This study aimed to identify variables associated with the appropriate recall of indications and the drug classes that represented the most unmatching medications (i.e., when the individual who used it had not reported any illness that matched its indications). Community-dwelling individuals aged ≥60 years using ≥1 medication, from Santa Cruz da Esperança-SP, Brazil, were home-interviewed. Logistic regression models were used to evaluate the association between the appropriate recall of the indications for all medications in use and the following: gender, age, education, individual income, living arrangement, self-perceived health, and medication number, administration, payment, and identification. Medications whose indications were inappropriately recalled were classified as matching or unmatching. One hundred seventeen individuals used an average of 5.1 (standard deviation, 3.3) medications. Sixty-one (52.1%) appropriately recalled all indications. The appropriate recall of all indications was negatively associated with the number of medications in use (e.g., individuals taking 5-6 medications were 25 times less likely to appropriately recall all indications than those taking 1-2). Antithrombotic, acid-related disorder and psychoanaleptic classes showed greater frequencies of unmatching than matching medications. Therefore, counseling the elderly about drug indications should focus on those using ≥3 medications and/or antithrombotic, acid-related disorder, and psychoanaleptic agents.

Obesity is a chronic inflammatory disease that affects millions of people worldwide. Most studies observe the effects of a high-fat diet (HFD) in 10-12 weeks. This work investigated the effects induced by a HFD administered for 6 weeks on the nutritional status of mice and some aspects of the inflammatory response in mouse peritoneal macrophages. Male Swiss Webster mice, 2-3 months of age, were fed a control diet or HFD for 6 weeks. After this period, the mice were euthanized, and peritoneal macrophages were collected for immunoassays and assessment of biochemical parameters. A HFD was associated with increased cholesterol, insulin resistance, C-reactive protein (CRP), leptin, and serum resistin levels. Lipopolysaccharide (LPS)- stimulated adipocyte cultures of animals subjected to a HFD showed increased production of proinflammatory cytokines such as tumor necrosis factor alpha (TNF-α), interleukin-1 (IL-1), and interleukin-6 (IL-6). However, peritoneal macrophages of the HFD group showed no changes in the levels of these cytokines. LPS-stimulated peritoneal macrophages from HFD-treated animals showed a reduction in mRNA expression of TNF-α and IL-6, as well as a decrease in expression of the transcription factor nuclear factor-kappa B (NF-kB). In conclusion, HFD treatment for 6 weeks induces similar signs to metabolic syndrome and decreases the capacity of peritoneal macrophages to develop an appropriate inflammatory response to a bacterial component.

ABSTRACT It is well established that protein malnutrition (PM) impairs immune defenses and increases susceptibility to infection. Macrophages are cells that play a central role in innate immunity, constituting one of the first barriers against infections. Macrophages produce several soluble factors, including cytokines and growth factors, important to the immune response. Among those growth factors, granulocyte-macrophage colony-stimulating factor (GM-CSF) and macrophage colony-stimulating factor (M-CSF). GM-CSF and M-CSF are important to monocyte and macrophage development and stimulation of the immune response process. Knowing the importance of GM-CSF and M-CSF, we sought to investigate the influence of PM on macrophage production of these growth factors. Two-month-old male BALB/c mice were subjected to PM with a low-protein diet (2%) and compared to a control diet (12%) mouse group. Nutritional status, hemogram and the number of peritoneal cells were evaluated. Additionally, peritoneal macrophages were cultured and the production of GM-CSF and M-CSF and mRNA expression were evaluated. To determine if PM altered macrophage production of GM-CSF and M-CSF, they were stimulated with TNF-α. The PM animals had anemia, leukopenia and a reduced number of peritoneal cells. The production of M-CSF was not different between groups; however, cells from PM animals, stimulated with or without TNF-α, presented reduced capability to produce GM-CSF. These data imply that PM interferes with the production of GM-CSF, and consequently would affect the production and maturation of hematopoietic cells and the immune response.

