The absence of eosinophils is associated with early metastatic lesions in Leishmania amazonensis-infected mice.

BACKGROUND: Eosinophils are granulocytes that rapidly increase frequency in the bloodstream during helminthic infections and allergic responses. They are found in tissue infected by Leishmania during early disease, but their role during infection is not entirely understood. OBJECTIVES: We aim to compare the disease due to Leishmania amazonensis in BALB/c and Δdbl-GATA1 mice, which lack eosinophils. METHODS: BALB/c and Δdbl-GATA1 mice infected with L. amazonensis were observed for several weeks. The parasite load and dissemination pattern were assessed. FINDINGS: The Δdbl-GATA1 mice developed an anticipated dissemination of L. amazonensis and a worsening disease. No differences were found in the lesion development or the parasite load in the footpad among Δdbl-GATA1 mice and BALB/c eight weeks after infection. However, nine weeks after infection, massive growth of metastatic lesions appeared in several parts of the skin in Δdbl-GATA1 mice, weeks earlier than BALB/c. We observed increased parasites in the bloodstream, probably an essential dissemination route. Thirteen weeks after infection, metastatic lesions were found in all Δdbl-GATA1 mice. MAIN CONCLUSION: These results suggest a protective role of eosinophils in delaying the disease caused by L. amazonensis, although several limitations of this mice strain must be considered.

Musculoskeletal embolization - endovascular treatment of adhesive capsulitis.

Adhesive capsulitis, commonly known as frozen shoulder, is a painful and restrictive condition that significantly impairs the quality of life for affected individuals. We present the successful endovascular treatment of adhesive capsulitis in the first-ever case performed in Portugal. A 6-month follow-up with objective results is presented, using the visual analog scale for pain and the Quick Dash questionnaire. Trans-arterial, musculoskeletal embolization, as a cutting-edge technique, offers a promising avenue for patients with adhesive capsulitis unresponsive to traditional management, opening new possibilities for improved outcomes and enhanced quality of life.

Natural Pigments Recovery from Food By-Products: Health Benefits towards the Food Industry.

Given the health risks associated with synthetic colorants, natural pigments have emerged as a promising alternative. These renewable choices not only provide health benefits but also offer valuable technical and sensory properties to food systems. The effective application of natural colorants, however, requires the optimization of processing conditions, exploration of new sources, and development of novel formulations to ensure stability and maintain their inherent qualities. Several natural pigment sources have been explored to achieve the broad color range desired by consumers. The purpose of this review is to explore the current advances in the obtention and utilization of natural pigments derived from by-products, which possess health-enhancing properties and are extracted through environmentally friendly methods. Moreover, this review provides new insights into the extraction processes, applications, and bioactivities of different types of pigments.

The mesopontine tegmentum in reward and aversion: From cellular heterogeneity to behaviour.

The mesopontine tegmentum, comprising the pedunculopontine tegmentum (PPN) and the laterodorsal tegmentum (LDT), is intricately connected to various regions of the basal ganglia, motor systems, and limbic systems. The PPN and LDT can regulate the activity of different brain regions of these target systems, and in this way are in a privileged position to modulate motivated behaviours. Despite recent findings, the PPN and LDT have been largely overlooked in discussions about the neural circuits associated with reward and aversion. This review aims to provide a timely and comprehensive resource on past and current research, highlighting the PPN and LDT's connectivity and influence on basal ganglia and limbic, and motor systems. Seminal studies, including lesion, pharmacological, and optogenetic/chemogenetic approaches, demonstrate their critical roles in modulating reward/aversive behaviours. The review emphasizes the need for further investigation into the associated cellular mechanisms, in order to clarify their role in behaviour and contribution for different neuropsychiatric disorders.

An overview of infective endocarditis in the context of COVID-19 pneumonia.

Infective endocarditis (IE) in the context of coronavirus disease (COVID-19) is an emerging clinical entity. If not identified timeously, it is associated with high morbidity and mortality. Herein, we provide an overview of the literature supported by a clinical vignette, and highlight the importance of early recognition and management of IE in the context of COVID-19 infection.

Caracterização fitossanitária do componente arbóreo marginalde um trecho de linha férrea no município de Três Barras, SC / Phytosanitary characterization of the marginal arboreal componentof the railway line in the municipality of Três Barras, SC

As condições fitossanitárias de plantas arbóreas podem ser utilizadas para caracterizar comunidades vegetais, indicando condições de qualidade estrutural do componente vegetal. Assim, ambientes alterados antropicamente podem representar uma ameaça à fitossanidade. O objetivo deste estudo foi averiguar as características fitossanitárias do componente arbóreo em um trecho de 400 metros de extensão ao longo da linha férrea localizada no município de Três Barras, estado de Santa Catarina, Brasil. Foram registradas 33 espécies arbóreas, 29 gêneros e 19 famílias. Os índices ecológicos avaliados foram a abundância, densidade, riqueza e equabilidade. Foram avaliados 190 indivíduos em relação a qualidade da copa, grau de infestação de cipós e sanidade da árvore. Embora a qualidade da copa e a sanidade sejam majoritariamente boas, houve um relativo alto número de infestação de cipós. Tal ocorrência pode ser devido à condição de borda em que as plantas se encontram. Os bons índices ecológicos aliados ao baixo número de espécies arbóreas exóticas também indicam boas condições ecológicas e de fitossanidade local. Contudo, são necessários mais estudos (p. ex. florísticos e fitossociológicos) na área. A arborização urbana das proximidades aliada à formação de corredores ecológicos que liguem os fragmentos à Floresta Nacional de Três Barras pode ser uma medida de conservação e regeneração a ser explorada.

