Gender determines long-lasting effects on adult offspring heart after early-life malnourishment

This study evaluates the effect of insulin in the association between nutrition and gender during lactation on inducing changes in heart morphology of pups when adults. Two groups of lactating rat dams were fed a normal diet containing 22% protein or 0% protein during the first 10 days of lactation. Eight-day-old rats from the female control group (FC) displayed a heart weight/body weight (H/B) ratio 100% greater when compared with the male control group (MC). An increased H/B ratio (65%) was found in the MC group when compared with the male malnourished group (MM). An effect on the development was present in the FC group in which, at 8 days, the H/B ratio was 70% greater than in this group at 60 days of age. A similar effect was observed in the female malnourished group (FM), where the H/B ratio was 100% greater. The effect on the development, at 8 days, in the FC group, when compared with the females at 60 days, displayed a larger cardiomyocyte volume [QA(c)] and a higher cardiomyocyte density [Vv(c)]: QA[c] 220% greater (p < 0.05) and Vv[c] 530% greater (p < 0.01). The FM group, at 8 days of age, had the QA[c] and Vv[c] greater than at the age of 60 days: QA[c] 100% greater (p < 0.05) and Vv[c] 290% greater (p < 0.05). The insulin/glucose ratio reflected the variable gender associated with the malnourishment in the male animals at 8 days of age. In these animals the insulin/glucose ratio of the malnourished animals was found to be reduced by 42% when compared with the control groups. At 60 days of age, a difference in the insulin/glucose ratio was present between FC and FM groups (33% greater in the FC group, p < 0.05). Gender was associated with a high insulin/glucose ratio in MC and MM groups when compared with the FC and FM groups. Also this association was observed in the animals at 60 days of age when the insulin/glucose ratio of the MM animals was 45% greater than that observed in the FM group.     

Liver transplantation with monosegment from a living donor

The shortage of organ donors for low-weight liver transplant recipients, especially for small children, has led to the development of new surgical techniques to increase the donor pool. Almost all of these techniques use the left lateral segment (Couinaud's segments II and III), but even this graft could be too large for children under 10 kg. We report here the case of an 8-month-old boy, weighing 6.1 kg, who received a monosegmental graft (segment III) from his grandmother weighing 68 kg. The graft was reduced at the donor surgery, before clamping of the vessels. The donor was discharged on the fourth post-operative day; the recipient had an uneventful post-operative period and was discharged after 22 days.     

Priority for children in cadaveric kidney sharing: the strategy adopted in Sao Paulo, Brazil

Abstract: Early kidney transplantation is crucial in order to accomplish both optimal mental development and the best adult height in children with end‐stage renal disease. The aim was to evaluate the efficacy of the child priority policy for cadaveric kidney sharing adopted in the State of Sao Paulo (Brazil). We performed a retrospective study of data collected by the Government Transplant Department in São Paulo, involving all patients included in the waiting list from August 13, 1998 to December 31, 2001. During the study period, the child priority policy had been changed giving: period A – from the outset up to March 14, 2001, where the rule was to direct cadaveric kidneys obtained from children <12 yr, to recipients <12 yr; period B – from March 14, 2001 onwards, where the policy had been broadened to include cadaveric donors <18 yr, destined for recipients <18 yr. We performed the analysis of the data comprising 8940 patients, 8622 being adults (mean age = 48.6 ± 14.1 yr, 3594 females) and 318 children (mean age = 11.9 ± 5.1 yr, 156 females). Over the 3.5‐yr follow‐up there were 1964 deaths [1933 adults and 31 children, odds ratio (OR) 0.37; 95% CI 0.25–0.55], 1032 living donor kidney transplants (963 adults and 69 children, OR 2.20; 95% CI 1.66–2.93), and 556 cadaveric kidney transplants (444 adults and 112 children, OR 10.11; 95% CI 7.75–12.94). Three and a half years after being enrolled on the list, 24% of the children and 75% of the adults, respectively, were still awaiting a cadaveric kidney transplant (log rank test = 539, p < 0.00001). The analysis of period A vs. period B, suggests that the raising of the inclusion age upper limit to 18 yr, resulted in a twofold increase in the percentage of children being grafted within 6 months of enrollment. Overall, our data shows a slow rate of cadaveric kidney transplantation activity in Sao Paulo. Children's chances of receiving a living donor kidney almost doubled. Moreover, 19.5% of pediatric recipients had received their kidney within the first year of being enrolled on the waiting list. The scheme adopted in Sao Paulo is encouraging, but the results remain less favorable than those observed in other countries. The adoption of the priority policy did not result in an unacceptable increase of adult waiting time, given that the number of adults on our waiting list outweighs by far the number of children.     

