Abstract Anderson-Fabry disease (AFD) is a rare inherited X-linked disease, caused by mutations of the gene encoding the α-galactosidase A enzyme, that leads to a deficiency or absence of its activity with consequent accumulation of globotriaosylceramide (Gb3) and other glycosphingolipids in the lysosomes of several cells types in the organism, mainly the endothelial, nervous system, cardiac, and renal cells. Its heterogeneous and nonspecific presentation, similar to other common pathologies, delays the diagnosis and leads to incorrect therapy. In the presence of attenuated phenotypes with predominant involvement of an organ, it is even harder to identify patients with AFD. It is highly important to be aware of this diagnosis, since enzyme replacement therapy is currently available. This review aims to approach the clinical manifestations of AFD and the phenotypes related to the differential diagnosis for each manifestation and the frequency of follow-up recommended.

Algumas espécies de Solanum causam intoxicações em ruminantes caracterizadas clinicamente por desordens cerebelares e microscopicamente como doença do depósito lisossomal. Não há lesões de necropsia específicas e microscopicamente ocorrem vacuolização e perda de neurônios de Purkinje. Por ser Solanum paniculatum a espécie de ocorrência na região Nordeste, sendo responsável pelos surtos de intoxicação espontânea descrito no Estado de Pernambuco foi realizado um delineamento experimental para caracterizar o quadro clínico-patológico da intoxicação. Foram usados cinco bovinos, sendo quatro no grupo experimental (GE) e um animal no controle (GC), de seis meses de idade, sem raça definida, com peso de 120 Kg, mantidos em baias durante cinco meses na Clínica de Bovinos de Garanhuns/UFRPE. Os animais receberam a planta, colhida nas propriedades em que ocorreram os surtos naturais, na dosagem de 5g/kg/PV/dia da planta dessecada misturada na ração por ingestão natural. Semanalmente realizou-se o Head Raising Test para determinar os sinais cerebelares e quando positivo os animais foram submetidos à colheita de sangue e do líquido céfalo-raquidiano e em seguida foi feito à eutanásia. O SNC e a rete mirabile foram fixados em formol a 10% tamponado, processados rotineiramente e corados pela hematoxilina e eosina para avaliação histopatológica. Foi realizada análise morfométrica das lesões cerebelares. Para avaliação dos resultados laboratoriais utilizou-se análise descritiva e em relação à morfometria, empregou-se o teste T de Student (p<0.05) na contagem de células de Purkinje e para a espessura da camada molecular do cerebelo o teste de Mann Whitney, com nível de 5% de significância. Três animais apresentaram sinais de intoxicação com tempo em média de 90 dias e um com 155 dias. Os sinais clínicos observados foram ataques convulsivos transitórios, e distúrbios do equilíbrio. Na necropsia não foram encontradas lesões específicas da intoxicação. Não houve alterações no hemograma e no líquido céfalo-raquidiano causado pela planta. No histopatológico havia principalmente vacuolização fina do pericário e perda de células de Purkinje, com degeneração Walleriana e esferóides axonais na camada granular e na substância branca medular, com proliferação dos astrócitos de Bergman. Vacuolização e necrose neuronal também foram observadas no óbex, pedúnculos cerebelares e colículos rostral e caudal e raramente no tálamo, núcleos da base, hipocampo e medula oblonga. Na análise morfométrica não houve diferença significativa (p<0,05) entre o número de células de Purkinje e a espessura da camada molecular entre o GE e GC, demonstrando que apesar dos bovinos desenvolverem quadro clínico da intoxicação e alterações histopatológicas acentuadas, mas nestas condições experimentais não ocorreram alteração morfométricas significativas em relação ao GC. Sugerindo que há necessidade de um tempo de administração maior da planta para o aparecimento de lesões mais acentuadas como as que ocorrem em casos naturais. Os resultados laboratoriais de sangue e do líquido céfalo-raquidiano não refletem alterações relacionadas à intoxicação pela planta.

