Remote epitaxy through graphene enables two-dimensional material-based layer transfer.

Epitaxy-the growth of a crystalline material on a substrate-is crucial for the semiconductor industry, but is often limited by the need for lattice matching between the two material systems. This strict requirement is relaxed for van der Waals epitaxy, in which epitaxy on layered or two-dimensional (2D) materials is mediated by weak van der Waals interactions, and which also allows facile layer release from 2D surfaces. It has been thought that 2D materials are the only seed layers for van der Waals epitaxy. However, the substrates below 2D materials may still interact with the layers grown during epitaxy (epilayers), as in the case of the so-called wetting transparency documented for graphene. Here we show that the weak van der Waals potential of graphene cannot completely screen the stronger potential field of many substrates, which enables epitaxial growth to occur despite its presence. We use density functional theory calculations to establish that adatoms will experience remote epitaxial registry with a substrate through a substrate-epilayer gap of up to nine ångströms; this gap can accommodate a monolayer of graphene. We confirm the predictions with homoepitaxial growth of GaAs(001) on GaAs(001) substrates through monolayer graphene, and show that the approach is also applicable to InP and GaP. The grown single-crystalline films are rapidly released from the graphene-coated substrate and perform as well as conventionally prepared films when incorporated in light-emitting devices. This technique enables any type of semiconductor film to be copied from underlying substrates through 2D materials, and then the resultant epilayer to be rapidly released and transferred to a substrate of interest. This process is particularly attractive in the context of non-silicon electronics and photonics, where the ability to re-use the graphene-coated substrates allows savings on the high cost of non-silicon substrates.

Unveiling the carrier transport mechanism in epitaxial graphene for forming wafer-scale, single-domain graphene.

Graphene epitaxy on the Si face of a SiC wafer offers monolayer graphene with unique crystal orientation at the wafer-scale. However, due to carrier scattering near vicinal steps and excess bilayer stripes, the size of electrically uniform domains is limited to the width of the terraces extending up to a few microns. Nevertheless, the origin of carrier scattering at the SiC vicinal steps has not been clarified so far. A layer-resolved graphene transfer (LRGT) technique enables exfoliation of the epitaxial graphene formed on SiC wafers and transfer to flat Si wafers, which prepares crystallographically single-crystalline monolayer graphene. Because the LRGT flattens the deformed graphene at the terrace edges and permits an access to the graphene formed at the side wall of vicinal steps, components that affect the mobility of graphene formed near the vicinal steps of SiC could be individually investigated. Here, we reveal that the graphene formed at the side walls of step edges is pristine, and scattering near the steps is mainly attributed by the deformation of graphene at step edges of vicinalized SiC while partially from stripes of bilayer graphene. This study suggests that the two-step LRGT can prepare electrically single-domain graphene at the wafer-scale by removing the major possible sources of electrical degradation.

Gravitationally Driven Wicking for Enhanced Condensation Heat Transfer.

Vapor condensation is routinely used as an effective means of transferring heat or separating fluids. Filmwise condensation is prevalent in typical industrial-scale systems, where the condensed fluid forms a thin liquid film due to the high surface energy associated with many industrial materials. Conversely, dropwise condensation, where the condensate forms discrete liquid droplets which grow, coalesce, and shed, results in an improvement in heat transfer performance of an order of magnitude compared to filmwise condensation. However, current state-of-the-art dropwise technology relies on functional hydrophobic coatings, for example, long chain fatty acids or polymers, which are often not robust and therefore undesirable in industrial conditions. In addition, low surface tension fluid condensates, such as hydrocarbons, pose a unique challenge because common hydrophobic condenser coatings used to shed water (with a surface tension of 73 mN/m) often do not repel fluids with lower surface tensions (<25 mN/m). We demonstrate a method to enhance condensation heat transfer using gravitationally driven flow through a porous metal wick, which takes advantage of the condensate's affinity to wet the surface and also eliminates the need for condensate-phobic coatings. The condensate-filled wick has a lower thermal resistance than the fluid film observed during filmwise condensation, resulting in an improved heat transfer coefficient of up to an order of magnitude and comparable to that observed during dropwise condensation. The improved heat transfer realized by this design presents the opportunity for significant energy savings in natural gas processing, thermal management, heating and cooling, and power generation.

Degenerative Atypia in Clival Chordoma: Two Case Reports.