Phytosanitary conditions of tree plants can be used to characterize plant communities, indicating structural quality conditions of the plant component. Thus, anthropically altered environments may pose a threat to plant health. The objective of this study was to investigate the phytosanitary and ecological condition of the tree component in a stretch of 400 meters along the railway line located in the municipality of Três Barras, Santa Catarina state, Brazil. Thirty-three tree species were recorded, in addition to 54 taxonomically unidentified individuals. The ecological indices evaluated were abundance, density, richness and evenness. 190 individuals were evaluated in terms of crown quality, Abstract degree of liana infestation and tree health. Although canopy quality and health are mostly good, there was a relatively high number of vine infestations. Such an occurrence may be due to the edge condition in which the plants are located. The good ecological indices combined with the low number of exotic tree species also indicate good ecological conditions and local plant health. However, more studies are needed in the area. Urban afforestation, combined with the formation of ecological corridors that connect the fragments to the Três Barras National Forest, can be a conservation and regeneration measure to be explored.

The absence of eosinophils is associated with early metastatic lesions in Leishmania amazonensis-infected mice

BACKGROUND Eosinophils are granulocytes that rapidly increase frequency in the bloodstream during helminthic infections and allergic responses. They are found in tissue infected by Leishmania during early disease, but their role during infection is not entirely understood. OBJECTIVES We aim to compare the disease due to Leishmania amazonensis in BALB/c and Δdbl-GATA1 mice, which lack eosinophils. METHODS BALB/c and Δdbl-GATA1 mice infected with L. amazonensis were observed for several weeks. The parasite load and dissemination pattern were assessed. FINDINGS The Δdbl-GATA1 mice developed an anticipated dissemination of L. amazonensis and a worsening disease. No differences were found in the lesion development or the parasite load in the footpad among Δdbl-GATA1 mice and BALB/c eight weeks after infection. However, nine weeks after infection, massive growth of metastatic lesions appeared in several parts of the skin in Δdbl-GATA1 mice, weeks earlier than BALB/c. We observed increased parasites in the bloodstream, probably an essential dissemination route. Thirteen weeks after infection, metastatic lesions were found in all Δdbl-GATA1 mice. MAIN CONCLUSION These results suggest a protective role of eosinophils in delaying the disease caused by L. amazonensis, although several limitations of this mice strain must be considered.

Adaptation And Use of the Papworth Haemostasis Checklist - Clinical Outcomes Analysis at Hospital Estadual Mário Covas

ABSTRACT Introduction: Postoperative bleeding is one of the main causes of complications in cardiovascular surgery, which highlights the importance of ensuring adequate intraoperative hemostasis, providing a better patient outcome. This study aimed to improve the prevention of postoperative bleeding in the Cardiovascular Surgery Department of the Hospital Estadual Mário Covas (Santo André, Brazil) using an adapted version of the Papworth Haemostasis Checklist to assess the impact of this standardization on bleeding rate, postoperative complications, reoperation, and mortality. Methods: This is a non-randomized controlled clinical trial, whose non-probabilistic sample consisted of patients undergoing cardiac surgery in the abovementioned service within a two-year interval. The Papworth Haemostasis Checklist was adapted to the Brazilian laboratory parameters and the questions were translated into Portuguese. This checklist was used before the surgeon started the chest wall closure. Patients were followed up until 30 days after surgery. A P-value < 0.05 was considered statistically relevant. Results: This study included 200 patients. After the checklist, a reduction in 24-hour drain output, postoperative complications, and reoperation was observed, although statistical significance was not reached. Finally, there was a significant reduction in the number of deaths (8 vs. 2; P=0.05). Conclusion: The use of the adapted checklist in our hospital proved to be an effective intervention to improve the prevention of postoperative bleeding, with a direct impact in the number of deaths in the study period. The reduction in deaths was possible thanks to the reduction in the bleeding rate, postoperative complications, and reoperations for bleeding.

Epidemiología y práctica médica / Epidemiology and medical practice

RESUMEN Se presenta un texto inédito de Ricardo Bruno Mendes Gonçalves, referente del campo de la salud colectiva, en el que aborda la relación entre la epidemiología y la práctica médica. Se trata de la conferencia dictada el 16 de diciembre de 1988, en el marco de la apertura del seminario "Epidemiología clínica: ¿campo científico posible o nueva ideología médica?", organizado por el Departamento de Medicina Preventiva, de la Facultad de Medicina de la Universidade Federal da Bahia, Brasil. Esta versión ha sido desgrabada y transcripta manualmente, revisada y, en muchos casos, reescrita por Naomar de Almeida Filho y Jose Ricardo Ayres, buscando siempre preservar el sentido original y el tono coloquial característico de sus conferencias.

