Malignant syphilis in an AIDS patient.

Malignant syphilis is an uncommon, but not unknown, ulcerative variation of secondary syphilis. The lesions typically begin as papules, which quickly evolve to pustules and then to ulcers with elevated edges and central necrosis. It is usually, but not mandatory, found in patients with some level of immunosuppression, such as HIV patients, when the TCD4(+) cell count is >200 cells/mm(3). Despite the anxiety the lesions cause, this form of the disease has a good prognosis. The general symptoms disappear right after the beginning of treatment, and lesions disappear over a variable period. This study reports the case of a 27-year-old man who has been HIV positive for 6 years, uses antiretroviral therapy incorrectly, has a TCD4(+) cell count of 340 cells/mm(3), a VDRL of 1:128 and itchy disseminated hyperchromic maculopapular lesions with rupioid crusts compatible with malignant syphilis.

Influence of essential oils on the quality of Vigna unguiculata L. (Walp.) seeds compared by traditional method, image and multivariate analysis.

The extracts of medicinal plants are used for the treatment of seeds in order to reduce the action of phytopathogens and increase the vigor of the seeds. Currently, computerized image analysis has been used to assess the physiological quality of seed lots. The objective was to evaluate the efficiency of the Vigor-S® software in the evaluation of the physiological quality of cowpea seeds treated with essential oils, comparing with a traditional test and the principal component analysis. Two cowpea cultivars were analyzed, BRS Tumucumaque and BRS Guariba, treated with doses of natural extracts of Alfavaca, garlic, horsetail, citronella and pyroligneous acid. The traditional method consisted of evaluations for germination, first germination count, seedling emergence, emergence speed index, accelerated aging, fresh matter and dry matter of seedling and the image analysis for: seedling length, growth index, uniformity index, vigor index, and germination. A Principal component analysis was applied to reduce the number of variables. Horsetail, Alfavaca and citronella extracts were efficient in increasing the physiological quality of the seeds of at least one cultivar. The Vigor-S® software proved to be efficient compared to traditional tests to assess the physiological quality of seeds. Principal Component Analysis is an ally to identify the best extracts and doses to be used. The image analysis method proved to be effective when compared to the traditional method and can therefore be used.

Different inflammatory stimuli in the footpad of mice influence the kinetics of resident peritoneal cells.

OBJECTIVES: Evidence from the literature that inflammation is a systemic biological phenomenon prompted us to investigate whether inoculation of different irritants to the footpad of mice might influence the kinetics of resident peritoneal cells. METHODS: Mice were inoculated in the footpad at different time intervals with Mycobacterium bovis bacillus Calmette-Guerin (BCG), Ehrlich ascitic tumor cells or lipopolysaccharide (LPS), and resident peritoneal cells were analyzed by flow cytometry. RESULTS: The results indicate that different stimuli induced different responses in resident peritoneal cells. FoxP3 positive regulatory T cells increased drastically in number after BCG inoculation. Conversely, tumor cell inoculation induced a decrease in FoxP3-positive T cells in the peritoneal cavity, although this effect was not statistically significant. Results also show that cells from the paw migrate to the popliteal lymph node and to the peritoneal cavity. Yet, there are cells in the peritoneal cavity that migrate to the popliteal lymph node. CONCLUSION: These data show that cells from the peritoneal cavity are influenced by pathologies in remote regions of the animal. How this novel phenomenon influences overall immune responses, courses of infection and tumor growth are open to further investigation.

RANKL Triggers Treg-Mediated Immunoregulation in Inflammatory Osteolysis.