In this study, we report surgical management combined with radiotherapy in two patients with typical chordoma. Different types of radiation have varied effects on chordomas when they are radiated. Classical cases display cellular atypia and fibrosis following irradiation, while necrosis and fibrosclerosis are observed after carbon ion therapy, implying that it is possible to control the tumor more effectively using carbon ion therapy with minimal side effects.

Bio-inspired apparatus to produce luminescent cavitation in a rigid walled chamber.

A mechanical device inspired by the rapid rotational motion of the pistol shrimp plunger has been developed to experimentally study the contraction/expansion dynamics of a gas bubble inside a confined liquid volume and in the vicinity of solid surfaces. The apparatus consists of a limb with a V-shaped end, which fits into a socket forming a cylindrical compression chamber. Air bubbles of different sizes and in different positions inside the chamber were seeded to study their shape evolution in liquids when subjected to pressure pulses induced by the limb closure. By changing the standoff and curvature parameters, as well as the closing power of the limb it was possible to control the dynamical behavior of the cavity. Four stages describing the dynamic behavior of the bubble were found: 1) A slight expansion-contraction stage accompanied by very weak volumetric oscillations. 2) First compression stage. The formation of gas and liquid micro-jets is observed when the vertical symmetry axis of the bubble is initially located outside of the chamber symmetry axis, on the other hand, when there is a coincidence between these axes, the bubble only contracts exhibiting non-spherical shapes, alternating between oblate and prolate spheroidal structures. 3) An expansion stage where the cavity reaches the walls of the chamber exhibiting irregular shapes on its surface. 4) Second compression stage. This process begins when the limb rebounds and stops sealing the chamber allowing a jet of liquid to enter from the fluid medium outside, inducing a very violent collapse accompanied by the emission of light. The proposed technique represents a novel alternative to study the dynamic evolution of bubbles near and on solid boundaries of various geometries. Other attractive features of the apparatus are its low manufacturing cost, simple design and compact size which makes it easily portable.

Profile of total IgG, IgG1, IgG2, IgG3 and IgG4 levels in sera of patients with paracoccidioidomycosis: treatment follow-up using Mexo and rPb27 as antigens in an ELISA.

The levels of total of IgG, IgG1, IgG2, IgG3 and IgG4 were evaluated in 54 patients with chronic paracoccidioidomycosis (PCM) before, during and after treatment using an enzyme-linked immunosorbent assay with Mexo and recombinant Pb27 (rPb27) as the antigens. Mexo was effective in distinguishing PCM patients from individuals in the negative control group (NC) based on total IgG and rPb27 performed worse than Mexo when these two groups were compared. IgG1, IgG2, IgG3 and IgG4 could not be used to clearly distinguish PCM patients from those in the NC group using either antigen. There was no clear relationship between antibody levels and the period of treatment. The majority of patients presented with decreased antibody levels during treatment, with no statistically significant differences among the different periods of treatment. Only IgG4 presented a negative correlation between its levels and clinical improvement during treatment. In total, 65% of untreated PCM patients showed reactivity against IgG4 when the Mexo antigen was used and this reactivity decreased over the course of treatment. There was a tendency towards decreasing antibody levels during treatment, but these antibody levels did not necessarily clear after the treatment was stopped. Mexo was useful for PCM diagnosis using total IgG; however, more studies are necessary before this antigen can be used in measuring the levels of total IgG and its subclasses for monitoring patients during treatment.

A unified approach and descriptor for the thermal expansion of two-dimensional transition metal dichalcogenide monolayers.

Two-dimensional (2D) materials have enabled promising applications in modern miniaturized devices. However, device operation may lead to substantial temperature rise and thermal stress, resulting in device failure. To address such thermal challenges, the thermal expansion coefficient (TEC) needs to be well understood. Here, we characterize the in-plane TECs of transition metal dichalcogenide (TMD) monolayers and demonstrate superior accuracy using a three-substrate approach. Our measurements confirm the physical range of 2D monolayer TECs and, hence, address the more than two orders of magnitude discrepancy in literature. Moreover, we identify the thermochemical electronegativity difference of compositional elements as a descriptor, enabling the fast estimation of TECs for various TMD monolayers. Our work presents a unified approach and descriptor for the thermal expansion of TMD monolayers, which can serve as a guideline toward the rational design of reliable 2D devices.

Real-Time Quality Control of Heat Sealed Bottles Using Thermal Images and Artificial Neural Network.