ABSTRACT In this unpublished work by Ricardo Bruno Mendes Gonçalves, a key figure in the field of collective health, the relationship between epidemiology and medical practice is considered. The text is based on an inaugural lecture delivered on December 16, 1988 as part of a seminar called "Clinical epidemiology: possible scientific field or new medical ideology?" organized by the Department of Preventive Medicine at the Federal University of Bahia School of Medicine, Brazil. This manually transcribed version of the lecture was prepared, revised, and in many cases rewritten by Naomar de Almeida Filho and Jose Ricardo Ayres, who always sought to preserve the original meaning and colloquial tone that was characteristic of his lectures.

Physiological and mechanical loads in Portuguese sub-elite football refereeing –a preliminary study / Carga fisiológica e mecânica em árbitros de futebol sub-elite português –um estudo preliminar / Carga fisiológica y mecánica en el arbitraje de fútbol sub-élite portugués –uno estudio preliminar

This study aimed to examine the variation in physiological and mechanical load in a sub-elite refereeing team, considering the different parts of the match and their role (field referee vs.assistant referees). One field referee (32.57 years) and two assistant referees (31.05 years) were monitored during 4 matches of the Portuguese Championship throughout the 2018-2019 season (senior age category, or adult), using the ZephyrTMBioHarness. The following variables were considered for analysis: skin temperature, respiratory rate (RR), heart rate (HR), percentage of maximum heart rate (%HRmax), posture, activity, and peak acceleration (ACCpeak). The impulse load, expressed as N∙s, was also calculated. No physiological and mechanical differences were observed according to match half, considering the refereeing team members. Significant differences were verified between field referee and assistant referees in the 1sthalf and the 2ndhalf and for total match-play: on average, the field referee had higher values forskin temperature (p= 0.016; r= -0.759), HR (p= 0.017;r = -0.757), %HRmax(p= 0.017; r= -0.757), activity (p= 0.017; r= -0.757), and ACCpeak(p= 0.017; r= -0.757). Curiously, no differences were found for impulse load between the field referee and the assistant referees. The football referee’s activity profile is both physiologically and mechanically demanding, even at a sub-elite level. Differences between field referee and assistants must be considered in refereeing fitness and conditioning training programs to cope with physical demands of a football match. (AU)

Este estudo teve como objetivo examinar a variação da carga fisiológica e mecânica numa equipa de arbitragem sub-elite, considerando as diferentes partes da partida e o seu papel (árbitro de campo vs.árbitro assistente). Um árbitro de campo (32.57 anos) e dois árbitros assistentes (31.05 anos) foram monitorizados durante quatro jogos do Campeonato de Portugal ao longo da época 2018-2019 (escalão etário sénior, ou adulto), utilizando o ZephyrTMBioHarness. As seguintes variáveis foram consideradas para análise: temperatura cutânea, frequência respiratória (FR), frequência cardíaca (FC), percentagem da frequência cardíaca máxima (%FCmáx), postura, atividade e pico de aceleração (ACpico). A carga de impulso, expressa em N∙s, também foi calculada. Não foramobservadas diferenças fisiológicas e mecânicas de acordo com a parte do jogo, considerando todos os membros da equipa de arbitragem. Diferenças significativas foram verificadas entre o árbitro de campo e os árbitros assistentes na 1ª e na 2ª parte e para o total do jogo: em média, o árbitro de campo apresentou valores superiores para a temperatura cutânea (p= 0.016; r= -0.759), FC (p= 0.017; r= -0.757), %FCmáx(p= 0.017; r= -0.757), atividade (p= 0.017; r= -0.757) e ACpico(p= 0.017; r= -0.757). Curiosamente, não foram encontradas diferenças para a carga de impulso entre o árbitro de campo e os árbitros assistentes. O perfil de atividade do árbitro de futebol é fisiológica e mecanicamente exigente, mesmo a um nível de sub-elite. As diferenças entre o árbitro de campo e os assistentes devem ser consideradas na preparação da arbitragem e nos programas de treino e condição física para melhor lidar com as exigências físicas de um jogo de futebol. (AU)

Este estudio tuvo como objetivo examinar la variación de la carga fisiológica y mecánica en un equipo arbitral de sub-élite, considerando las diferentes partes del partido y su rol (árbitro de campo vs.árbitro asistente). Un árbitro de campo (32.57 años) y dos árbitros asistentes (31.05 años) fueron monitoreados durante cuatro juegos del Campeonato de Portugal a lo largo de la temporada 2018-2019 (categoría de edad senior, o adulto), utilizando ZephyrTMBioHarness. Se consideraron para el análisis las siguientes variables: temperatura cutánea, frecuencia respiratoria, frecuencia cardíaca (FC), porcentaje de frecuencia cardíaca máximo (%FCmáx), postura, actividad y pico de aceleración (ACpico). También secalculó la carga de impulso, expresada en N∙s. No se observaron diferencias fisiológicas y mecánicas según la parte del juego, considerando a todos los miembros del equipo arbitral. Se verificaron diferencias significativas entre los árbitros de campo y los árbitros asistentes en la primera y segunda parte y para el total de partido: en promedio, el árbitro de campo mostró valores superiores para temperatura cutánea (p= 0.016; r= -0.759), FC (p= 0.017; r= -0.757), %FCmáx(p= 0.017;r = -0,757), actividad (p= 0,017; r= -0,757) y ACpico(p= 0,017; r= -0,757). Curiosamente, no se encontraron diferencias para la carga de impulso entre el árbitro de campo y los árbitros asistentes. El perfil de actividad del árbitro de fútbol es fisiológica y mecánicamente exigente, incluso en un nivel de sub-élite. Las diferencias entre el árbitro de campo y los asistentes deben ser consideradas nel dibujo de programas de entrenamiento de preparación y acondicionamiento de árbitros para hacer frente a las demandas físicas de un partido de fútbol. (AU)