Some species of Solanum cause poisoning in ruminants clinically characterized by cerebellar disorders and microscopically lysosomal storage disease. There are no specific necropsy injuries and microscopically occurs vacuolation and Purkinje cells loss. Since Solanum paniculatum is the species of greater occurrence in the Northeast region of Brazil and is responsible for spontaneous intoxication outbreaks in Pernambuco State, an experimental delineation was carried out to characterize the clinical and pathological condition of the intoxication. Five cattle were randomly allotted in two groups, with four animals in the experimental group (EG) and one animal as control (CG), with six months of age, no defined breed and weighting 120 kg. All animals were kept in stalls along 5 months in the Clínica de Bovinos de Garanhuns/UFRPE. All animals from the experimental group were fed 5g/kg/body weight/day of the dried leaves of S. paniculatum which was mixed in the ration. The plant was collected in farms where outbreaks of intoxication were described. A Head Raising Test was weekly performed to determine the occurrence of any cerebellum clinical signs and when the result was positive the animal was submitted to a blood and cerebrospinal fluid sampling and subsequently euthanized. The CNS and rete mirabile were fixed in 10% buffered formalin and stained by hematoxylin-eosin for histological evaluation. Morphometric analysis of cerebellum injuries was accomplished. To evaluate the laboratory results, it was used descriptive analysis and in relation to morphometry the Student t test (p<0.05) was used in the counting of Purkinje cells and the thickness of the molecular layer of the cerebellum the Mann Whitney test, with 5% level of significance. Three animals showed clinical signs of intoxication a mean period of 90 days and one animal in155 days. Clinical signs involved transient seizure episodes and balance disturbance. At necropsy there were no specific injuries of intoxication observed as well as changes in red and white cell blood count and liquor analysis. Histological examination showed mainly thin vacuolation of the pericardium, loss of Purkinje cells with Wallerian degeneration, spheroid axons in the granular layer and in the marrows white matter with astrocytes Bergman proliferation. Vacuolation and neuron necrosis were also observed in other sites the obex, cerebellum peduncles, rostral and caudal colliculi and rarely in the thalamus, basal ganglia, hippocampus and medulla oblongata. Morphometric analysis did not differ significantly (p <0.05) in number of Purkinje cells and in molecular layer thickness between the EG and CG, showing that despite the cattle develop clinical symptoms of intoxication and marked histopathological changes, these experimental conditions had caused no significant morphometric changes in relation to the CG. It is suggested a greater time of administration of the plant for the development of most intense lesions as natural cases. Laboratory results of blood and cerebrospinal fluid do not reflect changes related to poisoning by the plant.

Dietary intervention is an important approach in the prevention of cardiovascular disease. Over the last decade, some studies have suggested that a calcium-rich diet could help to control body weight, with anti-obesity effects. The potential mechanism underlying the impact of calcium on body fat has been investigated, but it is not fully understood. Recent evidence has also suggested that a calcium-rich diet could have beneficial effects on other cardiovascular risk factors, such as insulin resistance, dyslipidemia, hypertension and inflammatory states. In a series of studies, it was observed that a high intake of milk and/or dairy products (the main sources of dietary calcium) is associated with a reduction in the relative risk of cardiovascular disease. However, a few studies suggest that supplemental calcium (mainly calcium carbonate or citrate) may be associated with an increased risk of cardiovascular events. This review will discuss the available evidence regarding the relationship between calcium intake (dietary and supplemental) and different cardiovascular risk factors and/or events.