Quality control of heat sealed bottles is very important to minimize waste and in some cases protect people's health. The present paper describes a case study where an automated non invasive and non destructive quality control system was designed to assess the quality of the seals of bottles containing pesticide. In this case study, the integrity of the seals is evaluated using an artificial neural network based on images of the seals processed with computer vision techniques. Because the seals are not directly visible from the bottle exterior, the images are infrared pictures obtained using a thermal camera. The method is non invasive, automated, and can be applied to common conveyor belts currently used in industrial plants. The results show that the inspection process is effective in identifying defective seals with a precision of 98.6% and a recall of 100% and because it is automated it can be scaled up to large bottle processing plants.

Transmission of severe acute respiratory syndrome coronavirus 2 via fecal-oral: Current knowledge.

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in more than 93 million cases and 2 million deaths in the world. SARS-CoV-2 respiratory tract infection and its main clinical manifestations such as cough and shortness of breath are well known to the scientific community. However, a growing number of studies have reported SARS-CoV-2-related gastrointestinal involvement based on clinical manifestations, such as diarrhea, nausea, vomiting, and abdominal pain as well as on the pathophysiological mechanisms associated with coronavirus disease 2019. Furthermore, current evidence suggests SARS-CoV-2 transmission via the fecal-oral route and aerosol dissemination. Moreover, studies have shown a high risk of contamination through hospital surfaces and personal fomites. Indeed, viable SARS-CoV-2 specimens can be obtained from aerosols, which raises the possibility of transmission through aerosolized viral particles from feces. Therefore, the infection by SARS-CoV-2 via fecal-oral route or aerosolized particles should be considered. In addition, a possible viral spread to sources of drinking water, sewage, and rivers as well as the possible risk of viral transmission in shared toilets become a major public health concern, especially in the least developed countries. Since authors have emphasized the presence of viral RNA and even viable SARS-CoV-2 in human feces, studies on the possible fecal-oral coronavirus disease 2019 transmission become essential to understand better the dynamics of its transmission and, then, to reinforce preventive measures against this infection, leading to a more satisfactory control of the incidence of the infection.

Polymer Infused Porous Surfaces for Robust, Thermally Conductive, Self-Healing Coatings for Dropwise Condensation.

Hydrophobic coatings with low thermal resistance promise a significant enhancement in condensation heat transfer performance by promoting dropwise condensation in applications including power generation, water treatment, and thermal management of high-performance electronics. However, after nearly a century of research, coatings with adequate robustness remain elusive due to the extreme environments within many condensers and strict design requirements needed to achieve enhancement. In this work, we enable long-lasting condensation heat transfer enhancement via dropwise condensation by infusing a hydrophobic polymer, Teflon AF, into a porous nanostructured surface. This polymer infused porous surface (PIPS) uses the large surface area of the nanostructures to enhance polymer adhesion, while the nanostructures form a percolated network of high thermal conductivity material throughout the polymer and drastically reduce the thermal resistance of the composite. We demonstrate over 700% enhancement in the condensation of steam compared to an uncoated surface. This performance enhancement was sustained for more than 200 days without significant degradation. Furthermore, we show that the surfaces are self-repairing upon raising the temperature past the melting point of the polymer, allowing recovery of hydrophobicity and offering a level of durability more appropriate for industrial applications.

Glucose metabolism and NRF2 coordinate the antioxidant response in melanoma resistant to MAPK inhibitors.

Targeted therapies as BRAF and MEK inhibitor combination have been approved as first-line treatment for BRAF-mutant melanoma. However, disease progression occurs in most of the patients within few months of therapy. Metabolic adaptations have been described in the context of acquired resistance to BRAF inhibitors (BRAFi). BRAFi-resistant melanomas are characterized by an increase of mitochondrial oxidative phosphorylation and are more prone to cell death induced by mitochondrial-targeting drugs. BRAFi-resistant melanomas also exhibit an enhancement of oxidative stress due to mitochondrial oxygen consumption increase. To understand the mechanisms responsible for survival of BRAFi-resistant melanoma cells in the context of oxidative stress, we have established a preclinical murine model that accurately recapitulates in vivo the acquisition of resistance to MAPK inhibitors including several BRAF or MEK inhibitors alone and in combination. Using mice model and melanoma cell lines generated from mice tumors, we have confirmed that the acquisition of resistance is associated with an increase in mitochondrial oxidative phosphorylation as well as the importance of glutamine metabolism. Moreover, we have demonstrated that BRAFi-resistant melanoma can adapt mitochondrial metabolism to support glucose-derived glutamate synthesis leading to increase in glutathione content. Besides, BRAFi-resistant melanoma exhibits a strong activation of NRF-2 pathway leading to increase in the pentose phosphate pathway, which is involved in the regeneration of reduced glutathione, and to increase in xCT expression, a component of the xc-amino acid transporter essential for the uptake of cystine required for intracellular glutathione synthesis. All these metabolic modifications sustain glutathione level and contribute to the intracellular redox balance to allow survival of BRAFi-resistant melanoma cells.