Alterações eletrocardiográficas em pacientes com Leishmaniose Tegumentar Americana tratados com antimoniato de meglumina: revisão integrativa / Electrocardiographic changes in patients with American tegumentary leishmaniasis treated with meglumine antimoniate: integrative review

Introdução: a Leishmaniose Tegumentar Americana (LTA) é uma infecção zoonótica cujo tratamento é realizado com a droga antimoniato de meglumina (AM). Objetivo: Relatar as alterações eletrocardiográficas decorrentes do uso de AM em pacientes com LTA. Metodologia: foi realizada uma revisão integrativa da literatura por meio das bases de dados BIREME, PUBMED, COCHRANE, SCIELO e literatura cinzenta, usando como estratégia de busca o cruzamento dos seguintes descritores, nos idiomas português e inglês: leishmaniose cutânea, eletrocardiografia, meglumina e toxicidade. Não foi estipulado um intervalo temporal para que um maior número de publicações fosse obtido. Resultados: foram encontrados 134 artigos, desses apenas 09 atenderam aos critérios de inclusão. As principais alterações eletrocardiográficas encontradas durante a terapêutica foram as alterações de repolarização ventricular, com destaque para o prolongamento do intervalo QT corrigido pela frequência cardíaca. Já entre as alterações mais graves em termos de morbimortalidade, destacam-se as arritmias ventriculares complexas, principalmente a Torsade de pointes. Discussão: em todos os artigos selecionados foram encontradas alterações ao eletrocardiograma (ECG) durante o tratamento com AM, sendo recomendado em todos os pacientes, o acompanhamento eletrocardiográfico. Apenas um estudo excluiu as alterações do ECG basal, presença de comorbidades e uso de drogas cardiotóxicas sendo esses possíveis vieses para avaliação da toxicidade cardíaca diretamente provocada pelo antimonial. Conclusão: considerando as alterações na repolarização ventricular e as possíveis arritmias ventriculares em pacientes em tratamento para LTA em uso de AM, o acompanhamento eletrocardiográfico é recomendado durante a terapêutica de todos esses pacientes, sendo útil para prevenção de complicações cardiovasculares importantes.

Introduction: American Tegumentary Leishmaniasis (ATL) is a zoonotic infection whose treatment is carried out with the meglumine antimoniate drug (AM). Objective: To report the electrocardiographic changes resulting from the use of AM in patients with ATL. Methodology: an integrative literature review was carried out using the BIREME, PUBMED, COCHRANE, SCIELO and gray literature databases, using as a search strategy the crossing of the following descriptors, in Portuguese and English: cutaneous leishmaniasis, electrocardiography, meglumine and toxicity. A time interval was not stipulated in order to obtain a greater number of publications. Results: we found 134 articles, of which only 9 met the inclusion criteria. The main electrocardiographic changes found during therapy were changes in ventricular repolarization, with emphasis on the prolongation of the QT interval corrected by heart rate. Already the most serious changes in terms of morbidity and mortality, complex ventricular arrhythmias, especially Torsade de pointes, stand out. Discussion: changes in the electrocardiogram (ECG) were found in all selected articles during treatment with AM, with electrocardiographic monitoring being recommended in all patients. Only one study excluded: changes in the baseline ECG, the presence of comorbidities and / or use of cardiotoxic drugs, these being possible biases to assess cardiac toxicity directly caused by the antimonial. Conclusion: considering the changes in ventricular repolarization and possible ventricular arrhythmias in patients undergoing treatment for ATL using AM, electrocardiographic monitoring is recommended during the therapy of all these patients, being useful for the prevention of important cardiovascular complications.

Water management from the environmental certification perspective: a new proposal of criteria and weight rates for application in Brazilian regions / Gestão da água na perspectiva das certificações ambientais: uma nova proposta de critérios e ponderações para aplicação em regiões do Brasil

ABSTRACT Several countries have developed tools with criteria and evaluations to grant, through the environmental certification, a more sustainable undertaking, with quality and productivity for its users. The tools were developed for different needs and objectives, which makes it difficult to make a direct comparison, in addition to having specific demands for each region. This study aims to make a comparative analysis between some tools of greater international knowledge and to propose new parameters for the water use and management category, taking into account the design and operational phase, the water distribution, and the demands for 2025. Consequently, this study proposed the creation of an exclusive environmental tool for the management and water use, providing a seal that may be applied to any project and adopted by water work systems as an incentive to reduce the consumption of drinking water, to use alternative sources, and to decrease liquid effluents.

