Choline supplementation: Impact on broiler chicken performance, steatosis, and economic viability from from 1 to 42 days.

This study was carried out to compare the impact of choline supplementation (available from two sources synthetic and natural) on various dosages in broilers. The mode of choline supplementation, via diet and additional sources, synthetic and natural, and the data of performance, carcass quality, blood parameters, and hepatic steatosis were compared. A total of 1050 day-old male Cobb 500 broiler chicks were randomly assigned to 10 treatments, using a completely randomized design model in a factorial scheme, with 6 replicates per treatment and 25 birds per replicate. Choline was supplemented using three sources: synthetic choline chloride 60% (CC), and two sources of natural choline A (NCA), and B (NCB). The Control treatment did not receive any choline supplementation. The diets were supplemented with low, intermediate and high doses of choline sources (400g/t, 800g/t, and 1200g/t of CC; 100g/t, 200g/t, and 300g/t of both NCA and NCB). Data analysis was performed using a factorial model to investigate the effects of choline supplementation (CC, NCA, NCB) and doses on the measured variables. Overall, the results indicated that the the performance of NCA was better than CC & NCB, specifically the dose of 100g/t of NCA outperformed MAR at 100g/t & CC at 400g/t, leading to a significant increase in body weight gain (85.66g & 168.84g respectively), and a noteworthy (9- & 12-point respectively) improvement in feed conversion ratio. Furthermore, NCA contributed to a reduction in steatosis when contrasted with various NCB & CC doses, likely due to the presence of curcumins and catechins in the natural choline source. These findings demonstrated that NCA supplementation yielded superior results compared to CC and NCB across both performance and liver health aspects in broilers aged 1 to 42 days. In conclusion, NCA can be used to replace the CC 60% without compromise on the zootechnical performance in broilers.

Local anesthetics as a tool for Staphylococcus spp. control: a systematic review.

The objective of this work was to carry out a systematic review on the effectiveness of local anesthetics as antimicrobial agents against Staphylococcus spp. Searches were performed in the PubMed, Web of science, Scopus, Embase and Lilacs databases. As inclusion criteria, complete original articles, with in vitro experimental tests with the application of selected anesthetics and bacteria of the genus Staphylococcus spp. This review followed the methodological checklist for writing papers reporting systematic reviews by the PRISMA statement. The risk of bias was assessed according to the JBI critical appraisal checklist. Analysis was performed using an anesthetic-moderated simple linear regression model. This systematic review was registered by the Open Science Framework-OSF ( https://doi.org/10.17605/OSF.IO/C5JM7 ). Initially, 1141 articles were found, of which, after careful selection, 52 articles were analyzed. Lidocaine was the most commonly used anesthetic, being evaluated in 35 of the articles. S. aureus ATCC 25923 was the standard microorganism in 17 articles. The impact of the anesthetic concentration in relation to the antimicrobial effect was evaluated and the results showed that there was no statistically significant difference. (F [5, 12] = 0.688 p = 0.642), even when taking into account the moderator effect of anesthetics individually. Therefore, although the antimicrobial effect of local anesthetics was demonstrated in 82.7% of the studies evaluated, great heterogeneity of the results was found, which made it impossible to carry out a meta-analysis and make recommendations based on the evidence.

What do we know about the sleep effects of caffeine used to treat apnoea of prematurity? A systematic review of the literature.

OBJECTIVE: Scientific scrutiny has proved the safety and benefits of caffeine to treat apnoea of prematurity (AOP). However, there is no consensus on the effects of this treatment on sleep, especially considering the key role of adenosine and early brain development for sleep maturation. We systematically reviewed studies with sleep as a primary and/or secondary outcome or any mention of sleep parameters in the context of caffeine treatment for AOP. METHODS: We performed a systematic search of PubMed, Web of Science and the Virtual Health Library from inception to 7 September 2022 to identify studies investigating the short- and long-term effects of caffeine to treat AOP on sleep parameters. We used the PIC strategy considering preterm infants as the Population, caffeine for apnoea as the Intervention and no or other intervention other than caffeine as the Comparison. We registered the protocol on PROSPERO (CRD42021282536). RESULTS: Of 4019 studies, we deemed 20, including randomised controlled trials and follow-up and observational studies, to be eligible for our systematic review. The analysed sleep parameters, the evaluation phase and the instruments for sleep assessment varied considerably among the studies. The main findings can be summarised as follows: (i) most of the eligible studies in this systematic review indicate that caffeine used to treat AOP seems to have no effect on key sleep parameters and (ii) the effects on sleep when caffeine is administered earlier, at higher doses or for longer periods than the most common protocol have not been investigated. There is a possible correlation between the caffeine concentration and period of exposure and negative sleep quality, but the sleep assessment protocols used in the included studies did not have high-quality standards and could not provide good evidence. CONCLUSIONS AND IMPLICATIONS: Sleep quality is an important determinant of health, and better investments in research with adequate sleep assessment tools are necessary to guarantee the ideal management of children who were born preterm.