Biomass-derived carbonaceous positive electrodes for sustainable lithium-ion storage.

Biomass derived carbon materials have been widely used as electrode materials; however, in most cases, only electrical double layer capacitance (EDLC) is utilized and therefore, only low energy density can be achieved. Herein, we report on redox-active carbon spheres that can be simply synthesized from earth-abundant glucose via a hydrothermal process. These carbon spheres exhibit a specific capacity of ∼210 mA h gCS(-1), with high redox potentials in the voltage range of 2.2-3.7 V vs. Li, when used as positive electrode in lithium cells. Free-standing, flexible composite films consisting of the carbon spheres and few-walled carbon nanotubes deliver high specific capacities up to ∼155 mA h gelectrode(-1) with no obvious capacity fading up to 10,000 cycles, proposing to be promising positive electrodes for lithium-ion batteries or capacitors. Furthermore, considering that the carbon spheres were obtained in an aqueous glucose solution and no toxic or hazardous reagents were used, this process opens up a green and sustainable method for designing high performance, environmentally-friendly energy storage devices.

Perceived neighborhood characteristics and the health of adult Koreans.

This study examines the role of the perception of neighborhood quality with respect to its influence on adult health in Korea. Employing the Quality of Korean Life Survey 2001, we found that the extent to which respondents perceive their neighborhood quality selectively affects the health of adult Koreans. That is, how individuals are satisfied with overall neighborhood characteristics, with neighborhood safety and with relationships to neighbors is considerably and significantly associated with self-rated and emotional health status among Koreans, net of individual demographic and socioeconomic characteristics. Although not statistically significant, the same direction of effect is found for daily activity limitation status, which may have been significant if a larger sample size were considered. This study also demonstrates that most individual demographic and socioeconomic risk factors are associated with health in a pattern consistent with that generally found in most Western societies, with the exception of the effect of education on psychological aspects of health.

Cardiac sarcoidosis with severe involvement of the right ventricle: a case report.

We present the case of a patient who underwent cardiac transplantation with the diagnosis of idiopathic dilated cardiomyopathy. Once the explanted heart was examined, a type of granulomatous myocarditis compatible with cardiac sarcoidosis was observed. However, there was severe involvement of the right ventricle, with markedly reduced width of the muscular layer and extensive fibrofatty replacement, findings similar to the ones encountered in cases of arrhythmogenic right ventricular cardiomyopathy (ARVC). Confocal immunofluorescence analysis revealed a reduced signal for plakoglobin and desmoplakin at the cardiac intercalated disks. The immunoreactive signal for desmin showed the typical sarcomeric distribution but not a concentrated signal at the intercalated disks, a pattern previously seen in an 11-year-old girl with Carvajal syndrome bearing a C-terminal truncating mutation in the desmoplakin gene. This case illustrates the difficult and challenging work involved in performing a differential diagnosis among idiopathic dilated cardiomyopathy, isolated cardiac sarcoidosis, and ARVC, all of which are clinical entities known to masquerade as one another.

Cuidados paliativos: enfrentamento dos enfermeiros de um hospital privado na cidade do Rio de Janeiro – RJ / Cuidados paliativos: enfrentamiento de los enfermeros de un hospital privado en la ciudad del Río de Janeiro – RJ / Palliative care: coping nurses in a private hospital in the city of Rio de Janeiro - RJ

Objective: to highlight the nurses’ understanding of Palliative Care, to identify the main challenges encountered by nurses who care for patients outside the therapeutic possibility and to detect the confrontation of these nurses in dealing with this clientele. Methods: This was an exploratory, descriptive study in a qualitative approach. The instrument of data collection was through a semi-structured interview. The sample consisted of 13 nurses, aged over 20 years, who had at least one year of experience in hospital practice and who had assisted the patient in palliative care. Results: the data were analyzed by the content proposed by Bardin and allowed us to create three categories. Conclusion: we perceive that nursing professionals face internal conflicts by providing care to patients with no possibility of cure.