RESUMO Vários países desenvolveram ferramentas com critérios e avaliações para garantir um empreendimento mais sustentável, com qualidade e produtividade para seus usuários, por meio de certificação ambiental. As ferramentas foram desenvolvidas para diferentes necessidades e objetivos, o que dificulta a comparação direta, além de haver demandas específicas para cada região. Este estudo teve como objetivo fazer uma análise comparativa entre algumas ferramentas de maior conhecimento internacional e propor novos parâmetros para a categoria de uso e gestão da água, levando em conta a fase de projeto e operação, a distribuição de água e as demandas para 2025. Consequentemente, este estudo propôs a criação de uma ferramenta ambiental exclusiva para a gestão e o uso da água, proporcionando um selo que pode ser aplicado a qualquer projeto e adotado pelas concessionárias de água como incentivo para reduzir o consumo de água potável, usar fontes alternativas e diminuir os efluentes líquidos.

Mosaicplasty Technique in the Treatment of Isolated Knee Femoral Condyle Osteochondral Lesions - a Retrospective Study / Técnica de mosaicoplastia no tratamento de lesões osteocondrais isoladas do côndilo femoral do joelho - estudo retrospectivo

Abstract Objective Focal osteochondral lesions of the knee are found in two thirds of patients undergoing arthroscopy; their treatment, when isolated and especially in young individuals, remains a debating topic. The present study analyzes the results obtained by the application of the mosaicplasty technique on the treatment of isolated knee femoral condyle osteochondral lesions. Methods Retrospective study of patients submitted tomosaicplasty and to subjective analyseswith pre- and postsurgery International KneeDocumentation Committee (IKDC) scores. Results A total of 13 cases with an average age of 34 years old, with male patients (n = 4; 31%) with an average age of 23 years old (range: 17-31 years old), and female patients (n = 9; 69%) with an average age of 39 years old (range: 16-56 years old); medial versus lateral femoral (n = 11; 85% versus n = 2; 15%); the average size of the lesion was 1.8 cm2 (range: 0.6-4 cm2); average follow-up time: 5.045 ± 3.47 years (range: 1.15-11.01 years). The average preoperative IKDC score was of 31.63 points (± 20.24), the average postoperative IKDC score was of 74.18 points (± 20.26). The difference between the post- and preoperative IKDC scores was of 42.55 (± 21.05) points, being theminimal score increase of 8.1 points andthemaximumscore increaseof82.8 points.Astatistically significant difference (p < 0.001) was found between the IKDC scores before and after the surgery. A statistically significant relation (p = 0.038) was found between the IKDC score increase (the difference between the postoperative and the preoperative scores) and the dimension of the lesion. Conclusions Mosaicplasty with osteochondral autograft transfer, when adequately used, can produce excellent results with great durability and functional impact, low morbidity rates and costs. Expansion of the indication criteria shows promising midterm and long-term results.

Resumo Objetivo Lesões osteocondrais focais do joelho são encontradas em dois terços dos pacientes submetidos a artroscopia; seu tratamento, quando isoladas e, principalmente, em indivíduos jovens, ainda é debatido. O presente estudo analisa os resultados obtidos com a aplicação da técnica de mosaicoplastia no tratamento de lesões osteocondrais isoladas do côndilo femoral do joelho. Métodos Estudo retrospectivo de pacientes submetidos à mosaicoplastia e análise subjetiva com pontuações do International Knee Documentation Committee (IKDC, na sigla em inglês) antes e após a cirurgia. Resultados Um total de 13 casos, com média de idade de 34 anos; pacientes do sexo masculino (n = 4; 31%) apresentaram média de idade de 23 anos (17-31 anos), e pacientes do sexo feminino (n = 9; 69%) apresentaram média de 39 anos; (16-56 anos); femoral medial ou lateral (n = 11, 85% versus n = 2, 15%, respectivamente); o tamanho médio da lesão foi de 1,8 cm2 (0,6-4 cm); o tempo médio de acompanhamento foi de 5,045 ± 3,47 anos (1,15-11,01 anos). A pontuação IKDC média préoperatória foi 31,63 pontos ( ± 20,24), e a pós-operatória foi 74,18 pontos ( ± 20,26). A diferença entre as pontuações IKDC obtidas depois e antes da cirurgia foi de 42,55 ( ± 21,05) pontos, com o aumento mínimo de 8,1 pontos e o aumento máximo de 82,8 pontos. Uma diferença estatística significativa (p < 0,001) foi encontrada entre a pontuação IKDC antes e após a cirurgia. Uma relação estatisticamente significativa (p = 0,038) foi observada entre o aumento da pontuação IKDC (a diferença entre a pontuação pré- e pós-operatória) e as dimensões da lesão. Conclusões A mosaicoplastia com transferência de autoenxerto osteocondral, quando adequadamente usada, pode produzir resultados excelentes com grande durabilidade e impacto funcional, baixas taxas de morbidade e baixos custos. A expansão dos critérios de indicação mostra resultados promissores no médio e longo prazo.

