Low rate of complications in nipple-sparing mastectomy for patients with BRCA1 and BRCA2 mutation.

Background: To describe the indications and outcomes of BRCA mutation carriers undergoing nipple-sparing mastectomy (NSM). Methods: In this retrospective study, 76 BRCA mutation carriers with no cancer who opted to undergo risk reduction NSM or diagnosed with breast cancer (BC) who opted to undergo therapeutic NSM were included. Results: Indications for NSM: cancer treatment (n = 33), bilateral risk reduction (n = 39) and contralateral prophylactic NSM (n = 4). In a mean follow-up of 45 months (median: 30 months), one patient (2.5%) undergoing risk-reducing NSM developed a new BC. One (3%) local, one (3%) ipsilateral axillary and one (3%) distant recurrence were observed in BC patients. No partial or total nipple necrosis occurred. Conclusion: NSM is safe for reducing the risk of BC development in BRCA mutation carriers and for treating cancer.

Outbreaks of dermatopathy caused by Tephrosia noctiflora intoxication in Brazilian cattle.

This study aims to update the knowledge concerning the intoxication by Tephrosia noctiflora in Brazilian cattle herds by reporting new cases of intoxication in lactating cows, their calves and bulls and highlight the epidemiology, clinical signs, pathogenesis, gross, and microscopic lesions. The morbidity and mortality of this intoxication in the farms studied was low. Gross lesions in all affected cattle consisted of dermatitis with hyperpigmentation, crusts, ulceration, erythema, and lichenification in the skin of limbs, ventral abdomen, perianal and perineal areas of lactating calves and adult cattle. Microscopically, the main lesion observed consisted of severe dermatitis with parakeratotic hyperkeratosis, papillated proliferation, and diffuse, accentuated lymphoplasmacytic inflammatory infiltrate in the epidermis and dermis. The presence of skin lesions mainly in the limbs and ventral abdomen of cattle implies the pathogenesis of intoxication is related to a primary contact dermatitis, and the occurrence of similar lesions on the skin of nursing calves reinforces this hypothesis. The putative toxins of T. noctiflora have been thought to be rotenoids. Additional work is needed to define better if these compounds are the main toxin responsible for the dermatopathy observed in these herds.

Uso das Práticas Integrativas e Complementares em Saúde por profissionais dos Núcleos Ampliados de Saúde da Família e Atenção Básica / Use of Integrative and Complementary Health Practices by professionals from the Expanded Centers for Family Health and Primary Care

Resumo Buscou-se conhecer a compreensão de profissionais dos Núcleos Ampliados de Saúde da Família e Atenção Básica (Nasf-AB) sobre a utilização das Práticas Integrativas e Complementares em Saúde (PICS) na sua atuação no município de Jaboatão dos Guararapes-PE, entre julho e agosto de 2020. Trata-se de um estudo de abordagem qualitativa, de caráter exploratório, utilizando-se da análise de conteúdo de Bardin para tratamento dos dados. Foram entrevistados 12 profissionais, dos quais dez utilizavam PICS, sendo a maioria do sexo feminino, parda, com formação em terapia ocupacional, de 30 a 39 anos. A auriculoterapia foi a prática predominante, sendo utilizada na população e nas equipes apoiadas, de forma individual e coletiva, principalmente nos problemas de saúde mental e dores crônicas. Os resultados ainda evidenciaram benefícios, formas de uso, fragilidades e potencialidades das PICS. A falta de financiamento federal das PICS, a aprovação da Emenda Constitucional (EC) 95/2017 e o atual Programa "Previne Brasil", são vistos pelos autores como grandes desafios ao fortalecimento do Nasf-AB e à institucionalização das PICS na APS.

Abstract We sought to understand the understanding of professionals from the Expanded Centers for Family Health and Primary Care (Nasf-AB) on the use of Integrative and Complementary Health Practices (PICS) in their work in the municipality of Jaboatão dos Guararapes, Pernambuco state, Brazil, between July and August 2020. This is a qualitative, exploratory study, using Bardin's content analysis to process the data. Twelve professionals were interviewed, of which ten used PICS, the majority being female, brown skinned, with training in occupational therapy, aged between 30 and 39 years. Auriculotherapy was the predominant practice, being used in the population and in the supported teams, individually and collectively, mainly in mental health problems and chronic pain. The results also showed benefits, forms of use, weaknesses and potential of PICS. The lack of federal funding for PICS, the approval of Constitutional Amendment (EC) 95/2017 and the current "Previne Brasil" Program, are seen by the authors as major challenges to the strengthening of Nasf-AB and the institutionalization of PICS in Primary Health Care.Resumo: Buscou-se conhecer a compreensão de profissionais dos Núcleos Ampliados de Saúde da Família e Atenção Básica (Nasf-AB) sobre a utilização das Práticas Integrativas e Complementares em Saúde (PICS) na sua atuação no município de Jaboatão dos Guararapes-PE, entre julho e agosto de 2020. Trata-se de um estudo de abordagem qualitativa, de caráter exploratório, utilizando-se da análise de conteúdo de Bardin para tratamento dos dados. Foram entrevistados 12 profissionais, dos quais dez utilizavam PICS, sendo a maioria do sexo feminino, parda, com formação em terapia ocupacional, de 30 a 39 anos. A auriculoterapia foi a prática predominante, sendo utilizada na população e nas equipes apoiadas, de forma individual e coletiva, principalmente nos problemas de saúde mental e dores crônicas. Os resultados ainda evidenciaram benefícios, formas de uso, fragilidades e potencialidades das PICS. A falta de financiamento federal das PICS, a aprovação da Emenda Constitucional (EC) 95/2017 e o atual Programa "Previne Brasil", são vistos pelos autores como grandes desafios ao fortalecimento do Nasf-AB e à institucionalização das PICS na APS.