Objetivo: evidenciar o entendimento dos enfermeiros sobre Cuidados Paliativos, identificar os principais desafios encontrados pelos enfermeiros que cuidam de pacientes fora da possibilidade terapêutica e detectar o enfrentamento destes enfermeiros ao lidarem com essa clientela. Métodos: tratou-se de um estudo de caráter exploratório, descritivo numa abordagem qualitativa. O instrumento de coleta de dados foi por meio de uma entrevista semi estruturada. A amostra foi composta por 13 Enfermeiros, com idade superior a 20 anos, que possuíam no mínimo um ano de experiência na prática hospitalar e que tivessem prestado assistência ao paciente em cuidados paliativos. Resultados: os dados foram analisados pelo conteúdo proposto por Bardin e nos permitiu a criação de três categorias. Conclusão: percebemos que os profissionais de enfermagem enfrentam conflitos internos ao prestarem assistência à pacientes sem possibilidade de cura.

Objetivo: destacar la comprensión de las enfermeras sobre cuidados paliativos, identificando los principales retos encontrados por las enfermeras que cuidan a los pacientes fuera de la posibilidad terapéutica y detectar la confrontación de estas enfermeras cuando se trata de este Clientela. Métodos: se trataba de un estudio de carácter exploratorio, descriptivo en un enfoque cualitativo. El instrumento de recolección de datos fue a través de una entrevista semiestructurada. La muestra se compuso de 13 enfermeros, mayores de 20 años, que tenían al menos un año de experiencia en la práctica hospitalaria y que habían prestado asistencia al paciente en cuidados paliativos. Resultados: los datos fueron analizados por el contenido de Bardin y nos permitieron crear tres categorías. Conclusión: percibimos que los profesionales de enfermería enfrentan conflictos internos cuando prestan asistencia a pacientes sin posibilidad de curación.

Características Clínicolaboratoriais da Criptococose em Pacientes Admitidos em Pronto Socorro Hospital das Clínicas, Universidade Federal de Minas Gerais, Referência Terciária do Sistema Único de Saúde: Análise Retrospectiva desde 2000 a 2013 / Clinical Laboratory Characteristics of Cryptococcosis in Patients Admitted to the Emergency Room Hospital das Clínicas, Federal University of Minas Gerais, Tertiary Reference of the Unified Health System: Retrospective Analysis from 2000 to 2013

A criptococose é uma micose sistêmica, de ocorrência relativamente rara, potencialmente grave, geralmente oportunista e de elevada frequência em pacientes imunossuprimidos, com amplo espectro de acometimento de órgãos, tropismo especial para o sistema nervoso central (SNC), evolução subaguda ou crônica, e manifestações clínicas variadas. Este estudo descritivo, retrospectivo, observacional, transversal, objetivou descrever os dados demográficos, clínicos, comorbidades, sintomas ou sinais, e o prognóstico de pacientes com neurocriptococose, atendidos e internados no Hospital das Clínicas (HC) da Universidade Federal de Minas Gerais desde 2000 até 2013. O HC é unidade universitária, pública e geral, de nível terciário e quaternário, com 450 leitos de internação, integrado ao Sistema Único de Saúde (SUS), com clientela universalizada, cerca de 40% do total proveniente do interior do estado de Minas Gerais, predominando da região Metropolitana de Belo Horizonte, aberto à transferência de pacientes de todo o território mineiro, com área de abrangência de população de mais de cinco milhões de pessoas, de todas as faixas etárias e todas as especialidades médicas, encaminhados pela intensidade de sua expressão clínica, especialmente em situação crítica, o que torna sua casuísticade máxima gravidade. Os pacientes foram internados a partir do Pronto Socorro do HC que admite, em média, 80 pacientes com urgência clínicas por dia, incluindo obstétricas, e excluídas aquelas devido à acidente ou violência de qualquer natureza. Foram analisados 40 pacientes com neurocriptococose o que significou 0,13% de toda demanda de admissão de urgência para o período estudado, cerca de 603.000 pessoas, isto é 12% da população referida, e associou-se à letalidade de 25%; com frequência da distribuição de acordo com o gênero em 2:1, entre homens e mulheres, respectivamente; e nas faixas etárias entre 20-40, 40-60 e mais de 60 anos de idade, de 36%, 42%, e 22%, respectivamente, sendo a proporção entre 20 a 60 e mais de 60 de aproximadamente, 2:1. A neurocriptococose associou-se em mais de 50% dos pacientes com a: SIDA (57,5%); internação prévia (52,5%) relacionada à quimio e corticoterapia, transplante, cirurgias para ressecção de neoplasias; e, em menos de 20% com doença cardiovascular hipertensiva sistêmica (17,5%), cirurgia prévia (15%) e tuberculose (5%). A sintomatologia isolada presente em pelo menos 40% dos pacientes foi: cefaleia (70%), astenia (50%), febre (45%), vômitos (40%); entretanto, em até um terço deles constituiu-se de: emagrecimento (30%), tontura (30%), dor abdominal (27,5%), convulsão (22,5%). As anormalidades mais e menos especificamente indicadoras de acometimento do SNC foram cefaleia; e, vômito, tontura e convulsão,respectivamente. As alterações do exame neurológico foram relacionadas aos distúrbios da consciência (35%), lesão focal (30%), alteração da marcha (25%) e distúrbio do comportamento (15%). A concomitância de cefaléia, convulsão e vômitos foi anotada em 5% dos pacientes; enquanto de cefaléia e convulsão em 22,5%. Foi observada, à admissão hospitalar, em 40%, dos pacientes a associação de cefaléia e vômito; mas todos os pacientes com vômito e também os com lesão focal apresentavam cefaleia. A presença de cefaleia não foi descrita em 35% dos pacientes com alteração da consciência à admissão hospitalar. O diagnóstico presuntivo de neurocriptococose deve ser realizado, independentemente da sintomatologia clínica neurológica, o que realça a percepção geral do paciente, incluindo epidemiologia, história familiar, história prévia, manifestações clínicas, presença de imunossupressão, para surpreender a criptococose, e iniciar a terapêutica o mais apidamente possível para que possa ser reduzida sua letalidade. A limitação deste estudo relaciona-se ao fato de ter sido retrospectivo, em que o controle dos dados registrados é muito limitada, sendo impossível corrigir a ausência de dados registrados. (AU)