Seroepidemiologic survey of the household contacts of leprosy patients.

OBJECTIVE: Leprosy is a disabling infectious disease caused by Mycobacterium leprae. This study aimed to investigate the prevalence of leprosy among household contacts of leprosy patients. METHODS: This study is a serological survey in household contacts of leprosy patients who had been treated or were undergoing treatment in the city of Presidente Prudente, São Paulo, Brazil, from 2006-2016, using clinical examination and screening for anti- Phenolic glycolipid-I antibodies with Mycobacterium leprae-flow serology. RESULTS: A total of 263 index cases of leprosy were identified during the study period. Of these, 53 were approached, and among their household contacts, 108 were examined. The ML-flow test was positive in 2 (1.85%) individuals, but clinical examination revealed no signs or symptoms of leprosy in them. Therefore, they were considered to have a subclinical infection. Leprosy was not confirmed in any household contacts. In this study, a lower percentage of household contacts, when compared to that in the literature, had a positive Mycobacterium leprae-flow test result. CONCLUSION: The use of Mycobacterium leprae-flow should be encouraged during the follow-up of at-risk populations, such as the household contacts of leprosy patients.

Seroepidemiologic survey of the household contacts of leprosy patients

SUMMARY OBJECTIVE: Leprosy is a disabling infectious disease caused by Mycobacterium leprae. This study aimed to investigate the prevalence of leprosy among household contacts of leprosy patients. METHODS: This study is a serological survey in household contacts of leprosy patients who had been treated or were undergoing treatment in the city of Presidente Prudente, São Paulo, Brazil, from 2006-2016, using clinical examination and screening for anti- Phenolic glycolipid-I antibodies with Mycobacterium leprae-flow serology. RESULTS: A total of 263 index cases of leprosy were identified during the study period. Of these, 53 were approached, and among their household contacts, 108 were examined. The ML-flow test was positive in 2 (1.85%) individuals, but clinical examination revealed no signs or symptoms of leprosy in them. Therefore, they were considered to have a subclinical infection. Leprosy was not confirmed in any household contacts. In this study, a lower percentage of household contacts, when compared to that in the literature, had a positive Mycobacterium leprae-flow test result. CONCLUSION: The use of Mycobacterium leprae-flow should be encouraged during the follow-up of at-risk populations, such as the household contacts of leprosy patients.

Cryolipolysis Does not Modify the Behavior and Recovery of Cardiac Autonomic Modulation.

The desire to reduce and remodel undesirable fatty deposits has increased the popularity and use of aesthetic procedures, among them, cryolipolysis. However, repercussions on the autonomic nervous system must be considered, since the decrease in cutaneous body temperature can have repercussions on sympathetic and parasympathetic components. The aim was to evaluate the behavior of cardiac autonomic modulation during and after a single application of cryolipolysis. A single-arm, prospective interventional study evaluated data from 13 women with a mean age of 22.38 ± 2.95 years, who had an accumulation of abdominal fat of at least 1.5 mm, were using oral contraceptives, and were sedentary. A professional applied cryolipolysis in a single 40-min session. RR intervals were collected by means of a cardiofrequency meter, at rest prior to the technique for 10 min, during the performance of the technique, and immediately after the end of the technique for a period of 50 min. Heart rate variability (HRV) analysis was performed using time, frequency, and Poincaré plot indices. For the mean RR, SDNN, rMSSD, SD1, SD2, and LF [ms2] indices, the values increased during the execution of cryolipolysis when compared to rest. In the recovery period, increases in the mean values of the RR, SDNN, rMSSD, SD1, SD2, HF [ms2], LF [nu], and HF [nu] indices were also observed when compared to the baseline moment. Both during the technique and in the recovery period, there were changes in the behavior of HRV characterized by an increase in global and vagal indices. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Optimization of TAM16, a Benzofuran That Inhibits the Thioesterase Activity of Pks13; Evaluation toward a Preclinical Candidate for a Novel Antituberculosis Clinical Target.