Surfactants, Biosurfactants, and Non-Catalytic Proteins as Key Molecules to Enhance Enzymatic Hydrolysis of Lignocellulosic Biomass.

Lignocellulosic biomass (LCB) has remained a latent alternative resource to be the main substitute for oil and its derivatives in a biorefinery concept. However, its complex structure and the underdeveloped technologies for its large-scale processing keep it in a state of constant study trying to establish a consolidated process. In intensive processes, enzymes have been shown to be important molecules for the fractionation and conversion of LCB into biofuels and high-value-added molecules. However, operational challenges must be overcome before enzyme technology can be the main resource for obtaining second-generation sugars. The use of additives is shown to be a suitable strategy to improve the saccharification process. This review describes the mechanisms, roles, and effects of using additives, such as surfactants, biosurfactants, and non-catalytic proteins, separately and integrated into the enzymatic hydrolysis process of lignocellulosic biomass. In doing so, it provides a technical background in which operational biomass processing hurdles such as solids and enzymatic loadings, pretreatment burdens, and the unproductive adsorption phenomenon can be addressed.

Sarcopenia, body composition and factors associated with variceal gastrointestinal bleeding and splenectomy in hepatosplenic schistosomiasis mansoni.

BACKGROUND: Sarcopenia is a common complication of cirrhosis and an important predictor of morbimortality. We aimed to determine the prevalence of sarcopenia and its associated factors in hepatosplenic schistosomiasis (HSS) as well as to evaluate whether muscle mass and function are associated with variceal upper gastrointestinal bleeding (VUGIB) and previous splenectomy in subjects without other liver diseases. METHODS: We conducted a cross-sectional study including adults with HSS who underwent clinical, biochemical, anthropometric, muscle strength and physical performance evaluations and were submitted to bioelectrical impedance analysis and abdominal ultrasound. Sarcopenia was diagnosed according to the 2019 European consensus criteria. RESULTS: A total of 66 patients with HSS (62.1% male; mean age 48.8±8.6 y) were included. Overall, six subjects (9.1%) were diagnosed with probable sarcopenia and none had confirmed sarcopenia. Fat-free body mass index (BMI) was independently associated with VUGIB (odds ratio 0.701 [95% confidence interval 0.51 to 0.96]; p=0.025). Compared with patients who did not undergo surgery, individuals who underwent esophagogastric devascularization combined with splenectomy (EGDS) had higher serum lipid levels, fat percentage and frequency of metabolic syndrome, with lower skeletal muscle mass index and hand grip strength. CONCLUSIONS: HSS mansoni seems not to cause sarcopenia. However, a lower fat-free BMI was associated with previous VUGIB and the subgroup of patients who underwent EGDS presented higher lipid levels, fat percentage and frequency of metabolic syndrome and lower muscle mass and function.

Nipple-sparing Mastectomy with Immediate Implant-based Reconstruction for Patients with Pure Ductal Carcinoma in Situ.

OBJECTIVE: The presence of an extensive intraductal component is associated to an increasing risk of relapse in the nipple-areola complex. The aim of the present study was to evaluate the outcomes of patients diagnosed with ductal carcinoma in situ (DCIS) who underwent nipple-sparing mastectomy (NSM) with immediate breast reconstruction using silicone implants. METHODS: We retrospectively analyzed the postoperative complications and oncological safety of 67 breast cancer patients diagnosed with pure DCIS who underwent NSM with immediate breast reconstruction using silicone implants between 2004 and 2018. RESULTS: Among the 127 NSM procedures performed, 2 hematomas (1.5%) and 1 partial nipple necrosis (0.7%) were observed. After a mean follow-up of 60 months, the local recurrence rate was of 8.9%, the disease-free survival rate was of 90%, and 1 of the patients died. CONCLUSION: Despite the local recurrence rate, we showed that NSM with immediate breast reconstruction using silicone implants is a feasible surgical approach, with a low rate of complications and high survival rates for patients with a diagnosis of pure DCIS when breast-conserving surgery is not an option.

