypnea. Laboratory tests revealed abnormalities in coagulation tests; leukocytosis; reduced platelet, hemoglobin and red blood cell counts; and elevated direct bilirubin, serum aspartate transaminase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase and renal function biomarkers. Hepatitis B and C tests were not reactive. Carcinoembryonic antigen (CEA), CA-19-9 and CA-125 levels were increased by, respectively, 1,000, 10,000 and 13 fold, whereas the alpha-fetoprotein level was normal, thus indicating a malignant tumor in the bile duct that did not originate from the liver. Thirty-six hours after hospitalization, the patients condition worsened, leading to death. The necropsy findings included acute hepatitis with hepatocellular collapse, as well as metastasis of a carcinoma, probably from the bile duct. CONCLUSION Despite the carcinoma presented by the patient, nimesulide use may have contributed towards the fatal acute liver failure. Until this issue has been clarified, caution is required in prescribing nimesulide for liver disease patients.