Cryptococcosis is a systemic, relatively rare, potentially severe, often opportunistic and systemic mycosis in immunosuppressed patients with a broad spectrum of organ involvement, a special central nervous system (CNS) tropism, subacute or chronic clinical manifestations. This descriptive, retrospective, observational, cross-sectional study aimed to describe the demographic, clinical, comorbidities, symptoms or signs, and the prognosis of patients with neurocryptococcosis, attended and hospitalized at the Hospital das Clínicas (HC) of the Universidade Federal de Minas Gerais since 2000 until 2013. The HC is a university unit, public and general, tertiary and quaternary level, with 450 beds of hospitalization, integrated into the Unified Health System (SUS), with a universalized clientele, about 40% of the total coming from the interior of the state of Minas Gerais, predominating in the metropolitan region of Belo Horizonte, which is open to the transfer of patients from all over Minas Gerais, with an area of population of more than five million people, of all age groups and all medical specialties. intensity of its clinical expression, especially in a critical situation, which makes its series of age.The patients were hospitalized from the HC Emergency Room, which admitted, on average, 80 urgently needed clinics per day, including obstetrics, and excluded due to accidents or violence of any kind. We analyzed 40 patients with neurocryptococcosis, which represented 0.13% of all urgent admission demands for the period studied, about 603,000 people, ie 12% of the referred population, and was associated with a 25% lethality; with frequency of distribution according to gender in 2: 1, between men and women, respectively; and in the age groups between 20-40, 40-60 and over 60 years of age, of 36%, 42%, and 22% respectively, the ratio being between 20 to 60 and more than 60 of approximately 2: 1. Neurocryptococcosis was associated in more than 50% of patients with: AIDS (57.5%); previous hospitalization (52.5%) related to chemo and corticoid therapy, transplantation, surgeries for resection of neoplasias; and in less than 20% with systemic hypertensive cardiovascular disease (17.5%), previous surgery (15%) and tuberculosis (5%). The isolated symptoms present in at least 40% of the patients were: headache (70%), asthenia (50%), fever (45%), vomiting (40%); (30%), dizziness (30%), abdominal pain (27.5%), and seizure (22.5%). The most and least specific abnormalities of CNS involvement were headache; and, vomiting, dizziness and convulsion, respectively. Changes in neurological examination were related to disturbances of consciousness (35%), focal lesion (30%), gait alteration (25%) and behavior disorder (15%). The concomitance of headache, convulsion and vomiting was noted in 5% of the patients; while headache and seizure in 22.5%. The association of headache and vomiting was observed in 40% of patients; but all patients with vomiting and those with focal lesion also had headache. The presence of headache was not described in 35% of patients with altered consciousness at hospital admission. The presumptive diagnosis of neurocryptococcosis should be performed independently of the clinical neurological symptomatology, which highlights the general perception of the patient, including epidemiology, family history, previous history, clinical manifestations, presence of immunosuppression, to start cryptococcosis, and initiate therapy. as soon as possible so that their lethality can be reduced. The limitation of this study is the fact that it was retrospective, in which the control of the recorded data is very limited, and it is impossible to correct the absence of recorded data. (AU)