O presente estudo objetivou avaliar o efeito do desmame precoce sobre a composição corporal e sobre parâmetros indicativos do estado nutricional de camundongos. O grupo experimental consistiu de camundongos Swiss Webster, machos, desmamados precocemente (14º dia de vida) e alimentados com ração apropriada para roedores em crescimento até o 21º dia pós-natal (grupo DESM). O grupo controle consistiu de camundongos amamentados até o 21º dia pós-natal (grupo CON). Todos os animais foram sacrificados no 21º dia de vida. O grupo DESM apresentou redução da concentração e conteúdo hepático e muscular de proteínas, da concentração cerebral de proteínas, da concentração e conteúdo cerebral de DNA e da razão proteína/RNA hepática e muscular (p<0,05). Quanto à composição corporal, o grupo DESM apresentou maior conteúdo de umidade, maior percentual de umidade e lipídios e menor conteúdo e percentual de cinzas e proteína na carcaça (p<0,05). Os resultados indicam que o desmame precoce acarreta em prejuízo à composição corporal e a parâmetros indicativos do estado nutricional, o que pode estar relacionado ao retardo do processo de maturação química. Os dados do presente estudo podem contribuir para o entendimento da influência da alimentação com fórmulas infantis sobre a composição corporal e sobre o estado nutricional.

This study aimed to evaluate the effect of early weaning on body composition and on parameters related to nutritional status in mice. The experimental group consisted of male Swiss Webster mice that were weaned early (at postnatal day fourteen) and fed an appropriate diet for growing rodents until postnatal day twenty-one (EW group). The control group consisted of male mice breastfed until postnatal day twenty-one (CON group). All animals were sacrificed on the twenty-first day of life. The EW group showed a decrease in liver and muscle protein content and concentration, brain protein concentration, brain DNA content and concentration, as well as liver and muscle protein/RNA ratio (p<0.05). Concerning body composition, the EW mice showed increased moisture content, increased moisture and lipid percentage, and a smaller percentage and content of protein and ash in the carcass (p<0.05). These results indicate that early weaning impairs body composition and parameters related to nutritional status, which may be explained by retarded chemical maturation processes. This data may contribute to the overall understanding of the influence of breastfeeding versus feeding with artificial milk on body composition and on nutritional status.

Este trabalho tem por objetivo verificar se a matriz extracelular (MEC) obtida da medula óssea de camundongos com desnutrição protéica energética sustenta a sobrevivência, se induz proliferação de células mielóides, bem como avaliar a capacidade desta MEC de interagir com citocinas hematopoiéticas in vitro. Camundongos machos "Swiss" foram submetidos à desnutrição protéica (4% de caseína) até que perdessem 20% do peso inicial e o grupo-controle foi mantido com uma dieta contendo 14% de caseína. A medula óssea foi extraída com tampão PBS suplementado com 1 mg de aprotinina/mL. Os ensaios de proliferação foram realizados com a linhagem mielóide FDC-P1, pelo método colorimétrico de redução do MTT. A MEC obtida tanto do grupo-controle como do desnutrido induziu proliferação celular in vitro. Os ensaios de interação foram realizados com IL-3 e GM-CSF na concentração de 10 ρg e 500 ρg/mL, que demonstraram efeito sinérgico e efeito regulatório, respectivamente. A MEC obtida de animais do grupo desnutrido quando submetida ao ensaio de ligação ao GM-CSF mostrou maior proliferação celular do que a MEC obtida de animais do grupo-controle (p<0,05). Estes resultados sugerem que, provavelmente, as alterações na composição da MEC da medula óssea promovida pela desnutrição possam levar a modificações na modulação da atividade de GM-CSF.