Evaluation of the fluoride concentration and consumption of mineral water

OBJECTIVE: Considering that water is an importance source of fluoride intake, and that the consumption of mineral water and prevalence of dental fluorosis have been increasing, the aim of this study was to evaluate the consumption of mineral water and its fluoride concentration. METHODS: The study was performed in residential districts of the municipality of Bauru, State of S?o Paulo, by means of stratified sampling via clusters. Each cluster corresponded to one residential block. For randomization purposes, the residential blocks were numbered within the 17 districts established by the city plan. One thousand homes were thus visited. Mineral water samples were collected using previously labeled 50 ml plastic flasks. Fluoride analysis was done using an ion-sensitive electrode (Orion 9609), after buffering using TISAB II. Information on the consumption of mineral water was obtained by means of applying a questionnaire. RESULTS: Around 29.72% of the city's population was consuming mineral water. In the 260 samples analyzed from 29 different brands of water, the fluoride concentration ranged from 0.045 to 1.515 mg/l. For one brand, the label stated that the fluoride concentration was 0.220 mg/l, but analysis revealed a concentration of 1.515 mg/l. Moreover, some brands did not specify the fluoride concentration on the label and, for these, the analysis showed concentrations ranging from 0.049 to 0.924 mg/l. CONCLUSIONS: The results demonstrated wide variation in fluoride concentrations and reinforce the importance of the control of such waters by the sanitary surveillance agency.     

National Health Innovation System: relations between scientific fields and economic sectors

Health Science and Technology is currently the subject matter of government and university actions. Such actions should converge to the establishment of a National Health Innovation System, which still calls for acknowledgment from the economic sector counterpart. A study was carried out with the purpose of describing the relations between scientific fields and economic sectors as a means of learning more about this System. Records from the Brazilian Directory of Research Groups (version 4.1) were examined and selected when Health was a keyword either to field of knowledge or economic sector. Data were compiled into multiresponse variables and analyzed in contingency tables using residual, correspondence, and cluster analyses. It was found that the Brazilian National Health Innovation System constitutes a sectorial system where competitiveness is more socially than economically-oriented, making this System favorably in tandem with the National Unified Health System as well as responsive to public policies focused on social welfare.     

The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil

BACKGROUND: The association between overweight parents and overweight children/adolescents was investigated in Rio de Janeiro, Brazil between 1995 and 1996, controlling for the influence of socio-economic and demographic factors. METHODS: Data were obtained from a two-stage, residence-based, random sample survey of children and adolescents aged 6-19 years and their parents. Body mass index (BMI) was used to classify nutritional status. Initially, a logistic regression model was built, using an indicator of parental weight (maternal BMI) as one of the independent variables and the child/adolescent's BMI as the dependent variable. Following that, the association between socio-economic and demographic variables and overweight children/adolescents was analysed in a univariate analysis. These variables were pre-selected for inclusion in the logistic model, provided that their levels of statistical significance were below P=0.25, and were added to the model individually according to the order of association strength in the univariate analysis. Finally, variables were retained in this model at a significance level of P=0.05. RESULTS: This study found that 20.7% of girls and 26.9% of boys were overweight, with a larger prevalence among children aged less than 9 years. In addition to maternal BMI, the predictors of overweight children and adolescents were age, gender and the number of people in a house. CONCLUSIONS: These results demonstrate the relationship between maternal nutritional status and overweight children and adolescents, suggesting that obesity-prevention programmes should be focused on the family.     

Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites in the north eastern Amazon region of Brazil

The efficacies of specific Bothrops atrox-Lachesis and standard Bothrops-Lachesis antivenoms were compared in the north eastern Amazon region of Brazil. The main aim was to investigate whether a specific antivenom raised against the venom of B. atrox, the most important Amazon snake species from a medical point of view, was necessary for the treatment of patients in this region. Seventy-four patients with local and systemic effects of envenoming by Bothrops or Lachesis snakes were randomly allocated to receive either specific (n = 38) or standard (n = 36) antivenoms. In 46 cases (24 in the standard antivenom group, 22 in the other) the snake was identified either by enzyme immunoassay or by examination of the dead snake, as B. atrox in 45, L. muta in one. Patients were similar in all clinical and epidemiological respects before treatment. Results indicated that both antivenoms were equally effective in reversing all signs of envenoming detected both clinically and in the laboratory. Venom-induced haemostatic abnormalities were resolved within 24 h after the start of antivenom therapy in most patients. The extent of local complications, such as local skin necrosis and secondary infection, was similar in both groups. There were no deaths. The incidence of early anaphylactic reactions was 18% and 19%, respectively for specific and standard antivenoms; none was life-threatening. Measurement of serum venom concentrations by enzyme immunoassay (EIA) confirmed that both antivenoms cleared venom antigenaemia effectively. EIA also revealed that one patient had been bitten by Lachesis muta, although the clinical features in this case were not distinctive.