With increasing drug resistance in tuberculosis (TB) patient populations, there is an urgent need for new drugs. Ideally, new agents should work through novel targets so that they are unencumbered by preexisting clinical resistance to current treatments. Benzofuran 1 was identified as a potential lead for TB inhibiting a novel target, the thioesterase domain of Pks13. Although, having promising activity against Mycobacterium tuberculosis, its main liability was inhibition of the hERG cardiac ion channel. This article describes the optimization of the series toward a preclinical candidate. Despite improvements in the hERG liability in vitro, when new compounds were assessed in ex vivo cardiotoxicity models, they still induced cardiac irregularities. Further series development was stopped because of concerns around an insufficient safety window. However, the demonstration of in vivo activity for multiple series members further validates Pks13 as an attractive novel target for antitubercular drugs and supports development of alternative chemotypes.

Reference Equation of a New Incremental Step Test to Assess Exercise Capacity in the Portuguese Adult Population.

Step tests are important in community- and home-based rehabilitation programs to assess patients' exercise capacity. A new incremental step test was developed for this purpose, but its clinical interpretability is currently limited. This study aimed to establish a reference equation for this new incremental step test (IST) for the Portuguese adult population. A cross-sectional study was conducted on people without disabilities. Sociodemographic (age and sex), anthropometric (weight, height, and body mass index), smoking status, and physical activity (using the brief physical activity assessment tool) data were collected. Participants performed two repetitions of the IST and the best test was used to establish the reference equation with a forward stepwise multiple regression. An analysis comparing the results from the reference equation with the actual values was conducted with the Wilcoxon test. A total of 155 adult volunteers were recruited (60.6% female, 47.8 ± 19.7 years), and the reference equation was as follows: steps in IST = 475.52 - (4.68 × age years) + (30.5 × sex), where male = 1 and female = 0, and r2 = 60%. No significant differences were observed between the values performed and those obtained by the equation (p = 0.984). The established equation demonstrated that age and sex were the determinant variables for the variability of the results.

Calendula officinalis L. flower extract-mediated green synthesis of silver nanoparticles under LED light

Abstract Silver nanoparticles (AgNPs) are among the most known nanomaterials being used for several purposes, including medical applications. In this study, Calendula officinalis L. flower extract and silver nitrate were used for green synthesis of silver nanoparticles under red, green and blue light-emitting diodes. AgNPs were characterized by Ultraviolet-Visible Spectrophotometry, Field Emission Scanning Electron Microscopy, Dynamic Light Scattering, Electrophoretic Mobility, Fourier Transform Infrared Spectroscopy and X-ray Diffraction. Isotropic and anisotropic silver nanoparticles were obtained, presenting hydrodinamic diameters ranging 90 - 180 nm, polydispersity (PdI > 0.2) and moderate stability (zeta potential values around - 20 mV)

A Turing mechanism in order to explain the patchy nature of Crohn's disease.

Crohn's disease is an inflammatory bowel disease (IBD) that is not well understood. In particular, unlike other IBDs, the inflamed parts of the intestine compromise deep layers of the tissue and are not continuous but separated and distributed through the whole gastrointestinal tract, displaying a patchy inflammatory pattern. In the present paper, we introduce a toy-model which might explain the appearance of such patterns. We consider a reaction-diffusion system involving bacteria and phagocyte and prove that, under certain conditions, this system might reproduce an activator-inhibitor dynamic leading to the occurrence of Turing-type instabilities. In other words, we prove the existence of stable stationary solutions that are spatially periodic and do not vanish in time. We also propose a set of parameters for which the system exhibits such phenomena and compare it with realistic parameters found in the literature. This is the first time, as far as we know, that a Turing pattern is investigated in inflammatory models.