First report of treatment failure in a patient with cutaneous leishmaniasis infected by Leishmania (Viannia) naiffi carrying Leishmania RNA virus: a fortuitous combination?

Abstract We report the case of a 32-year-old man from Rio de Janeiro, who was infected in the Amazon region of Brazil by Leishmania (Viannia) naiffi. Generally, patients with L. naiffi cutaneous leishmaniasis exhibit a good therapeutic response to either pentavalent antimonials or pentamidine. However, after pentamidine treatment, this patient's infection evolved to therapeutic failure. To understand this clinical outcome, we investigated the presence of the Leishmania RNA virus (LRV) in parasites isolated from the cutaneous lesion; herein, we discuss the possible association between a poor response to pentamidine therapy and the presence of the LRV.

Migraine in 746 patients with multiple sclerosis / Enxaqueca em 746 pacientes com esclerose múltipla

ABSTRACT Migraine adds to the burden of patients suffering from multiple sclerosis (MS). The ID-migraine is a useful tool for screening migraine, and the Migraine Disability Assessment questionnaire can evaluate disease burden. The aim of the present study was to assess the presence and burden of migraine in patients with MS. Methods: Patients diagnosed with MS attending specialized MS units were invited to answer an online survey if they also experienced headache. Results: The study included 746 complete responses from patients with MS and headache. There were 625 women and 121 men, and 69% of all the patients were aged between 20 and 40 years. Migraine was identified in 404 patients (54.1%) and a moderate-to-high burden of disease was observed in 68.3% of the patients. Conclusion: Migraine is a frequent and disabling type of primary headache reported by patients with MS.

RESUMO Enxaqueca piora o sofrimento do paciente que tem esclerose múltipla (EM). ID-migraine é uma ferramenta útil para seleção de pacientes com enxaqueca e Migraine Disability Assessment (MIDAS) é um questionário que avalia o impacto da doença. O objetivo do presente estudo foi avaliar a presença e impacto de enxaqueca em pacientes com EM. Métodos: Pacientes diagnosticados com EM e tratados em clínicas especializadas foram convidados a responder um questionário online se também apresentassem cefaleia. Resultados: O estudo incluiu 746 participantes com cefaleia e EM que preencheram completamente as respostas. Foram 625 mulheres e 121 homens, sendo 69% dos pacientes com idade entre 20 e 40 anos. Enxaqueca foi identificada em 404 pacientes (54,1%) e moderado a grave impacto da doença foi observado em 68,3% dos casos. Conclusão: Enxaqueca é uma cefaleia primária frequente e incapacitante relatada por pacientes com EM.

Organização dos cuidados de reabilitação nas unidades de cuidados intensivos portuguesas / Organization of rehabilitation care in Portuguese intensive care units

RESUMO Objetivo: Descrever os diferentes modelos de prestação de cuidados de reabilitação em prática nas unidades de cuidados intensivos de adultos portuguesas. Métodos: Estudo observacional simples (transversal), realizado por meio de inquérito on-line enviado aos enfermeiros-chefes ou responsáveis das 58 unidades de cuidados intensivos de adultos que integram a base de dados da Sociedade Portuguesa de Cuidados Intensivos. Resultados: Foram identificados três modelos de organização dos cuidados de reabilitação: cuidados prestados pela equipe da unidade de cuidados intensivos (22,9%), cuidados prestados por equipes externas especializadas (25,0%), um misto dos modelos anteriores, conjugando as duas situações (52,1%). No primeiro modelo, os cuidados eram prestados essencialmente por enfermeiros com especialização em reabilitação e, no segundo, por fisioterapeutas. Não foram encontradas diferenças significativas entre os modelos no que diz respeito à disponibilidade de cuidados, em horas/dia ou dias/semana (p = 0,268 e 0,994 respetivamente), ou a resultados como tempo de internamento em cuidados intensivos, tempo de ventilação ou taxa de mortalidade na unidade (p = 0,418, 0.923 e 0,240 respetivamente). Conclusão: A organização dos cuidados de reabilitação nas unidades de cuidados intensivos portuguesas é singular e heterogênea. Apesar dos diferentes modelos de organização de cuidados, a disponibilidade de horas de cuidados é semelhante, bem como os resultados gerais observados nos doentes.

ABSTRACT Objective: To describe the different rehabilitation care models in practice in Portuguese adult intensive care units. Methods: A simple observational (cross-sectional) study was conducted through an online survey sent to the head nurses or individuals responsible for the 58 adult intensive care units that are part of the database of the Sociedade Portuguesa de Cuidados Intensivos. Results: We identified three models of organization of rehabilitation care: care provided by the staff of the intensive care unit (22.9%), care provided by specialized external teams (25.0%), and a mixture of the previous models, combining the two situations (52.1%). In the first model, the care was provided mainly by nurses with specialization in rehabilitation and, in the second model, the care was provided by physiotherapists. No significant differences were found between the models regarding the availability of care, in hours/day or days/week (p = 0.268 and 0.994, respectively), or results such as length of hospital stay in intensive care, ventilation time, or mortality rate in the unit (p = 0.418, 0.923, and 0.240, respectively). Conclusion: The organization of rehabilitation care in Portuguese intensive care units is unique and heterogeneous. Despite different care organization models, the availability of hours of care is similar, as are the overall results observed in patients.