Complicações pós-operatórias do transplante hepático: evidências para otimização da assistência de enfermagem / Las complicaciones postoperatorio de trasplante de hígado: evidencias parala optimización de la asistencia de enfermería / Postoperative complications of liver transplant: evidence for the optimization of nursing care

Objetivo: investigar as principais complicações mais frequentes no pós-operatório do transplante hepático e apontar as evidencias para a detecção precoce e otimização da assistência de enfermagem. Método: Trata-se de um estudo com abordagem quantitativa do tipo descritiva. Foram analisados todos os prontuários eletrônicos disponíveis no sistema MvPep no período de janeiro de 2012 a dezembro de 2014. Os dados foram coletados por meio de um formulário esquematizado, e, para a analise, foram transferidos para o Microsoft Office Excel 2007, transcritos em forma de tabelas e transformado em gráficos para melhor visualização dos dados. Resultados: Destacaram-se diversas complicações como as neurológicas, pulmonares, respiratórias, cardíacas, hematológicas, vasculares, biliares, as do próprio enxerto, intestinais, peritoneais, cirúrgicas, infecciosas e renais. Conclusão: Evidenciou-se a necessidade de uma assistência diferenciada e individualizada aos transplantados, com um olhar aguçado e minucioso, sendo o enfermeiro o responsável por planejá-la.

Objective: to investigate the main and most frequent complications in postoperative liver transplantation and to point out the evidence for early detection and optimization of nursing care. Method: This is a study with a quantitative approach of a descriptive type. All electronic records available in MvPep system from January 2012 to December 2014. Were analyzed. The data were collected through a schematic form, and for the analysis, they were transferred to Microsoft Office Excel 2007, transcribed in the form of tables and graphs were made for better visualization of data. Results: Several complications were noteworthy such as neurological, pulmonary, respiratory, cardiac, hematologic, vascular, biliary, the graft itself, intestinal, peritoneal, surgical, infectious and kidney related. Conclusion: The need for a differentiated and individualized assistance to the transplant patient, with a keen and thorough look, was made evident, and the nurse is responsible for planning it.

Objetivo: investigar las principales complicaciones mas frecuentes em el postoperatorio del trasplante hepatico y senalar las pruebas para La deteccion temprana y la optimizacion de los cuidados de enfermeria. Método: Se trata de un estudio con un enfoque cuantitativo descriptivo, se analizaron todos los registros electronicos disponibles en el sistema MvPep desde enero de 2012 hasta diciembre de 2014. Los datos fueron recogidos a traves de una forma esquematica, y para la analisis fueron transferidos a Microsoft Office Excel 2007, transcritos en forma de tablas y graficos fueran realizados para una mejor visualizacion de datos. Resultados: Se destacaron varias complicaciones como neurologica, pulmonar, respiratorias, cardiacas, hematologicas, vasculares, biliares, el propio injerto, intestinal, peritoneal, quirurgica, infecciosas y en el rinon. Conclusión: Se demostro la necesidad de uma atencion diferenciada e individualizada al paciente de trasplante, com una mirada penetrante y profunda, y el enfermero responsable de La planificacion de la misma.

Epidemiological profile and clinical characteristics of patients with intestinal inflammatory disease / Perfil epidemiológico e características clínicas dos pacientes com doença inflamatória intestinal

ABSTRACT According to several epidemiological studies, there is a significant increase in cases of inflammatory disease in developing countries. Objective: To describe epidemiological data and clinical features of patients with inflammatory bowel disease in patients enrolled in Campo Grande, MS. Method: A retrospective descriptive study with a database analysis of patients who were enrolled and renewed their process in the Exceptional Medications Program of the Health Department from January 2008 to December 2016. Results: 423 patients participated in the study, 260 women and 163 men. Of these, 238 patients had Crohn's disease and 185 had ulcerative rectocolitis. The patients' mean age was 46 years. The most commonly used medication for both diseases was mesalazine and 34.3% of the patients needed to switch their medication during the treatment, most of them with Crohn's disease. In Crohn's patients, the most affected segment was the colon (40.6%) and in patients with ulcerative rectocolitis the entire large intestine was involved (78.8%) was more common. Of the total number of patients, 10.8% of the women and 18.4% of the men needed to use an anti-TNF. Conclusion: Most people on treatment for IBD are female, with a mean age of 46 years and suffering from Crohn's disease. The most affected segments were the entire large intestine in URC cases and the colon in Crohn's disease cases. Mesalazine was the most used drug in both diseases. There was more drug replacement in Crohn's disease patients. In Crohn's disease, younger patients used infliximab more frequently.