Histoplasmosis diseminada progresiva aguda en un paciente inmunocompetente / Acute progressive disseminated histoplasmosis in an immunocompetent patient

RESUMEN La histoplasmosis diseminada progresiva constituye una expresión singular y rara de la infección por Histoplasma capsulatum. Sus formas agudas de presentación suelen aparecer en pacientes con deficiencias inmunitarias graves (fundamentalmente VIH). Sin embargo, en regiones de alta endemicidad, incluso pacientes sin inmunodeficiencia demostrada pueden desarrollar esta afección. Se presentó un paciente de 47 años de edad, con antecedentes de haber sufrido un cuadro grave de histoplasmosis pulmonar 18 años antes. El paciente fue ingresado por un cuadro de: fiebre, astenia, sudoración nocturna, disnea, tos seca, hepatoesplenomegalia, anemia y trombocitopenia marcada. Progresó a una insuficiencia respiratoria aguda y fue internado en cuidados intensivos con ventilación mecánica invasiva. Se demostró crecimiento de Histoplasma capsulatum en la muestra de lavado bronquioalveolar y reacción granulomatosa no caseificante en médula ósea, confirmándose el diagnóstico de histoplasmosis diseminada progresiva. El paciente recibió tratamiento con anfotericina B y se recuperó totalmente en pocas semanas.

ABSTRACT Progressive disseminated histoplasmosis is a unique and rare expression of the infection cause by Histoplasma capsulatum. Its acute forms of presentation usually appear in patients with severe immunodeficiency disorders (mainly HIV). However, even patients without proven immunodeficiency can develop this condition in regions of high endemicity. We present a 47-year-old male patient with a previous history of severe pulmonary histoplasmosis eighteen years earlier. The patient was admitted due to the presence of fever, asthenia, night sweats, dyspnea, dry cough, hepatosplenomegaly, anemia and marked thrombocytopenia. He progressed to acute respiratory failure and was admitted to the intensive care unit requiring invasive mechanical ventilation. Growth of Histoplasma capsulatum was demonstrated in the bronchoalveolar lavage sample and a non-caseating granulomatous reaction was found in the bone marrow, confirming the diagnosis of progressive disseminated histoplasmosis. The patient received amphotericin B treatment and made a full recovery within a few weeks.

Trastornos neuropsiquiátricos secundarios al tratamiento corticoide en pacientes con cáncer / Corticosteroid-induced neuropsychiatric disorders in cancer patients

RESUMEN Introducción: el cáncer es una de las principales causas de muerte en todo el mundo. Los corticoides son los fármacos más utilizados en el tratamiento del cáncer y pueden inducir diversas manifestaciones psiquiátricas. Objetivo: describir los trastornos neuropsiquiátricos secundarios al tratamiento corticoide en pacientes con cáncer. Métodos: se realizó una revisión de la literatura a través de diferentes bases de datos: SciELO, PubMed y Elsevier; se utilizaron estas palabras clave: corticoides, trastornos neuropsiquiátricos, cáncer, y psicosis esteroidea. Para este estudio se seleccionaron un total de 31 referencias bibliográficas. Conclusiones: los corticoides son ampliamente utilizados en el tratamiento de los pacientes con cáncer, hospitalizados o ambulatorios, y no exentos de efectos adversos. Los corticoides pueden provocar todo tipo de trastornos mentales: desde ánimo lábil a episodios maníacos o depresión, demencia reversible y delirium (psicosis esteroidea). La dosificación del corticoide es el factor de riesgo más importante para el desarrollo de síntomas psiquiátricos. La principal herramienta en el tratamiento de los cuadros psiquiátricos inducidos por esteroides es la reducción gradual de la dosis de estos medicamentos, y cuando esto no es posible, o cuando los síntomas son muy marcados, la administración de psicofármacos. El paciente con cáncer es un paciente diferente en cuanto a su psicopatología. Los corticoides pueden inducir diversas manifestaciones psiquiátricas, las cuales deben tenerse presentes durante la terapéutica, para no incurrir en sesgos e identificar tempranamente trastornos secundarios al uso de estos medicamentos.

ABSTRACT Introduction: cancer is one of the main causes of death worldwide. Corticosteroids are the most widely used drugs in the treatment of cancer and can induce various psychiatric manifestations. Objective: to describe corticosteroid-induced neuropsychiatric disorders in cancer patients. Methods: a literature review was carried out through different databases: SciELO, PubMed and Elsevier; corticosteroids, neuropsychiatric disorders, cancer and steroid psychosis were the keywords used. A total of 32 bibliographic references were selected for this study. Conclusions: corticosteroids are widely used in the treatment of hospitalized or ambulatory cancer patients, and are not exempt from adverse effects. Corticosteroids can cause all kinds of mental disorders: from labile mood to manic episodes or depression, reversible dementia and delirium (steroid psychosis). Corticosteroid dosage is the most important risk factor for the development of psychiatric symptoms. The main tool in the treatment of steroid-induced psychiatric conditions is the gradual reduction of the dose of these drugs, and when this is not possible, or when the symptoms are very marked, the administration of psychotropic drugs. Cancer patient is a different patient in terms of psychopathology. Corticosteroids can induce some psychiatric manifestations, which must be taken into account during therapy, in order not to incur bias and to identify early disorders induced by these drugs.