The aim of this study was to verify the capacity of the extracellular matrix (ECM) obtained from bone marrow of malnourished mice to sustain survival and to induce the proliferation of myeloid cells. We also verified the capacity of the tests to interact with in vitro hematopoietic cytokines. Male "Swiss" mice were submitted to protein malnutrition with a diet content of '4% casein until they lost 20% of the original weight, while the group-control was kept with a diet content of 14% of casein. The bone marrow was extracted with 1.0 mg of aprotinin/mL in PBS. The proliferation tests were carried out with myeloid cell line FDCP-1, by the colorimetric method of reduction of the MTT. The obtained ECM from nourished and undernourished mice induced cellular proliferation invitro. Tests performed with Il-3 and GM-CSF cytokines in a concentration of 10 and 500 ρg/mL displayed synergic and regulatory effects respectively. The ECM obtained from the malnourished group submitted to the binding to GM-CSF demonstrated higher cellular proliferation than the ECM obtained from the control group (p<0.05). The results suggest that the alterations in the composition of ECM of bone marrow caused by malnutrition might lead to modification of the GM-CSF activity modulation.

OBJETIVO: O objetivo do presente estudo foi verificar a concentração de trombospondina da matriz extracelular da medula óssea em camundongos após indução de hipoplasia por desnutrição protéica. MÉTODOS: Camundongos machos Swiss foram submetidos à desnutrição protéica com uma dieta contendo 4,0% de caseína até que perdessem 20,0% do peso original, enquanto o grupo-controle foi mantido com uma dieta contendo 14,0% de caseína por 15 dias. A medula óssea dos dois grupos foi então aspirada e extraída com tampão fosfato. A matriz extracelular foi analisada por SDS-PAGE 7,5% e a concentração de trombospondina foi quantificada por Enhanced Chemiluminescence Light Western blotting, com luminescência química avançada. RESULTADOS: A quantidade de trombospondina foi 30% superior nas amostras obtidas de animais desnutridos em relação às amostras do grupo-controle. CONCLUSÃO: Este estudo sugere que a concentração de trombospondina está aumentada na hipoplasia induzida por desnutrição protéica, provavelmente por alterar o microambiente da medula óssea.

OBJECTIVE: The objective of the present study was to measure the concentration of bone marrow extracellular matrix thrombospondin in mice, following hypoplasia induced by protein malnutrition. METHODS: Two-month-old male Swiss mice were submitted to protein malnutrition by way of a low-protein diet containing 4.0% casein until they lost 20.0% of their original body weight, while the control group mice were fed 14.0% casein for 15 days. The bone marrows of the animals were aspirated and transferred to phosphate-buffered saline tubes for extraction. The extracellular matrix protein was analyzed by 7.5% SDS-PAGE and thrombospondin by Enhanced Chemiluminescence Light Western blotting. RESULTS: The amount of thrombospondin was 30% higher in the undernourished samples when compared to the control samples. CONCLUSION: This study suggests that the hypoplasia induced by protein malnutrition probably alters the functioning of the bone marrow microenvironment resulting in a higher thrombospondin concentration.

As três espécies de esquistossoma podem comprometer o sistema nervoso. O S. mansoni é responsável pela esquistossomose no Brasil, sendo a mielopatia uma forma grave desta helmintose. O propósito deste trabalho é analisar as alterações do líquido cefalorraquidiano (LCR) para dar mais subsídios para o diagnóstico da esquistossomose raquimedular. Fizeram parte deste estudo 22 amostras de LCR de pacientes com esquistossomose espinal. Os resultados das análises destas amostras mostraram que a associação de alterações do LCR com quadro inflamatório e RIFI-IgM positiva ocorreu em 88% dos pacientes, que o eosinófilo esteve presente em apenas 7 amostras (36,8%), e que 3 dos 22 pacientes estudados apresentaram LCR normal. Conclui-se que o exame de LCR é coadjuvante muito útil para o diagnóstico da neuroesquistossomose.