INTRODUÇÃO: O método capaz de melhor identificar desnutrição energético-protéica (DEP) em pacientes em hemodiálise (HD) ainda se mantém em debate. Logo, avaliamos o estado nutricional de pacientes em HD por diferentes métodos e verificamos qual deles identificava o maior número de pacientes com DEP. MÉTODOS: Quinze pacientes em HD (52,7 ± 10 anos; 33,3% Masculino). O estado nutricional foi avaliado por medidas antropométricas, pela avaliação subjetiva global (ASG), por albumina plasmática e pelo consumo alimentar (recordatório de 24 horas). A gordura corporal foi avaliada por antropometria. O critério de diagnóstico de DEP preconizado pela International Society of Renal Nutrition and Metabolism (ISRNM) foi empregado. RESULTADOS: Observou-se que o índice de massa corporal esteve dentro da normalidade (24,2 ± 4,4 kg/m²). Ao avaliar a condição nutricional pela adequação da circunferência muscular do braço CMB) e da prega cutânea de tríceps (PCT) notou-se que a adequação da CMB esteve dentro dos parâmetros de normalidade (102,6 ± 13%), ao passo que a adequação da PCT esteve abaixo da normalidade (Feminino: 75,3 ± 40,4%; Masculino: 73,5 ± 20,6%). Contudo, o percentual de gordura corporal esteve elevado (Feminino: 34,5 ± 7,3%; Masculino: 23,6 ± 4,2%). Com relação à ASG, a maioria dos pacientes (n = 12) apresentou algum grau de desnutrição e este constituiu o método que identificou o maior número de pacientes com DEP. Ao empregar os critérios da ISRNM, notou-se que apenas dois pacientes apresentaram DEP. CONCLUSÃO: Todos os pacientes avaliados encontravam-se com DEP por algum dos métodos utilizados. A ASG foi o método que, isoladamente, conseguiu detectar o maior número de pacientes com DEP.

INTRODUCTION: The method capable of best identifying protein-energy wasting (PEW) in hemodialysis (HD) patients is controversial. Thus, we assessed the nutritional status of HD patients by use of different methods and verified which one identified the highest number of patients with PEW. METHODS: The study assessed the nutritional status of 15 HD patients (age: 52.7 ± 10.1 years; males: 33.3%) by use of anthropometric measurements, subjective global assessment (SGA), serum albumin, and dietary intake (24-hour food recall). Body fat was assessed by use of anthropometry. The International Society of Renal Nutrition and Metabolism (ISRNM) criteria were used to diagnose PEW. RESULTS: The body mass index (24.2 ± 4.4 kg/m²) and the percentage of standard value for mid-arm muscle circumference were within the normal limits (102.6 ± 13%). Nevertheless, the percentage of standard value for triceps skinfold was below the normal limits (females, 75.3 ± 40.4%; and males, 73.5 ± 20.6%), although a high body fat percentage was observed (females, 34.5 ± 7.3%; males, 23.6 ± 4.2%). When assessing the nutritional status by use of SGA, most patients (80%, n = 12) were malnourished, and SGA was the method that identified the highest number of patients with PEW. By using the ISRNM criteria, PEW was diagnosed in only two patients. CONCLUSION: All patients were diagnosed with PEW by use of one of the methods studied. The SGA was the method that, in isolation, could detect the greatest number of patients with PEW.

OBJECTIVE: This study aimed to evaluate long-term weight loss in overweight hypertensive patients receiving dietary counseling. METHODS: Longitudinal study included overweight hypertensive patients who had an initial individual consultation with a nutritionist between January 2002 and December 2005 and were followed for four years in a hypertension clinic. Patients who had at least four consultations during the follow-up period were included in the dietary counseling group. Those who scheduled their first consultation but missed that appointment or had fewer than four consultations during the follow-up period were allocated to the control group. Target Energy intake was calculated at 20-25 kcal/kg actual body weight/day. RESULTS: The study included 102 patients aged 55 + 1 years old (58 in the dietary counseling group). As compared with the control group, patients in the dietary counseling group showed a significantly greater reduction in body weight (-3.6 + 0.8 vs. 0.8 + 0.7 kg), which remained significant after controlling for age, gender, baseline body mass index, and the use of different antihypertensive and antidiabetic drugs. Weight loss between 5.0% and 9.9% was observed in a significantly higher percentage of patients in the dietary counseling group (28% vs. 11%). A weight loss of at least 10% was only observed in dietary counseling group patients, who had a significantly lower odds ratio for increasing the number and/or dosage of antihypertensive agents, even after controlling for age, gender, and baseline body mass index. CONCLUSIONS: Dietary counseling may be associated with long-term weight loss in overweight hypertensive patients.