RESUMO De acordo com vários estudos epidemiológicos, há aumento significativo de casos de doença inflamatória nos países em desenvolvimento. Objetivo: Descrever os dados epidemiológicos e características clinicas dos pacientes com doença inflamatória intestinal em Campo Grande - MS. Método: Pesquisa descritiva retrospectiva, com análise dos prontuários em banco de dados, em pacientes que cadastraram e renovaram o processo no Programa de Medicamentos Excepcionais da Secretaria de Saúde, de janeiro de 2008 e dezembro de 2016. Resultados: Participaram da pesquisa 423 pacientes, 260 mulheres e 163 homens. Deste total, 238 possuíam doença de Crohn e 185 Retocolite Ulcerativa. A média de idade foi de 46 anos. O medicamento mais utilizado em ambas doenças foi a mesalazina e 34,3% dos pacientes necessitaram realizar troca de medicamentos ao longo do tratamento, sendo a maioria portador da doença de Crohn. Nos pacientes com Crohn o segmento mais acometido foi o cólon (40,6%) e nos pacientes com RCU foi todo o intestino grosso (78,8%). Do total de pacientes, 10,8% das mulheres e 18,4% dos homens necessitaram utilizar anti-TNF. Conclusão: A maioria das pessoas em tratamento para DII são do sexo feminino, com média de idade de 46 anos e portadores de Doença de Crohn. Os segmentos mais acometidos na RCU foi todo o intestino grosso e na Doença de Crohn o colo. A mesalazina foi o medicamento mais utilizado em ambas as doenças. Houve mais troca de medicamentos na Doença de Crohn. Na Doença de Crohn pessoas mais jovens utilizaram mais o infliximabe.

Paracoccidioidomicose (doença de Lutz-Splendore-Almeida): etiologia, epidemiologia e patogênese / Paracoccidioidomycosis disease (Lutz-Splendore-Almeida): etiology, epidemiology, and pathogenesis

A paracoccidioidomicose (PCM) é uma micose granulomatosa sistêmica, polimórfica, determinada pelos Paracoccidioides brasiliensis e P. lutzii e constitui-se em uma das 10 causas de morbimortalidade entre as doenças endêmicas parasitárias no Brasil. A atualização do conhecimento sobre sua etiologia, epidemiologia e patogênese constitui estímulo para que seja incluída no espectro do diagnóstico diferencial da prática médicarotineira, reconhecida com precocidade e tratada convenientemente, evitando-se que evolua com sequelas e morte.

Paracoccidioidomycosis (PCM) is a polymorphic systemic granulomatous mycosis determined by Paracoccidioides brasiliensis and P. lutzii and constitutes one of the 10 leading causes of morbidity and mortality by the parasitic diseases endemic in Brazil. The need for updates on the etiology, epidemiology, and pathogenesis is a for routinely including this disease in the differential diagnosis of current medical practice, recognizing it early and treating it properly, so as to avoid progression with sequelae and death.

Paracoccidioidomicose (doença de Lutz-Splendore-Almeida): manifestações clínicas / Paracoccidioidomycosis disease (Lutz-Splendore-Almeida): clinical manifestations

A paracoccidioidomicose possui clínica polimórfica, com manifestações localizadas em pele e mucosas até comprometimento de vários órgãos e sistemas, potencialmente capaz de provocar sequelas graves e morte. Deve ser incluída no diagnóstico diferencial das doenças granulomatosas, em áreas endêmicas, como ocorre no Brasil, para que seja reconhecida com precocidade, tratada convenientemente e evitada sua evolução para sequelas e morte prematura.

Paracoccidioidomycosis has polymorphic clinical features with lesions located in the skin and mucous membranes, as well as involvement of various organs and systems, as is potentially capable of causing death and serious sequelae. It should be included in the differential diagnosis of granulomatous diseases in endemic areas, including Brazil, so that it is recognized early, for more convenient treatment as to prevent progression with sequelae or premature death.