Cerebrospinal fluid (CSF) changes in spinal shistosomiasis have been described. Its characteristic features are mild to moderate pleocytosis, presence of eosinophils, slight to moderate protein increase, elevated gamma globulin concentration and a positive immune assay. Nevertheless, these abnormalities are not always present together and therefore difficulties may arise in the assessment of the diagnosis. The purpose of this paper is to evaluate the importance of each CSF alteration concerning the diagnosis in 22 cases of spinal shistosomiasis. According to the results, only 20% of the cases had all the five feature that are considered to be characteristic of spinal shistomiasis. Abnormal cell count was present in 86%, protein increase in 77.3%, immunoglobulin G increase in 60,8%, eosinophils were present in 36.8% and indirect fluorescent antibody test was positive in 68.2%. In three cases all CSF parameters studied were within the normal limits. As the most specific test among those described was the indirect fluorescent antibody test, it should be regarded for the diagnosis.

Desnutrição protéico-calórica (DPC) é geralmente encontrada em crianças, idosos, pacientes com neoplasias ou doenças crônicas, pacientes submetidos à quimioterapia ou à nutrição parenteral. A DPC apresenta uma variedade de sinais e sintomas que são um resultado não apenas da(s) causa(s) que provocam a desnutrição, mas também de diferentes graus de deficiência de proteínas e carboidratos. Nesta revisão, nós apresentamos resultados a partir de estudos epidemiológicos observacionais e experimentais, que evidenciam que indivíduos desnutridos freqüentemente apresentam uma maior susceptibilidade para infecções com índices elevados de morbidade e mortalidade. Dados obtidos a partir da literatura e do nosso grupo evidenciam que a desnutrição modifica os processos de defesa do organismo, prejudicando órgãos linfo-hematopoéticos e alterando a resposta imune. As alterações hematológicas na desnutrição, tais como leucopenia e hipoplasia, foram descritas, com ênfase em relação aos resultados em desnutrição protéica experimental obtidos pelo nosso grupo, especialmente as alterações estruturais e ultra-estruturais da medula, baço e timo; alterações funcionais, como a redução da migração celular, da capacidade de espraiamento, da fagocitose, da atividade bactericida e fungicida, bem como alterações na produção de espécies reativas de oxigênio. As implicações das modificações do ambiente hematopoético em estados de desnutrição são ainda obscuras, contudo, parecem ser responsáveis pela hematopoese ineficiente, especialmente pela mielopoese ineficiente, e parecem ser irreversíveis em curto período de tempo.

Protein-calorie malnutrition (PCM) is usually found in children, the elderly, patients suffering from neoplasia or chronic disease, patients undergoing chemotherapy, or even patients under parenteral nutrition. PCM presents a wide spectrum of signs and symptoms that are a result of not only the cause(s) that led to malnutrition, but also of the different degrees of protein or carbohydrate deficiency. Here we present data obtained from observational and experimental epidemiological studies that suggest that malnourished individuals frequently present a greater susceptibility to infection with high morbidity and mortality indices. Data both found in literature and obtained by our group evidence that malnutrition modifies the organism's defence processes, impairing lympho-haematopoietic organs and modifying immune response. The haematological alterations in malnutrition, such as leucopoenia and hypoplasia, are described, with an emphasis on the results in experimental protein malnutrition obtained by our group. In particular, the structural and ultra-structural alterations of bone marrow, spleen and thymus; functional alterations such as the reduction of cell migration and spreading, phagocytosis, bactericidal and fungicidal activity as well as alterations in the production of reactive oxygen species are discussed. The implications of modifications of the haemopoietic environment in malnutrition states are still obscure, however, they seem to be responsible for inefficient haemopoiesis, especially inefficient myelopoiesis, and they seem to be irreversible over the short-term.