The chronic inflammatory immune response triggered by the infection of the tooth root canal system results in the local upregulation of RANKL, resulting in periapical bone loss. While RANKL has a well-characterized role in the control of bone homeostasis/pathology, it can play important roles in the regulation of the immune system, although its possible immunoregulatory role in infectious inflammatory osteolytic conditions remains largely unknown. Here, we used a mouse model of infectious inflammatory periapical lesions subjected to continuous or transitory anti-RANKL inhibition, followed by the analysis of lesion outcome and multiple host response parameters. Anti-RANKL administration resulted in arrest of bone loss but interfered in the natural immunoregulation of the lesions observed in the untreated group. RANKL inhibition resulted in an unremitting proinflammatory response, persistent high proinflammatory and effector CD4 response, decreased regulatory T-cell (Treg) migration, and lower levels of Treg-related cytokines IL-10 and TGFb. Anti-RANKL blockade impaired the immunoregulatory process only in early disease stages, while the late administration of anti-RANKL did not interfere with the stablished immunoregulation. The impaired immunoregulation due to RANKL inhibition is characterized by increased delayed-type hypersensitivity in vivo and T-cell proliferation in vitro to the infecting bacteria, which mimic the effects of Treg inhibition, reinforcing a possible influence of RANKL on Treg-mediated suppressive response. The adoptive transfer of CD4+FOXp3+ Tregs to mice receiving anti-RANKL therapy restored the immunoregulatory capacity, attenuating the inflammatory response in the lesions, reestablishing normal T-cell response in vivo and in vitro, and preventing lesion relapse upon anti-RANKL therapy cessation. Therefore, while RANKL inhibition efficiently limited the periapical bone loss, it promoted an unremitting host inflammatory response by interfering with Treg activity, suggesting that this classic osteoclastogenic mediator plays a role in immunoregulation.

Possible benefit of consolidation therapy with high-dose cytarabine on overall survival of adults with non-promyelocytic acute myeloid leukemia.

In adults with non-promyelocytic acute myeloid leukemia (AML), high-dose cytarabine consolidation therapy has been shown to influence survival in selected patients, although the appropriate doses and schemes have not been defined. We evaluated survival after calculating the actual dose of cytarabine that patients received for consolidation therapy and divided them into 3 groups according to dose. We conducted a single-center, retrospective study involving 311 non-promyelocytic AML patients with a median age of 36 years (16-79 years) who received curative treatment between 1978 and 2007. The 131 patients who received cytarabine consolidation were assigned to study groups by their cytarabine dose protocol. Group 1 (n=69) received <1.5 g/m2 every 12 h on 3 alternate days for up to 4 cycles. The remaining patients received high-dose cytarabine (≥1.5 g/m2 every 12 h on 3 alternate days for up to 4 cycles). The actual dose received during the entire consolidation period in these patients was calculated, allowing us to divide these patients into 2 additional groups. Group 2 (n=27) received an intermediate-high-dose (<27 g/m2), and group 3 (n=35) received a very-high-dose (≥27 g/m2). Among the 311 patients receiving curative treatment, the 5-year survival rate was 20.2% (63 patients). The cytarabine consolidation dose was an independent determinant of survival in multivariate analysis; age, karyotype, induction protocol, French-American-British classification, and de novo leukemia were not. Comparisons showed that the risk of death was higher in the intermediate-high-dose group 2 (hazard ratio [HR]=4.51; 95% confidence interval [CI]: 1.81-11.21) and the low-dose group 1 (HR=4.43; 95% CI: 1.97-9.96) than in the very-high-dose group 3, with no significant difference between those two groups. Our findings indicated that very-high-dose cytarabine during consolidation in adults with non-promyelocytic AML may improve survival.

Isolated limb perfusion with fotemustine after chemosensitization with dacarbazine in melanoma.

Isolated limb perfusion (ILP) has been reported as the most effective treatment for localized recurrent melanoma of the limbs. In terms of local and regional control with melphalan, complete remission is achieved in about 40% of patients, with frequent toxicity causing significant short-term disability in many and long-term incapacity in a few. Since 1989, several studies have reported success using a combination of fotemustine and dacarbazine (DTIC) in the systemic treatment of disseminated melanoma and brain metastasis. In May 1995, we began a pilot study with systemic DTIC 400 mg/m2 given intravenously about 4 h before ILP using fotemustine in an intra-arterial bolus of 100-150 mg/m2 as the perfusion agent. By July 1996, 10 patients had been included in the study. The results were evaluated in terms of the response rate (five complete responses and one partial response in the six patients who could be evaluated), local toxicity (nine patients with level I and one with level II, measured on the Wieberdink scale) and systemic toxicity (nine patients with level 0 and one with level 1, measured on the World Health Organization scale). Treatment was effective, with a similar response rate to that obtained with melphalan but with much lower toxicity, so this protocol may represent an innovation in loco-regional therapy and should be further investigated in a large trial.

