O estudo etiológico das citopenias nos doentes submetidos a transplante de órgãos sólidos constitui um desafio dada a multiplicidade de causas subjacentes: infeções, toxicidade medular induzida por fármacos ou doença hematológica. A leishmaniose visceral (LV) é uma doença endémica em diversas regiões do globo, sendo, contudo, uma complicação rara após a transplantação renal (TR) (menos de 100 casos descritos na literatura). Os autores descrevem o caso de um doente do sexo masculino, 57 anos, transplantado renal, internado na unidade de TR 17 meses após o transplante por síndrome febril e pancitopenia grave. O doente apresentava leucopenia e trombocitopenia com 2 meses de evolução e de agravamento progressivo, apesar da suspensão da terapêutica potencialmente mielotóxica e queixas de astenia, sudorese nocturna e perda ponderal. Ao exame objectivo encontrava-se febril, com palidez muco-cutânea e esplenomegalia. O estudo laboratorial inicial revelou leucócitos 1,1 x109/l, plaquetas 68 x109/l, hemoglobina 10,3 g/dl, creatinina 1,48 mg/dl e proteína C reactiva 9,72 mg/dl e a ecografia abdominal confirmou a existência de esplenomegalia. Realizada punção aspirativa de medula óssea e iniciada terapêutica antibiótica empírica sem melhoria clínica. O estudo analítico adicional foi inconclusivo: culturas de sangue e de urina negativas, sem evidência de infeção por citomegalovírus, parvovírus B 19, VIH, vírus da hepatite B ou C. Excluídas massas tumorais e adenopatias por tomografia computorizada. Apesar da inexistência de um contexto epidemiológico óbvio, o exame de medula óssea revelou presença de amastigotas de Leishmania spp. Iniciada anfotericina B lipossómica (4 mg/Kg/dia; total de 10 administrações) com registo de melhoria clínica e laboratorial a partir do 2º dia de tratamento. A LV é uma infeção potencialmente fatal se o tratamento adequado não for instituído/iniciado tardiamente. Apesar de constituir uma complicação infeciosa rara após a TR, os autores destacam a importância da sua inclusão no diagnóstico diferencial de pancitopenia febril neste grupo de doentes.

The aetiological study of cytopenia in solid organ transplant recipients could be challenging, given the need to exclude infectious disorders, drug toxicity or neoplastic disease. Visceral leishmaniasis is endemic in several regions of the world, but a rare complication after renal transplantation (less than 100 cases described in literature). We report the case of a male renal transplant recipient, 57 years of age, admitted to our Unit 17 months after transplantation with febrile illness and severe pancytopenia. He had a history of leucopenia and thrombocytopenia detected in follow-up exams two months earlier, with progressive worsening despite discontinuation of drugs with potential haematologic toxicity. On admission, his complaints were weakness, night sweats and weight loss. On examination, he was febrile, pale, and had a palpable spleen. Laboratory exams demonstrated: leukocytes 1.1 x109/L, platelets 68 x109/L, haemoglobin 10.3 g/dl, serum creatinine 1.48 mg/dl, C-reactive protein 9.72 mg/dl. Abdominal ultrasound confirmed splenomegaly. A bone marrow aspiration was performed and antibiotic therapy was instituted empirically, without improvement. Additional laboratory results were inconclusive: negative blood and urine cultures, no evidence of cytomegalovirus, parvovirus B19 or HIV infections, hepatitis B and C and masses/ adenopathies were excluded by computerized tomography. Despite the absence of an evident epidemiological context, the bone marrow examination showed amastigotes of Leishmania spp. He was started on liposomal amphotericin B (4 mg/kg/day; total of 10 administrations) with a sustained clinical and laboratory improvement after the second day of therapy. Visceral leishmaniasis is a potentially lethal infection if treatment is delayed or not instituted. Although rare among renal transplant recipients it should be included in the differential diagnosis of febrile pancytopenia

O presente artigo tem como objectivo tratar a relação existente entre cultura e imagem corporal. Pretendemos saber de que forma é que os factores socioculturais influenciam a maior ou menor satisfação com a imagem física. A ênfase é dada à cultura ocidental, cujos principais “representantes” são os Estados Unidos da América e a Europa, uma vez que, principalmente através dos media, os seus valores chegam a toda a parte do mundo, influenciando, mesmo, as demais culturas. Nesta perspectiva, ao longo do artigo, é retratada uma verdadeira “cultura do magro” que, atendendo às investigações até agora realizadas, apontam o sexo feminino como a principal “vítima”. Todavia, é cada vez mais evidente que a insatisfação corporal é uma realidade para ambos os sexos e um resultado directo do não enquadramento em padrões estético-culturais.