Doping esportivo e consumo de suplementos alimentares: uma relação delicada / Sports doping and dietary supplements consumption: a delicate relationship / Dopaje desportivo y consumo de suplementos alimenticios: uma relación delicada

Objetivo: neste estudo, procura-se saber se os suplementos alimentares tão consumidos são aptos a causarem doping, já que os atletas buscam recursos ergogênicos visando à melhora da sua performance e, no campo nutricional, os suplementos aparecem como os mais consumidos. Metodologia: pesquisa bibliográfica descritiva, de abordagem exploratória; foram utilizadas informações oficiais de órgãos afetos ao controle de competições esportivas mundiais, bem como normas da Anvisa, agência reguladora brasileira. Resultados: verificou-se que a opção pelo alto consumo de suplementos alimentares se deve tanto à influência massiva da publicidade, que promete resultados miraculosos, quanto à facilidade de aquisição desses produtos. A eficácia de muitos deles carece de comprovação científica, enquanto outros podem causar efeitos colaterais graves pouco divulgados, além de conter substâncias de uso proibido e aptas a causar doping. No Brasil, a indústria de suplementos alimentares ganhou marco regulatório apenas em 2018, razão pela qual ainda não foi possível uma avaliação rigorosa dos seus efeitos. Conclusão: constatou-se que a multidisciplinariedade que envolve a relação entre dopagem e consumo de suplementos alimentares é a responsável pela dificuldade de controle do setor, reveladora ainda de quão movediça é a abordagem do problema no qual, frequentemente, se imiscuem novas áreas de conhecimento, exigindo profundo saber interdisciplinar. Daí a necessidade da interferência de profissionais habilitados para a prescrição de tais suplementos somente nos casos em que eles se mostrem necessários.

Objective: this study seeks to know if the massive consumed dietary supplements can cause doping, since, unable to accept their limits, athletes search ergogenic methods aiming for the increase of their performance and, in the nutritional field, dietary supplements appear as the most prominent choice. Methods: the present paper is a descriptive bibliographic research, with an exploratory approach, in which were used official information of organs related to the control of world sports competitions, as well as Brazilian regulatory agency rules. Results: It was found that the option for the huge consumption of dietary supplements is due to the influence of massive publicity ­ that promises miraculous results ­ and to the ease of the purchase of these products. The effectiveness of many of them lack scientific proof; many others may cause serious side effects that are not disclosed, containing substances of prohibited use and able to characterize doping. In Brazil, the sector has reached a regulation mark only in 2018, the reason why a rigorous evaluation of its effects was not possible to be done. Conclusions: it was found that the multidisciplinarity that concerns the relationship between doping and consumption of dietary supplements is responsible for the difficulty of controlling the sector, revealing how unstable is the approach to the problem, in which new areas of knowledge are often inserted, requiring deep interdisciplinary knowledge. Hence the need for the intervention of qualified professionals to prescribe such supplements only in cases where they are necessary.

Objetivo: en este estudio se busca conocer si los complementos alimenticios que se consumen ampliamente son susceptibles de provocar dopaje, ya que los deportistas buscan recursos ergogénicos con el objetivo de mejorar su rendimiento y, en el ámbito nutricional, los complementos aparecen como los más consumidos. Metodología: investigación bibliográfica descriptiva, con enfoque exploratorio; Se utilizó información oficial de agencias relacionadas con el control de las competiciones deportivas mundiales, así como normas de Anvisa, la agencia reguladora brasileña. Resultados: se encontró que la opción por un alto consumo de complementos dietéticos se debe tanto a la influencia masiva de la publicidad, que promete resultados milagrosos, como a la facilidad de compra de estos productos. La eficacia de muchos de ellos carece de pruebas científicas, mientras que otros pueden provocar efectos secundarios graves y poco conocidos, además de contener sustancias de uso prohibido y aptas para causar dopaje. En Brasil, la industria de complementos alimenticios obtuvo un marco regulatorio recién en 2018, por lo que aún no ha sido posible evaluar rigurosamente sus efectos. Conclusión: se constató que la multidisciplinariedad que implica la relación entre el dopaje y el consumo de complementos alimenticios es responsable de la dificultad para controlar el sector, revelando además lo rápido que es el abordaje del problema, en el que muchas veces se imbuyen nuevas áreas de conocimiento. lo que requiere un profundo conocimiento interdisciplinario. De ahí la necesidad de la intervención de profesionales cualificados para prescribir dichos suplementos solo en los casos en que sean necesarios.