Molecular association of pathogenicity and resistance to multiple antimicrobials in Acinetobacter baumannii strains recovered from patients with diverse infectious diseases / Associação molecular de fatores de patogenicidade e resistência a múltiplos antimicrobianos em linhagens de Acinetobacter baumannii recuperados de pacientes com doenças infecciosas diversas

ABSTRACT INTRODUCTION: The success of Acinetobacter baumannii infections can be attributed to its various virulence factors and antimicrobial resistance mechanisms. OBJECTIVE: To evaluate the presence and correlation between different resistance and virulence factors in clinical A. baumannii strains. METHODS: Study conducted at a University Hospital in Belo Horizonte, Minas Gerais, Brazil. The confirmation of Acinetobacter baumannii-calcoaceticus complex was performed by detecting the blaOXA-51 gene through the polymerase chain reaction (PCR), as well as the search for genes: blaOXA-23, 24, 58, 143, blaVIM-1, csuE, ompA and ISAba1. Antimicrobials and metallo-betalactamase (MβL) expression were evaluated by E-test®; and genetic diversity, by enterobacterial repetitive intergenic consensus (ERIC)-PCR. Biofilm formation was classified into four categories according to the mean optical density obtained. RESULTS: 98.4% (61/62) of the strains were resistant to meropenem; 71%, to ceftazidime; and 61.3%, to ampicillin-sulbactam; while 98.4% were sensitive to polymyxin B; and 48.4%, to tigecycline. The production of MβL was detected in 95.2% of the strains. The blaOXA-51 gene was detected in all strains tested; blaVIM-1, in 83.9%; and ISAba1, in 90.3%. On the other hand, the csuE and ompA genes were present in 43.5% and 53.2% of the strains, respectively. CONCLUSION: There was a possible correlation between gentamicin resistant samples and those that were positive for the ompA gene. The csuE gene correlated positively with ISAba1.

RESUMO INTRODUÇÃO: O sucesso das infecções por Acinetobacter baumannii pode ser atribuído a seus vários fatores de virulência e a mecanismos de resistência a antimicrobianos. OBJETIVO: Avaliar a presença e a correlação entre diferentes fatores de resistência e virulência em amostras clínicas de A. baumannii. MÉTODOS: Estudo conduzido em um hospital universitário em Belo Horizonte, Minas Gerais, Brasil. A confirmação do complexo Acinetobacter baumannii-calcoaceticus foi realizada pela detecção do gene blaOXA-51, por meio da reação em cadeia da polimerase (PCR), assim como a pesquisa dos genes: blaOXA-23, 24, 58, 143, blaVIM-1, csuE, ompA e ISAba1. Os antimicrobianos e a expressão das metalobetalactamases (MβL) foram avaliados pelo E-test®; e a diversidade genética, por enterobacterial repetitive intergenic consensus (ERIC)-PCR. A formação de biofilme foi classificada em quatro categorias de acordo com a média da densidade ótica obtida. RESULTADOS: Do total de amostras, 98, 4% (61/62) foram resistentes ao meropenem; 71%, a ceftazidime; e 61, 3%, a ampicilina-sulbactam; enquanto 98, 4% foram sensíveis a polimixina B; e 48, 4%, a tigeciclina. A produção de MβL foi detectada em 95, 2% das amostras. O gene blaOXA-51 foi detectado em todas as amostras testadas; blaVIM-1, em 83, 9%; e ISAba1, em 90, 3%. Por outro lado, os genes csuE e ompA estiveram presentes em 43, 5% e 53, 2% das amostras, respectivamente. CONCLUSÃO: Houve uma possível correlação entre as amostras resistentes a gentamicina e aquelas positivas para o gene ompA. O gene csuE correlacionou-se positivamente com ISAba1.

Anatomical characters and chemical profile of leaves of three species in Lauraceae family

ABSTRACT The Lauraceae family is widely distributed in tropical and subtropical climates, has more than 2500 species and in the taxonomic point of view, it is one of the most difficult families to identify species. The aim of this study was to analyze the leaf anatomy of three species of Lauraceae (Ocotea indecora (Schott) Mez, Nectandra barbellata Coe-Teix. and Endlicheria paniculata (Spreng.) J.F.Macbr.) and identify the chemical profile of essential oil extracted from the leaves by hydrodistillation method. The leaves of the three species were obtained in "Parque Estadual Intervales", Atlantic Forest, São Paulo state, Brazil. Samples of leaves were fixed, dehydrated, embedded in synthetic resin and sectioned for mounting histological slides for anatomical description of leaf tissues. The essential oil extracted by hydrodistillation method from dried leaves was analyzed by gas chromatography to establish its chemical profile. The leaves are hypostomatic, the epidermis in E. paniculata and N. barbellata present regular cells walls and irregular cells walls in O. indecora in both sides of epidermis. The three species present a dorsiventral mesophyll. Histochemical analyses presented lipid substances in secretory cavity and cuticle; starch, phenolic compounds and mucilage were observed in parenchyma cells of midrib and mesophyll. Ultra structural analyses demonstrated that trichomes in the species E. paniculata and O. indecora are shown only on the abaxial leaf face and species N. barbellata presented trichomes on both sides of the epidermis (abaxial and adaxial). Ocotea indecora essential oil revealed as main compound the bicyclogermacrene and N. barbellata the δ-cadinene. The species showed different morphological characters and different compounds of the essential oil, being these data useful for the differentiation of the species.