Rat models of protein and protein-energy malnutrition.

Two animal models of infantile malnutrition were produced where some aspects of carbohydrate metabolism can be studied: protein-depleted (PD, "kwashiorkor") rats, fed a protein-free diet for 18 days, starting 3 days before weaning, and chronically malnourished animals during suckling (PED, "marasmus") where 20-22 pups were fed by the same dam. PED and PD rats were sacrificed at 21 and 36 days of age, respectively. Body weight was 35% in PD, and 50% in PED groups when compared to their age-matched controls. After an overnight fast, some of the PD animals presented with low blood glucose levels, and the levels of lactic and pyruvic acids were depressed in PED, while lactic acid was increased in PD animals. Blood glucose utilization was reduced in PED, and increased in PD rats, while the opposite was true for the kidney gluconeogenic capacity. When compared to the respective control values, muscle glycogen was high in both groups, while the level of liver glycogen was unchanged. The rate of muscle glycolysis was decreased in both groups. These results are in agreement with clinical observations, suggesting that these models may be used to study some of the metabolic changes brought about by infantile malnutrition.

B-1 cells and concomitant immunity in Ehrlich tumour progression.

Concomitant immunity is a phenomenon in which a tumour-bearing host is resistant to the growth of an implanted secondary tumour. Metastases are considered to be secondary tumours that develop spontaneously during primary tumour growth, suggesting the involvement of concomitant immunity in controlling the rise of metastases. It has been demonstrated that B-1 cells, a subset of B-lymphocytes found predominantly in pleural and peritoneal cavities, not only increase the metastatic development of murine melanoma B16F10, but also are capable of differentiating into mononuclear phagocytes, modulating inflammatory responses in wound healing, in oral tolerance and in Paracoccidiose brasiliensis infections. Here, we studied B-1 cells' participation in concomitant immunity during Ehrlich tumour progression. Our results show that B-1 cells obtained from BALB/c mice previously injected with Ehrlich tumour in the footpad were able to protect BALB/c and BALB/Xid mice against Ehrlich tumour challenge. In addition, it was demonstrated that BALB/Xid show faster tumour growth and have lost concomitant immunity, and that this state can be partially restored by reconstituting these animals with B-1 cells. However, further researches are required to establish the mechanism involving B-1 cells in Ehrlich tumour growth.

Ropivacaína isolada ou associada à metadona ou à morfina, pela via epidural, em cadelas submetidas à ovário-histerectomia / Ropivacaine sole or associated to methadone or morphine, by epidural route, in bitches undergoing ovariohysterectomy

Objetivou-se avaliar os efeitos fisiológicos, sedativos e analgésicos da administração peridural de ropivacaína isolada ou associada à morfina ou à metadona. Para tal, 24 cadelas submetidas à ovário-histerectomia receberam acepromazina, e a anestesia foi induzida e mantida com propofol e isoflurano (FiO2 = 1,0), respectivamente. De acordo com o protocolo peridural, formaram-se três grupos de igual número: GR (ropivacaína - 2,0mg/kg); GRMETA (ropivacaína - 2,0mg/kg e metadona - 0,3mg/kg) e GRMORF (ropivacaína - 2,0mg/kg e morfina - 0,1mg/kg). Registraram-se os parâmetros fisiológicos intraoperatórios e os graus de sedação e analgesia pós-operatórios. No GR constataram-se maiores médias de pressões arteriais 30 minutos após a anestesia epidural em relação ao GRMETA (sistólica e média) e ao final do procedimento cirúrgico comparativamente ao GRMORF (sistólica, diastólica e média). Não foram observadas diferenças significativas entre os grupos relativamente à analgesia e ao grau de sedação pós-operatórios. A administração epidural de ropivacaína é segura e eficaz e proporciona boa analgesia, independentemente da sua associação com morfina ou metadona.(AU)