Development, Characterization and Microbiological Evaluation of Silver Nanoparticles, Obtained by Green Synthesis, from the Extract of Annona muricata L

Abstract Green synthesis is an efficient method, frequently applied in nanobiotechnology, as it does not use toxic reagents or solvents. Biological organisms, including medicinal plants, have been used successfully for manufacturing of different types of metallic nanoparticles. The aim of this work was to synthesize, characterize and evaluate the antimicrobial activity of silver nanoparticles (AgNPs) obtained from the extract of the pulp, seed and leaves of Annona muricata L. The particle size, polydispersity index, zeta potential, as well as morphological aspects of AgNPs were evaluated. With the data obtained from the analyses, we concluded that the nanoparticles were successfully obtained by a simple and green method using the aqueous extract of the pulp, seeds and leaves of A. muricata. AgNPs obtained by A. muricata pulp extract without exposure to artificial light showed lowest average of hydrodynamic diameter and smallest size at field emission scanning electron microscope (FESEM). In addition, these nanoparticles showed the best polydispersity index (PDI), and zeta potential of - 29.6, which indicates good stability. AgNPs obtained from the extract of the pulp, seed and leaves showed antimicrobial activity, against strains of gram positive and gram negative bacteria, and antifungal activity, compared to the pure extract.

Linfohistiocitosis hemofagocítica, un síndrome potencialmente fatal. Presentación de tres casos / Hemophagocytic lymphohistiocytosis, a potentially fatal syndrome. Presentation of three cases

Introducción: La evidencia actual sobre el síndrome de linfohistiocitosis hemofagocítica se basa en series de casos y, por tanto, las decisiones clínicas se fundamentan en el criterio de expertos. En Cuba son escasos los informes publicados, lo cual valida los esfuerzos que incrementen la comprensión de esta entidad en nuestro medio. Objetivo: Describir tres casos de síndrome de linfohistiocitosis hemofagocítica secundaria, una complicación extremadamente infrecuente y poco sospechada. Casos clínicos: De los tres pacientes estudiados, dos presentaron linfoma como enfermedad subyacente. A uno de ellos se le diagnosticó un linfoma no Hodgkin de células T anaplásico en la necropsia; mientras el otro paciente fue diagnosticado y tratado precozmente por linfoma no Hodgkin de células grandes B, el cual evolucionó satisfactoriamente. El tercer paciente presentó endocarditis de valva tricúspide y alcanzó la remisión luego de tratamiento antibiótico, inmunomodulador y quirúrgico. Conclusiones: Los casos presentados destacan la complejidad del síndrome de linfohistiocitosis hemofagocítica y refuerzan la necesidad crítica de su diagnóstico y tratamiento oportuno en nuestro medio(AU)

Introduction: The current evidence about hemophagocytic lymphohistiocytosis syndrome is based on case series and, therefore, clinical decisions are based on expert criteria. In Cuba, there are few published reports, which validates the efforts that may increase understanding of this entity in our environment. Objective: To describe three cases of secondary hemophagocytic lymphohistiocytosis syndrome, an extremely rare and little suspected complication. Clinical cases: Of the three patients studied, two presented lymphoma as subjacent disease. One of them was diagnosed with anaplastic T-cell non-Hodgkin lymphoma at autopsy. The other was diagnosed and treated early for large B-cell non-Hodgkin lymphoma, and evolved satisfactorily. The third patient presented tricuspid valve endocarditis and achieved remission after antibiotic, immunomodulatory and surgical treatment. Conclusions: The cases presented highlight the complexity of hemophagocytic lymphohistiocytosis syndrome and reinforce the critical need for diagnosis and timely treatment of this condition in our setting(AU)

Mycoplasma Pneumoniae, asociado a polineuropatía axonal autoinmune, ¿variante clínica del síndrome Guillain-Barré en niños? / Mycoplasma Pneumoniae, associated to autoimmune axonal polyneuropathy, clinical variant of Guillain-Barré Syndrome in children?