Project PANK: Rationale, study protocol and baseline results of a multidisciplinary school based intervention in children with cardiovascular and metabolic risk factors

Abstract Aims: Cardiovascular disease risk factors occur more frequently in children with obesity. Project PANK is a multidisciplinary school-based intervention lasting 6 months to improve BMI z-score, waist circumference (WC), waist-to-height ratio (WHtR), blood pressure (BP), nutrition, physical activity (PA), sedentary behaviour (SB), cardiorespiratory fitness (CRF), glucose, cholesterol, and triglycerides (TG). Methods/DesignA total of 77 children (7-10 years) were recruited from an urban school. The protocol includes PA and SB individual meetings for children/parents; increasing school exercise; PA and SB lessons for children; A goal in the number of steps/day to accomplish in and after school. In nutrition, the protocol includes three individual meetings for children/parents and six lessons for children. ResultsPositive associations were found between the BMI Z-score, WC, and WHtR with TG; the BMI Z-score and WHtR with glucose; the light PA time and HDL-C; the vigorous and moderate-to-vigorous PA with CRF; the caloric intake and lipids with LDL-C, BMI z-score, WC, and WHtR. A negative association was found between CRF and TG. ConclusionBaseline results stress the importance of multidisciplinary school-based interventions. We hypothesized that PANK will improve blood variables, anthropometric measures, and BP, by changing food intake, enhancing PA and CRF, and decreasing SB.(AU)

Double-bundle PCL reconstruction using autologous hamstring tendons: outcome with a minimum 2-year follow-up / Reconstrução do ligamento cruzado posterior em dupla banda com tendões flexores autólogos: resultados com seguimento mínimo de dois anos

ABSTRACT OBJECTIVE: To present the outcomes of posterior cruciate ligament (PCL) double-bundle reconstruction using autologous hamstring tendons, with a minimum follow-up of two years. METHODS: Evaluation of 16 cases of PCL injury that underwent double-bundle reconstruction with autogenous hamstring tendons, between 2011 and 2013. The final sample consisted of 16 patients, 15 men and one woman, with a mean age of 31 years (21-49). The predominant mechanism was motorcycle accident in half of the cases. There was a mean interval of 15 months between the time of lesion and the surgery (three to 52 months). Five lesions were isolated and 11, associated. Clinical evaluation, application of validated scores, and measurements with use of the KT-1000 were performed. RESULTS: The analysis showed a mean preoperative Lysholm score of 50 points (28-87), progressing to 94 points (85-100) postoperatively. The IKDC score also demonstrated improvement. In the preoperative evaluation, four and 12 patients were respectively classified as C (abnormal) and D (very unusual), and in the postoperative evaluation six as A (normal) and ten as B (close to normal). In the post-operative evaluation by KT1000 arthrometer, 13 patients showed difference between 0-2 mm and 3 between 3 and 5 mm, when compared with the contralateral side. CONCLUSION: Autologous hamstring tendons are a viable option in double-bundle reconstruction of the PCL, with good clinical results in a minimum follow-up of two years.

RESUMO OBJETIVO: Apresentar os resultados de uma série de casos de reconstrução do ligamento cruzado posterior (LCP) em dupla banda com o uso dos tendões flexores autólogos, com seguimento mínimo de dois anos. MÉTODO: Avaliação de 16 casos de lesão do LCP submetidos a reconstrução em dupla banda com tendões flexores autólogos entre 2011 e 2013. A amostra final foi composta por 16 pacientes, 15 homens e uma mulher, com média de 31 anos (21-49). O mecanismo predominante foi acidente motociclístico em metade dos casos. Houve um intervalo médio de 15 meses entre a lesão e a cirurgia (três a 52 meses). Cinco lesões eram isoladas e 11, associadas. Foram feitas avaliação clínica, aplicação de escores validados e mensuração com uso do artrômetro KT-1000. RESULTADOS: A avaliação pela escala de Lysholm pré-operatória teve média de 55 pontos (28-87), evoluiu para uma média pós-operatória de 94 pontos (85-100). O IKDC também demonstrou melhoria. Na avaliação pré-operatória, quatro e 12 pacientes foram respectivamente classificados como C (anormal) e D (muito anormal); na avaliação pós-operatória, seis foram classificados como A (normal) e dez como B (próximo ao normal). Na avaliação pós-operatória pelo artrômetro KT1000, 13 pacientes apresentaram diferença entre 0-2 mm e três, entre 3-5 mm, na comparação com o lado contralateral. CONCLUSÃO: O uso dos tendões flexores autólogos é uma opção viável na reconstrução do LCP em dupla banda, apresenta bons resultados clínicos em seguimento mínimo de dois anos.