O potencial citotóxico de extratos orgânicos do caule de Calotropis procera (Asclepiadaceae) foi primeiramente avaliado frente a linhagens de células tumorais através do ensaio de MTT. Aquelas amostras consideradas citotóxicas foram sub-sequentemente testadas para atividade antimitótica sobre o desenvolvimento de ovos de ouriço-do-mar e para atividade antiproliferativa in vivo em camundongos transplantados com tumor Sarcoma 180. Dentre os cinco extratos estudados (hexano, diclorometano, acetato de etila, acetona e metanol), os extratos acetato de etila e acetona mostraram maior potencial citotóxico contra células tumorais, com CI50 variando de 0,8 to 4,4 μg/mL, enquanto o extrato metanólico revelou ser fracamente citotóxico. s extratos citotóxicos também exibiram capacidade de inibição da divisão celular com valores de CI50 menores que 5 μg/mL. Nas avaliações antitumorais in vivo, os animais tratados com os extratos acetato de etila e acetona mostraram taxas de inibição do crescimento tumoral de 64,3 e 53,1%, respectivamente, com efeitos tóxicos reversíveis sobre o fígado e os rins.

The cytotoxic potential of stem organic extracts from Calotropis procera (Asclepiadaceae) was firstly evaluated against cancer cell lines by MTT assay. Subsequently, samples considered cytotoxic were tested for antimitotic activity on sea urchin egg development and for in vivo antiproliferative activity in mice bearing Sarcoma 180 tumor. Among the five extracts (hexane, dichloromethane, ethyl acetate, acetone and methanol), ethyl acetate and acetone extracts displayed higher cytotoxic potential against tumor cells, with IC50 ranging from 0.8 to 4.4 μg/mL, while methanolic extract was weakly cytotoxic. Cytotoxic extracts also exhibited cell division inhibition capacity by antimitotic assay, revealing IC50 values lower than 5 μg/mL. In the in vivo antitumor assessments, ethyl acetate- and acetone-treated animals showed tumor growth inhibition ratios of 64.3 and 53.1%, respectively, with reversible toxic effects on liver and kidneys. Further studies are in progress in order to identify C. procera cytotoxic compound(s) and to understand the mechanism of action responsible for this tumor-decreasing potential.

Sob anestesia geral e com controle da pressão arterial, 12 eqüinos foram submetidos simultaneamente a modelos de isquemia venosa e distensão intraluminal em segmentos do jejuno por 2 h, seguidos de 12 h de reperfusão. Seis eqüinos foram tratados com glutamina a 2% (50mg/kg) por via intravenosa e seis com solução fisiológica em igual volume, 1 h após o início da isquemia e às 6h de reperfusão. Foram colhidas amostras de tecido intestinal antes e com 2 h de isquemia e com 2 e 12 h de reperfusão para avaliações histopatológica e ultraestrutural, mensuração da área e número das vilosidades por mm² e atividade de mieloperoxidade (MPO). Não foram encontradas diferenças entre os grupos controle e tratado. Concluiu-se que a glutamina, nas condições deste trabalho, não atenua lesões de isquemia e reperfusão intestinal em eqüinos.

Under general anesthesia and arterial pressure control, twelve horses were submitted simultaneously to intraluminal distension and venous ischemia of jejune for 2 hours, followed by 12 hours of reperfusion. Six horses were treated with intravenous 2% glutamine (50mg/kg), and six others were treated with the same volume of saline solution 1h after the beginning of ischemia and 6 hours after reperfusion. Intestinal samples were collected before and after 2 hours of ischemia and after 2 and 12 hours of reperfusion, and were submitted to hystopatological analyses, ultrastructural examination, measurement of area and number of villi per mm², and to myeloperoxidases activity. No statistical differences between the groups were found. It was concluded that glutamine did not attenuate the ischemia and reperfusion lesions under the methodology used in this study.