Introducción: Mycoplasma penumoniae es un patógeno reconocido como principal agente causal de neumonía atípica, así como también por generar diferentes tipos de complicaciones extrapulmonares, especialmente de carácter neurológico y afectar directamente el sistema nervioso, gracias a sus mecanismos de virulencia, mimetismo y de inmunomodulación en el huésped. Causa afecciones como neuropatías, polineuropatías, encefalopatías, síndrome de Guillain Barré y otros. Objetivo: Reforzar en el área pediátrica la necesidad de modificar criterios diagnósticos e incorporar variantes clínicas del síndrome de Guillain Barre, además de instrumentos para diagnóstico de afecciones neuropáticas. Presentación del caso: Paciente masculino, 9 años 8 meses de edad, quien consulta en repetidas ocasiones por: dispepsias, episodios de diarrea, constipación y fiebre. Se constató según consulta: disbiosis, resfriado común, y finalmente, neumonía atípica por Mycoplasma Pneumoniae. Paciente evoluciona, con debilidad muscular, paresia, hiperalgesia y alodinia de extremidades superiores e inferiores. Acude a neurólogo, quien indica exámenes neurofisiológicos (velocidad de conducción nerviosa, potenciales evocados y se descartó una electromiografía, debido a la hiperalgesia). Se diagnosticó una polineuropatía axonal, la que se caracterizó por presentar ciertos aspectos del síndrome de Guillain-Barré. Tanto la evolución clínica de este síndrome, así como sus variantes clínicas, tienen un curso en adultos, caracterizado por un comienzo y signos distintos, lo que puede retrasar y errar el diagnóstico en pacientes pediátricos. Conclusiones: Hace falta nuevos criterios diagnósticos y su amplitud y herramientas de abordaje, para hacer un diagnóstico rápido y eficaz, y contribuir a la recuperación optima del paciente(AU)

Introduction: Mycoplasma pneumoniae is a pathogen know as to the main causal agent of atypical pneumonia, as well as to generate different extrapulmonary sickness, especially in neurological ways, directing to the nervous system, thanks to all its different mechanisms, like: virulence, mimetysm and immunomodulation in to the host. Producing, pathologies like neuropathies, polyneuropathies, encephalopathies, Guillain Barré Syndrome. Objetives: To highlight in the pediatric area, the need to modificate diagnosis criteria and incorporate Guillain-Barre Syndrome clinicals variants, also instruments to diagnosis of neuropathic pathologies. Case presentation: Male patient, 9 years, 8 months old, who consulted in repeated occasions for: dyspepsia, diarrhea and constipation episodes and fiber. Confirmed according to consultation: dysbiosis, common cold, and finally, atypical pneumonia by Mycoplasma Pneumoniae. The patient evolves with: muscular weakness, hyperalgesia and allodynia of upper and inferior extremities. Then, the Neurologist, indicates neurophysiological exams (nerve conduction velocity, evoked potentials, discarding an electromyography, due to hyperalgesia). Diagnosing an axonal polyneuropathy. Which was characterized to present some same aspects, from clinical course of Guillain-Barre Syndrome. Highlighting that the clinical evolution, as also, the syndrome clinical variants, has it a course in adults, characterized by a different beginning and signs, than in children. Retarding and do a wrong diagnosis in pediatric patients. Conclusion: Lack of new diagnosis criteria, the amplitude of these and tools of approach to give a fast and effective diagnosis, and contribute to the optimal recovery of the patient(AU)

Enfermedad linfoproliferativa asociada a artritis reumatoide: reporte de tres casos / Lymphoproliferative disease associated with rheumatoid arthritis: report of three cases

Las investigaciones en la última década han demostrado que el riesgo de desarrollar linfoma en pacientes con artritis reumatoide es el doble que el riesgo de la población general. Sin embargo, no se cuenta con datos de la magnitud de este problema en Cuba. Se presentan los casos de tres pacientes con diagnóstico de artritis reumatoide seropositiva tratadas con metotrexate, que durante su evolución desarrollaron linfoma no Hodgkin. Las pacientes recibieron quimioterapia de primera línea y alcanzaron remisión total con supervivencia de tres años hasta el momento. El diagnóstico de las enfermedades linfoproliferativas en pacientes con artritis reumatoide es un desafío; por lo que es necesario un elevado índice de sospecha que, en ausencia de marcadores fiables de linfomagénesis, permita el manejo oportuno de estos pacientes(AU)