The aim of this study was to evaluate the physiological, sedative and analgesic effects of epidural administration of ropivacaine sole or associated to morphine or methadone. Twenty-four bitches were submitted to ovariohysterectomy and received acepromazine and after, propofol and isoflurane (FiO 2 = 1.0) for anesthesia induction and maintenance, respectively. Based on established epidural protocol (L7-S1), three groups were formed: GR (ropivacaine - 2.0mg/kg); GRMETA (ropivacaine - 2.0mg/kg and methadone - 0.3mg/kg) and GRMORF (ropivacaine - 2.0mg/kg and morphine - 0.1mg/kg). Intraoperative physiological parameters and degrees of postoperative sedation and analgesia were recorded. In the GR, the means of arterial pressures, 30 minutes after epidural anesthesia, were higher compared with GRMETA (systolic and mean) and, at the end of the clinical procedure, compared to GRMORF (systolic, diastolic and mean). Differences between groups were not observed for postoperative analgesia and degree of sedation. Epidural administration of ropivacaine is safe and effective and provides good analgesia regardless of its association with morphine or methadone.(AU)

Possible benefit of consolidation therapy with high-dose cytarabine on overall survival of adults with non-promyelocytic acute myeloid leukemia

In adults with non-promyelocytic acute myeloid leukemia (AML), high-dose cytarabine consolidation therapy has been shown to influence survival in selected patients, although the appropriate doses and schemes have not been defined. We evaluated survival after calculating the actual dose of cytarabine that patients received for consolidation therapy and divided them into 3 groups according to dose. We conducted a single-center, retrospective study involving 311 non-promyelocytic AML patients with a median age of 36 years (16-79 years) who received curative treatment between 1978 and 2007. The 131 patients who received cytarabine consolidation were assigned to study groups by their cytarabine dose protocol. Group 1 (n=69) received <1.5 g/m2 every 12 h on 3 alternate days for up to 4 cycles. The remaining patients received high-dose cytarabine (≥1.5 g/m2 every 12 h on 3 alternate days for up to 4 cycles). The actual dose received during the entire consolidation period in these patients was calculated, allowing us to divide these patients into 2 additional groups. Group 2 (n=27) received an intermediate-high-dose (<27 g/m2), and group 3 (n=35) received a very-high-dose (≥27 g/m2). Among the 311 patients receiving curative treatment, the 5-year survival rate was 20.2% (63 patients). The cytarabine consolidation dose was an independent determinant of survival in multivariate analysis; age, karyotype, induction protocol, French-American-British classification, and de novo leukemia were not. Comparisons showed that the risk of death was higher in the intermediate-high-dose group 2 (hazard ratio [HR]=4.51; 95% confidence interval [CI]: 1.81-11.21) and the low-dose group 1 (HR=4.43; 95% CI: 1.97-9.96) than in the very-high-dose group 3, with no significant difference between those two groups. Our findings indicated that very-high-dose cytarabine during consolidation in adults with non-promyelocytic AML may improve survival.

Spawning season, recruitment and early life distribution of Anchoa tricolor (Spix and Agassiz, 1829) in a tropical bay in southeastern Brazil.

The pattern of the use of the Sepetiba Bay, a semi-closed 450 km(2) area in southeastern Brazil, by Anchoa tricolor was investigated to assess spawning period, recruitment and to detect spatial-temporal patterns of this major fishery resource. Fishes were sampled by seine nets, from spring, 1998 to winter, 1999 and by beach seine, from spring, 1998 to winter, 2000. Reproductive season, measured in terms of GSI, gonad development and appearance of recruits, indicate that reproduction occurs from August to March, when they reach the best condition. Recruitment peaks in winter/spring at sandy beaches where they stay until late summer, moving toward deeper bay areas during autumn. After that, they join adults and perform movements between the bay and the adjacent continental shelf to reproduce.