A matriz extracelular (MEC) desempenha um papel importante em lesões hepáticas crônicas e tem sido estudada em modelos de intoxicação experimental. Em bovinos, no entanto, não há estudos específicos sobre a MEC hepática normal ou com lesões crônicas. Por isso, foi desenvolvido um modelo de intoxicação experimental hepático usando Senecio brasilliensis, uma planta que contém alcalóides pirrolizidínicos e causa lesão hepática dependente da dose. Cinco bezerros receberam por via oral, 0.38g/kg de folhas secas por 24 dias. Biópsias hepáticas foram obtidas a cada 15 dias durante 60 dias. Sinais clínicos de complicações digestivas surgiram da terceira semana do experimento. Um bezerro morreu aos 45 dias e os outros quatro foram avaliados até os 60 dias. As biópsias hepáticas foram processadas para microscopia óptica, imuno-histoquímica e microscopia eletrônica de transmissão. No trigésimo dia, as lesões hepáticas eram progessivas caracterizadas por vacuolização hepatocelular, necrose, apoptose, megalocitose, e fibrose centrolobular, pericelular e portal. Foram realizadas avaliações quantitativas e semi-quantitativas de componentes da MEC hepática antes e após o aparecimento das lesões. Foi realizada morfometria do colágeno total e do sistema de fibras elásticas. Colágeno total e colágenos tipos I e III aumentaram progressivamente em todos os locais do fígado. Mudanças na localização, quantidade e disposição do sistema de fibras elásticas foram também observadas. Houve um aumento significativo de células de Kupffer aos 30 dias e de células sinusoidais totais aos 45 e 60 dias. As lesões hepáticas neste experimento foram progressivas mesmo após a remoção da planta. Lesões de fibrose severa foram localizadas principalmente nos espaços porta, seguido por fibrose veno-oclusiva e pericelular. Os colágenos tipo I e tipo III foram observados no fígado normal e no fígado dos bezerros afetados, com predomínio do tipo I. Nos bezerros afetados o aumento do colágeno total e do sistema de fibras elásticas foi paralelo ao aumento no número das células sinusoidais.

Extracellular matrix plays an important role in chronic hepatic lesions and has been studied in experimental intoxication models. However in cattle, studies on chronic disease have focused on the hepatocellular damage and extracellular matrix (ECM) changes are usually overlooked. There are no specific studies on the hepatic ECM in either normal or chronically damaged bovine liver. Thus an experimental model of hepatic toxicity model using Senecio brasiliensis poisoned calves was designed. Senecio brasiliensis contains pyrrolizidine alkaloids which cause either acute or chronic progressive dose dependent liver damage. Five calves were orally fed with 0.38g of dry leaves of S. brasiliensis/kg/day for 24 days. Liver needle biopsy specimens were obtained every 15 days for 60 days. Clinical signs of digestive complications appeared at 3rd week. One calf died on 45th day and four were evaluated up to 60th day. Biopsy samples were processed for routine light microscopy, immuno-histochemistry and transmission electron microscopy. From 30th day on progressive liver damage characterized by hepatocellular ballooning, necrosis, apoptosis and megalocytosis, centrilobular, pericellular and portal fibrosis were seen by light microscopy. Quantitative and semi-quantitative measurements of hepatic ECM components were performed before and after the onset of lesions. Morphometric analysis of total collagen and elastic fiber system was conducted. Total collagen and I and III collagen types progressively increased in throughout the liver of affected calves. Changes in location, amount and disposition of the elastic fiber system were also observed. Then numbers of Kupffer cells were significantly increased at 30th day and total numbers of sinusoidal cells were significantly increased at 45th and 60th days. Liver damage was progressive and irreversible even after the exposure to the plant was discontinued. Severe fibrotic lesions occurred mainly in portal tracts, followed by veno-occlusive and pericellular fibrosis. Collagen types I and III s were present in every normal and damaged liver, with predominance of type I. In affected calves the increase of total collagen and elastic fibers system paralleled the number of total sinusoidal cells.