Research in the last decade has shown that the risk of developing lymphoma in patients with rheumatoid arthritis is twice the risk of the general population. However, there is not data on the magnitude of this problem in Cuba.We present the cases of three patients with a diagnosis of seropositive rheumatoid arthritis treated with methotrexate who during their evolution developed non-Hodgkin's lymphoma.The patients received first-line chemotherapy and they achieved total remission with three-year survival so far.The diagnosis of lymphoproliferative diseases in patients with rheumatoid arthritis is a challenge; therefore, a high index of suspicion is necessary that, in the absence of reliable markers of lymphomagenesis, allows the timely management of these patients(AU)

Estresse em Estudantes ao longo da Graduação Médica / Stress in Undergraduate Medical Students

RESUMO O estresse corresponde a uma resposta física, psíquica e hormonal que ocorre quando o organismo necessita se adaptar frente a uma situação desafiadora. É uma das respostas mais recorrentes no meio acadêmico devido à rotina exaustiva e conteúdo denso que exigem responsabilidade e competitividade dos estudantes. Na graduação médica, somam-se a estes fatores a preocupação do estudante em aprender o conteúdo discutido em aulas e a pressão exercida pelos próprios acadêmicos, além da cobrança da sociedade. Diante da relevância do tema, este estudo teve como objetivo avaliar a ocorrência do estresse durante a graduação médica em acadêmicos de uma universidade privada da região do Alto Tietê, no Estado de São Paulo. Foram aplicados dois instrumentos de pesquisa, o Inventário de Sintomas de Estresse para Adultos de Lipp (ISSL) e a Escala de Estresse Percebido (PSS), em 420 estudantes (67,14% do sexo feminino) matriculados entre os ciclos básico (primeiro e segundo ano) e profissionalizante (terceiro ao sexto ano). Todos os participantes da pesquisa eram voluntários. De acordo com o PSS, foram verificados maiores níveis de estresse entre os alunos do primeiro ao terceiro ano quando comparados aos discentes do quarto ao sexto ano. O ISSL demonstrou a ocorrência de estresse em 65% dos estudantes. Entre estes, 9,04% se encontravam em fase de "quase exaustão" e 0,95% na fase de "exaustão", as fases mais elevadas dos níveis de estresse, sendo que a ocorrência de sintomas teve prevalência no sexo feminino. Em todas as turmas analisadas, os alunos do primeiro ao terceiro ano apresentaram maior índice de estresse em relação aos demais, o que pode estar associado à distribuição dos conteúdos curriculares com predomínio de disciplinas conceituais, assim como ao processo de transição de conteúdos teóricos para atividades práticas. Estes resultados podem estar vinculados à adaptação dos alunos à rotina das universidades, às disciplinas cursadas e às obrigações que o ensino superior exige.

ABSTRACT Stress corresponds to physical, psychological and hormonal responses that occur when the body needs to adapt to a challenging situation. It is one of the most recurrent responses in the academic world due to the exhaustive routine and dense content that demand responsibility and competitiveness from the students. In medical undergraduate schools, we add to these factors the student's concern to learn the content that was discussed in class and the pressure exerted by the students themselves, in addition to the demands of society. Given the relevance of the topic, this study aimed to evaluate the occurrence of stress during medical undergraduate school in students from a private university in the Alto Tietê region, in the state of São Paulo. Two research instruments, the Lipp Adult Stress Symptom Inventory (ISSL) and the Perceived Stress Scale (PSS), were applied to n= 420 undergraduate students (67.14% females) attending the basic (first and second years) and vocational cycles (third to sixth years), and all participants were volunteers. According to the PSS, higher levels of stress were observed in students from the first to the third years, when compared to students from the fourth to the sixth years of medical school. The ISSL demonstrated the occurrence of stress in 65% of the students, of which 9.04% were in the "near exhaustion" phase and 0.95% in the "exhaustion" phase, which represent the highest levels of stress, with the occurrence of symptoms being more prevalent in female students. Among all the analyzed groups, students attending the first to the third years showed a higher stress index than the others, which may be associated to the distribution of curricular contents with the predominance of conceptual disciplines, as well as the process of transition from theoretical contents to practical activities. These results may be related to the students' adaptation to the university routine, to the courses taken and to the obligations that higher education demands.