A re-examination of the stability of retinol in blood and serum, and effects of a standardized meal.

We examined the stability of retinol in blood and serum samples, kept in the dark, under different handling procedures. Samples not protected from contact with air oxygen were highly unstable, even when kept at ice temperature. Samples collected under anaerobic conditions, with Vacutainer Tubes, or treated with nitrogen after collection to displace the air from the tubes were stable during the usual interval between collection and freezing or analysis in biochemical surveys. Ingestion of a moderate amount of vitamin. A significantly increased serum retinol concentrations in normal volunteers, showing the importance that survey samples be preprandial.

Development and properties of polycaprolactone/hydroxyapatite composite biomaterials.

Polycaprolactone/hydroxyapatite (PCL/HA) composites were prepared by two different procedures. The first one consists of a conventional blending of the polymer and the reinforcement material in an extruder. The second method consists of grafting of PCL on the surface of HA particles. This was achieved by a ring opening polymerization of caprolactone in the presence of HA, where its OH groups act as initiators. By this method, it was possible to obtain, in one step, a composite of PCL and surface modified HA. In both methods different percentages of filler were used to obtain several composites. These composites were characterized with respect to their mechanical properties, in the dry and wet state, by means of tensile tests on compression molded samples. The polymer/filler interface was analyzed by scanning electron microscopy. Water uptake and weight loss degradation experiments were also performed. An increase in the modulus for higher amounts of filler was, as expected, observed in the composites obtained by both processes. Furthermore, the mechanical properties of the materials in the wet state are considerably lower than those in the dry state. However, this difference is more significant for the composites obtained by conventional blending than for composites obtained by the grafting procedure, indicating that the later procedure can be an adequate route to reduce water susceptibility of PCL/HA composites.

Inbreeding in a Brazilian general hospital.

A group of 925 adult in-patients of a Brazilian general hospital was matched by race (subdivided in five groups) and age with a group of 925 of their visitors, who were taken as controls. Illiteracy increases from Whites to Blacks and is significantly more prevalent among the patients than among their respective controls. Inbreeding, on the contrary, increases from Blacks to Whites. White patients showed a significantly higher rate of inbreeding than their corresponding controls. The difference is also significant for the fraction Whites plus Light Mulattoes, but not for the other race subgroups. As regards the total, the significance is present only in a one-tailed distribution. It is concluded that the inbreeding load (if any) acting on the total of the patients is negligible; it seems significantly different from 0 only among Whites. No inbreeding effect could be verified, however, on any particular condition among the Whites. Estimates of the number of morbid equivalents per gamete (morbons) revealed values which are both significantly (among Whites and Whites plus Light Mulattoes) and non-significantly (among the other racial subgroups) different from zero. These estimates reflect the situation in the sample which has been artificially organized to contain 50% of patients.

[Perinatal mortality at Maternidade da Encruzilhada]. / Mortalidade perinatal na Maternidade da Encruzilhada.

PIP: According to the WHO, perinatal mortality consists of both fetal and neonatal mortality. Included are only fetuses weighing more than 1000 g, or in case this data is unavailable, only fetuses having a gestational age of more than 28 weeks or a length equal to 35 cm. However, for regional studies fetal weights between 500-1000 g are sometimes also considered. Neonatal mortality accounts for deaths occurring until the 7th day after birth. The same measurement criteria apply. Better pre and postnatal care is responsible for a lower perinatal mortality coefficient. Also, in regions with an even distribution of wealth, the perinatal mortality coefficient is low. The present study appraises perinatal mortality occurring at the maternity hospital in Encruzilhada, during the year 1985. The perinatal mortality coefficient was approximately 40/1000 and represents the sum of the fetal mortality coefficient (21.56/1000) and the neonatal mortality coefficient (18.79/1000). This figure is considered high and reflects the state of poverty of the population visiting the hospital. The maternal condition most frequently connected with fetal death is arterial hypertension, in isolation or combined with toxemic pregnancy. Respiratory problems are the most frequent cause of early death for babies, a condition that typically afflicts prematurely born babies. A comparison is made with a study of 12,600 high-risk pregnancies during the same year in Canada. Perinatal mortality for babies of that group was only 1.9/1000. From this discrepancy it is obvious that urgent measures must be directed toward improving this neglected area of maternal/infant health.^ieng

Granisetron plus methylprednisolone for the control of high-dose cisplatin-induced emesis.