Para estudar os efeitos da ingestão de sementes de Crotalaria spectabilis em suínos, 14 porcos foram divididos em 5 grupos; quatro (A-D) eram formados por 3 porcos e um (Grupo E) por dois porcos. Com exceção do grupo A, que serviu como controle, os porcos foram alimentados com ração contendo 0,3 e 0,5% (Grupos B e C) e 1% (Grupos D e E) de sementes moídas de C. spectabilis por 32 (Grupo D), 44 (Grupo E) e 120 (Grupo B e C) dias. Um suíno do Grupo D e 2 suínos do Grupo B, morreram 8, 70 e 137 dias após o início do experimento; os restantes 11 suínos foram sacrificados em períodos que variaram entre 52 e 159 dias após o início do experimento. Dez dos 11 suínos tratados apresentaram perda do apetite e subdesenvolvimento. Outros sinais clínicos observados foram depressão, perda localizada de pêlos e distúrbios respiratórios. As principais lesões ocorreram no fígado. Em um caso eram agudas e consistiam principalmente de padrão lobular acentuado resultante de necrose centrolobulara massiva. Os outros 11 suínos apresentavam lesões hepáticas crônicas; o fígado estava firme, com cápsula espessada e aderências fibrosas entre os lobos e a estruturas adjacentes. Microscopicamente havia fibrose capsular, interlobar, interlobular e intralobular; hepatomegalocitose e proliferação de ductos biliares. Bilestase foi observadada no fígado de dois suínos; num outro havia regeneração hepatocelular nodular. Os pulmões de 4 suínos estavam avermelhados e firmes. Histologicamente havia espessamento dos septos interalveolares e interlobulares por edema, fibrose e infiltração celular, e proliferação de pneumócitos tipo II. Alterações renais foram observadas apenas microscopicamente e incluíam, principalmente, hepatomegalocitose das células epiteliais tubulares. Em 6 porcos observaram-se edemas cavitários (ascite, hidrotórax e hidropericárdio) de intensidade discreta a moderada. Alterações vasculares microscópicas consistindo de espessamento e hialinização da parede arterial foram observadas no pulmão de 5 suínos e no rim de 3. Quatro suínos tinham alterações sugestivas de encefalopatia hepática. Essas alterações não foram observadas nos suínos controles.

To study the effects of the ingestion of Crotalaria spectabilis seeds, fourteen pigs were alloted in 5 groups. Four groups (A-D) consisted each of three pigs and the other (Group E) of two pigs. With the exception of those from Group A, which served as control, pigs were fed a ration containing 0.3 and 0.5% (groups B and C) and 1% (Groups D and E) of ground seeds of C. spectabilis for 32 (group D), 44 (group E), and 120 (groups B and C) days. One pig from Group D and two pigs from Group B died at 8, 70, and 137 days after the beginning of the experiment; the remaining 11 pigs were euthanatized at periods varying from 52 to 159 days from the beginning of the experiment. Ten of the 11 treated pigs had loss of apetite and poor growth rate. Depression, localized loss of hair, and respiratory distress were other observed clinical signs. Main pathological changes occurred in the liver. They were acute in one case and consisted of accentuation of the lobular pattern; due to centrilobular to massive hepatic necrosis. The remaining 11 treated pigs had chronic hepatic lesions, which included firmness, thickening of the capsule and fibrous adhesions between lobes and between hepatic capsule and adjacent structures. Histologically there was capsular, interlobar, interlobular, and intralobular fibrosis, hepatomegalocytosis and proliferation of bile ducts. In two case there was bilestasis and, in one pig, nodular regeneration was observed. The lungs of 4 pigs were reddened and firm. Histologically there was thickenning of interalveolar and interlobular septa by edema, fibrosis, cell infiltration and type II pneumocytes proliferation. The kidneys were grossly unremarkable. Histologically there was megalocytosis of the tubular epithelium and of the cells of the glomerular tuft. Hialinization of the glomerular tuft was also observed. Mild to moderate cavitary edema (ascites, hydrothorax and hydropericardium) was observed in 6 pigs. Microscopic vascular lesions consisting of arterial wall thickening and hialinization were seen in the lung of 5 pigs and in the kidney of 3 pigs. Four pigs had microscopic changes suggestive of hepatic encephalopathy. Those changes were not observed in the controls.