A interação de células neoplásicas com moléculas da membrana basal é a primeira etapa para a disseminação, in vivo, de células tumorais in vivo. As células leucêmicas possuem grande capacidade de espraiamento e disseminação no organismo uma vez que as mesmas são liberadas da medula óssea para a circulação. Neste trabalho avaliamos a capacidade das linhagens celulares CEM, U937, K562 and HL-60 em aderirem a uma matriz extracelular constituída por diferentes concentrações de laminina e,ou fibronectina e sobre colágeno IV. A adesão de todas a linhagens leucêmicas a colágeno IV foi baixa, mas aumentou com a associação à laminina. Por outro lado, as células U937 e HL-60 apresentaram alta ligação à fibronectina porém, foi reduzida com a adição de laminina. A associação de colágeno IV e fibronectina possibilitou um bom substrato para a adesão celular. Entretanto, a adição de laminina a este substrato reduziu a adesão das células U937, HL-60 e K562. Estes resultados sugerem que a adesão à matriz extracelular e a disseminação de células leucêmicas pode ser modulada pela laminina.

The interaction of neoplastic cells with basement membrane molecules is the first step for the dissemination of tumor cells in vivo. Leukemic cells have a great ability to spread in the host, since cells are released from the bone marrow to the circulation. In this study we analysed whether CEM, U937, K562 and HL-60 cells were able to attach to different concentrations of laminin and/or fibronectin and/or type IV collagen. Attachment to type IV collagen was low, but it increased with the addition of laminin and occurred in all four leukemic cell lines. On the other hand, attachment to fibronectin was higher, but it decreased with the addition of laminin in the assays using U937 and HL-60 cells. The combination of type IV collagen and fibronectin was a good substratum for cellular attachment. However, the addition of laminin to this substratum impaired its attachment activity in U937, HL-60 and K562. These data suggest that laminin may control cellular attachment to the extracellular matrix during leukemic dissemination in hosts in different ways.

A hematopoese é um sistema altamente organizado responsável pela produção das células sanguíneas. O controle da proliferação, diferenciação e maturação destas células é feito através de uma complexa interação molecular das células com o microambiente da medula óssea. Este microambiente complexo produz glicoproteínas solúveis genericamente chamadas de citocinas, que controlam a mitose e a diferenciação das células hematopoéticas. Nos processos neoplásicos, especialmente nos malignos, ocorrem alterações moleculares induzindo nas células um novo comportamento biológico podendo, inclusive, alterar seus mecanismos de adesão. A interação de células leucêmicas com moléculas da matriz extracelular da medula óssea, pode ser um dos mecanismos utilizados por essas células para chegar ao sangue periférico. Particularmente, precursores celulares, matriz extracelular e interações com células endoteliais determinam a manutenção ou liberação das células hematopoéticas do microambiente da medula óssea para o sangue periférico. Assim, mudanças na afinidade ou na quantidade de moléculas de adesão pelas células do estroma ou pelos precursores das células sanguíneas, afetarão a adesão celular. Vários trabalhos têm sido realizados na tentativa de se entender melhor a interação existente entre os precursores hematopoéticos e o microambiente indutivo formado pelo estroma medular.

Hematopoesis is an organize system that is responsible for blood cells production. The proliferation, differentiation and maturation control of this cells is achieved by interaction between cells and medular microenvironment. This microenvironment produce glicoproteins called cytokines, that control proliferation of hematopoietic cells. In neoplasic processes, several molecular alterations occur, it induce a new biological behaviour by cells, like become altered its adhesion. The interaction of leukemic cells with the extracellular matrix (ECM) of bone marrow can be considered one of the mechanisms used by these cells to reach the peripheric blood. Privately, precursor cells, ECM and endthelial cells control the maintennance or release of this hematopoietic cells to peripheric blood. In this way, changes in affinity or in molecular amount by stroma cells or by precursors of blood cells will afect cellular adhesion. Thefore several works have been realized to understand very much about the interaction between hematopoietic progenitors cells and the microenvironment constituted by medular stroma.