This double-blind, double-dummy, randomized study compared the 24 h efficacy and safety of granisetron alone (3 mg i.v. over 30 s) or in combination with methylprednisolone (250 mg i.v. twice daily) in preventing nausea and vomiting in 308 patients (254 males) receiving high-dose cisplatin (100 mg/m2 or above) for mainly lung, and head and neck cancers. All patients received oral follow-on therapy comprising oral granisetron and methylprednisolone during the following 6 days. Primary efficacy variables were the proportions of complete responses (CR; no vomiting, no worse than mild nausea, no rescue and no withdrawal), no vomiting and no nausea over the first 24 h following initiation of the cisplatin infusion. The two treatment groups were well matched for demographics, cancer site, cisplatin dose and duration of infusion. Granisetron plus methylprednisolone was significantly more effective than granisetron alone for all primary efficacy variables: CR 78 versus 59% (p<0.001), no vomiting 80 versus 61% (p<0.001) and no nausea 74 versus 57% (p<0.002). Significantly more patients receiving the combination were free of any emetic symptoms (74 versus 54%, p<0.001). Significantly fewer patients receiving combination therapy also required rescue therapy with i.v. granisetron (12.2 versus 21.7%, p=0.026). During the follow-on period, complete response rates varied day by day from 50 to 71%. Both treatments were well tolerated, with constipation, abdominal pain and headache as the most frequent adverse events.

Spawning season, recruitment and early life distribution of Anchoa tricolor (Spix and Agassiz, 1829) in a tropical bay in southeastern Brazil / Período de reprodução, recrutamento e distribuição de jovens de Anchoa tricolor (Spix and Agassiz, 1829) em uma baía tropical do sudeste do Brasil

The pattern of the use of the Sepetiba Bay, a semi-closed 450 km² area in southeastern Brazil, by Anchoa tricolor was investigated to assess spawning period, recruitment and to detect spatial-temporal patterns of this major fishery resource. Fishes were sampled by seine nets, from spring, 1998 to winter, 1999 and by beach seine, from spring, 1998 to winter, 2000. Reproductive season, measured in terms of GSI, gonad development and appearance of recruits, indicate that reproduction occurs from August to March, when they reach the best condition. Recruitment peaks in winter/spring at sandy beaches where they stay until late summer, moving toward deeper bay areas during autumn. After that, they join adults and perform movements between the bay and the adjacent continental shelf to reproduce.

O padrão de uso da Baía de Sepetiba, uma área semifechada no Sudeste do Brasil, por Anchoa tricolor foi estudado visando determinar o período reprodutivo, recrutamento e detectar padrões de distribuição espacial e temporal. As amostras foram realizadas por rede de cerco, entre a primavera de 1998 e o inverno de 1999, e por arrasto de praia, da primavera de 1998 ao inverno de 2000. O período reprodutivo, estimado com base no índice gonadossomático, desenvolvimento gonadal e aparecimento de recrutas, ocorre de agosto a março, quando é atingida a melhor condição dos adultos. O recrutamento ocorre principalmente no inverno/primavera nas praias arenosas onde eles permanecem até fins do verão, movendo-se para áreas mais fundas da baia durante o outono. Depois disto eles se juntam aos adultos e fazem movimentos entre a baia e a plataforma costeira adjacente para reproduzir.

Curso: Tópicos de Medicina Interna: Hemorragia digestiva alta não-varicosa: avaliação da gravidade e conduta terapêutica / Course: Internal Medicine topics: Nonvariceal upper gastrointestinal bleeding: Gravity evaluation and therapeutical approach

A hemorragia digestiva alta (HDA) continua sendo uma das principais causas de atendimento hospitalar emergencial