The present study aims to investigate the relationship between culture and body image. We intend to know how socio-cultural factors influence the levels of satisfaction with body image. The emphasis is given to the cultural values as represented by the sociocultural norms of societies such as the United States of America and Europe. It is argued that through the media, the values of these industrialized societies are dissipated throughout the world provoking cultural changes and uniformization of behavioural standards. From the literature review, it is possible to conclude that body dissatisfaction is a reality to both sexes and a direct result of the non-conformity to cultural-esthetical patterns promoted by the profit-oriented societies.

Alkaline phosphatase (ALP) is important in calcification and its expression seems to be associated with the inflammatory process. We investigated the in vitro acute effects of compounds used for the prevention or treatment of cardiovascular diseases on total ALP activity from male Wistar rat heart homogenate. ALP activity was determined by quantifying, at 410 nm, the p-nitrophenol released from p-nitrophenylphosphate (substrate in Tris buffer, pH 10.4). Using specific inhibitors of ALP activity and the reverse transcription-polymerase chain reaction, we showed that the rat heart had high ALP activity (31.73 ± 3.43 nmol p-nitrophenol·mg protein-1·min-1): mainly tissue-nonspecific ALP but also tissue-specific intestinal ALP type II. Both ALP isoenzymes presented myocardial localization (striated pattern) by immunofluorescence. ALP was inhibited a) strongly by 0.5 mM levamisole, 2 mM theophylline and 2 mM aspirin (91, 77 and 84%, respectively) and b) less strongly by 2 mM L-phenylalanine, 100 mL polyphenol-rich beverages and 0.5 mM progesterone (24, 21 to 29 and 11%, respectively). β-estradiol and caffeine (0.5 and 2 mM) had no effect; 0.5 mM simvastatin and 2 mM atenolol activated ALP (32 and 36%, respectively). Propranolol (2 mM) tended to activate ALP activity and corticosterone activated (18%) and inhibited (13%) (0.5 and 2 mM, respectively). We report, for the first time, that the rat heart expresses intestinal ALP type II and has high total ALP activity. ALP activity was inhibited by compounds used in the prevention of cardiovascular pathology. ALP manipulation in vivo may constitute an additional target for intervention in cardiovascular diseases.

A review of the statistics of the years 2003, 2004 to August 2005 has provided data corresponding to 255 patients that were diagnosed and included in the treatment protocol of chronic hepatitis C. Epidemiologically, the 2/1 man/woman ratio, mean age of 43 years and history of transfusion (transf.) in 18.6% are to be noted. Parenteral drug addcition (PDA) in 17% and alcoholism in 14.1%, of unknown origin in 58.74% of the cases. 79.05% corresponded to genotype 1, 4.74% to genotype 4, 14.22% to genotype 3, and 2.76% to genotype 2. Genotypes 1 and 4 were included in the treatment regime with PEG-Interferon alpha-2b + Ribavirin (with doses adjusted for weight) and those of genotype 3 and 2 in the regime with Interferon alpha 2b + Ribavirin. In 95 cases of Genotype 1 (87) and 4 (8), a sustained viral response (SVR) of 61.95% was obtained, with three drop-outs. In the 20 cases of genotypes 3 (17) and 2 (3), SVR was 85%, with no drop-outs. In the 20 cases of genotypes 3 (17) and 2 (3), SVR was 85%, with no drop-outs. The adjustment of treatment to body mass involved an economic savings per case amounting to 868.94 €. Finally, in 16 cases of Genotype 1, before treated with Interferon in monotherapy, a sustained viral response of 31.25% was obtained with combined therapy.

Revisando la estadística de los años 2003, 2004, hasta agosto de 2005, tenemos datos correspondientes a 255 pacientes que fueron diagnosticados e introducidos en protocolo de tratamiento de hepatitis crónica por virus C. Epidemiológicamente es de destacar la proporción de 2/1 entre hombre/mujer, edad media de 43 años y antecedentes de transfusión (Transf.) en un 18,6%. Adicción a drogas por vía parenteral (ADVP) en el 17% y etilismo del 14,1%, siendo el origen desconocido en el 58,74% de los casos. Correspondieron al genotipo 1 el 79,05% de los casos, genotipo 4 el 4,74%, genotipo 3 el 14,22% y genotipo 2 el 2,76%. Los genotipos 1 y 4 fueron introducidos en protocolo de tratamiento con PEG-interferón alfa-2b + ribavirina (con dosis ajustadas según peso) y los de genotipo 3 y 2 con interferon alfa 2b + ribavirina. En los 95 casos de genotipo 1 (87) y 4 (8), se obtuvo una respuesta viral sostenida (RVS) del 61,95%, con tres abandonos. De los 20 casos de genotipos 3 (17) y 2 (3), la RVS fue del 85%, sin ningún abandono El ajuste del tratamiento al peso supuso un ahorro económico por caso, teniendo sólo en cuenta PEG-interferón, que se cifró en 868,94 €. Por último, grupo de 16 casos del genotipo 1 había sido tratado anteriormente con interferón en monoterapia, consiguiéndose con el nuevo tratamiento una RVS en 5 casos de los primeros (31,25%).