OBJETIVO: A presença de componente intraductal extenso é associada ao risco aumentado de recorrência no complexo aréolo-mamilar. O objetivo deste estudo foi avaliar os resultados de pacientes diagnosticados com carcinoma ductal in situ (CDIS) submetidas a adenomastectomia (nipple-sparing mastectomy, NSM, em inglês) com reconstrução mamária imediata utilizando prótese de silicone. MéTODOS: Restrospectivamente, foram analisadas as complicações pós-operatórias e a segurança oncológica de 67 pacientes com câncer de mama diagnosticadas com CDIS puro, e submetidas a NSM com reconstrução mamária imediata utilizando prótese de silicone, entre 2004 e 2018. RESULTADOS: Entre os 127 procedimentos realizados, 2 hematomas (1,5%) e 1 necrose parcial de mamilo (0,7%) foram observados. Após um período médio de 60 meses de seguimento, a taxa de recorrência local foi de 8,9%, a sobrevida livre de doença, de 90%, e apenas 1 paciente foi a óbito. CONCLUSãO: Apesar da taxa de recorrência local, demostrou-se que NSM com reconstrução mamária imediata com prótese de silicone é um procedimento viável, com baixa taxa de complicação e alta sobrevida para pacientes com diagnóstico de CDIS puro quando a cirurgia conservadora da mama não é uma opção.

Utilização da fisioterapia na reabilitação de bezerro com poliartrite e paresia neuromuscular: relato de caso / Use of physiotherapy in the rehabilitation of calves with polyarthritis and neuromuscular paresis: case report / Uso de la fisioterapia en la rehabilitación de un ternero con poliartritis y parisia neuromuscular: reporte de caso

A reabilitação animal na medicina veterinária é um campo recente, porém crescente a cada dia. Neste sentido, a fisioterapia veterinária atua trazendo inúmeros benefícios, como melhoria dos movimentos, redução da dor, edema e outras. Interfere ainda no tempo de recuperação, redução de custos para o proprietário, podendo ser hoje utilizada como um tratamento na recuperação pós-cirúrgica. Desta forma, objetivou-se relatar o uso da fisioterapia em uma bezerra com poliartrite e paresia neuromuscular. O animal apresentou um aumento de volume nas articulações cárpicas e társicas após histórico de onfalite, permanecendo em decúbito esternal por vários dias. O proprietário resolveu aplicar ferro dextrano na região glútea do animal, o que causou uma lesão de nervo isquiático. Foram instituídos protocolos medicamentosos e fisioterápicos, que culminaram no estímulo da marcha, propriocepção, além de hipertrofia muscular. Porém, em virtude de complicações resultantes de onfalite, o animal veio a óbito.(AU)

Animal rehabilitation in veterinary medicine is a recent field, but growing every day. In this sense, veterinary physiotherapy works bringing numerous benefits, such as improved movements, reduced pain, edema and others. Reducing the recovery time, reducing costs for the owner, and today it can be used as a treatment in post-surgical recovery. In this sense, the objective was to report the use of physiotherapy in a heifer with polyarthritis and neuromuscular paresis. The animal showed an increase in volume in the carpal and tarsal joints after a history of omphalitis, remaining in sternal decubitus for several days. The owner decided to apply iron dextran to the animal's gluteal region, which caused an injury to the sciatic nerve. Medicinal and physical therapy protocols were instituted, which culminated in the stimulation of gait, proprioception, in addition to muscle hypertrophy. However, due to complications resulting from omphalitis, the animal died.(AU)

La rehabilitación animal en medicina veterinaria es un campo reciente, pero en crecimiento cada día. En este sentido, la fisioterapia veterinaria actúa aportando numerosos beneficios, como mejora de los movimientos, reducción del dolor, edemas y otros. Disminución del tiempo de recuperación, reducción de costos para el propietario, pudiendo ser utilizado hoy en día como tratamiento en la recuperación posquirúrgica. En ese sentido, el objetivo fue reportar el uso de fisioterapia en una vaquilla con poliartritis y paresia neuromuscular. El animal presentó un aumento de volumen en las articulaciones del carpo y del tarso tras un antecedente de onfalitis, permaneciendo en decúbito esternal durante varios días. El propietario decidió aplicar hierro dextrano en la región glútea del animal, lo que provocó una lesión en el nervio ciático. Se instauraron protocolos farmacológicos y de fisioterapia, que culminaron con estimulación de la marcha, propiocepción, además de hipertrofia muscular. Sin embargo, debido a complicaciones derivadas de la onfalitis, el animal falleció.(AU)

Salvage Nipple-sparing Mastectomy for Patients with Breast Cancer Recurrence: A Case Series of Brazilian Patients / Mastectomia preservadora de mamilo para pacientes com recidiva de câncer de mama: Uma série de casos de pacientes brasileiras

Abstract Objective Few studies analyzed the safety of salvage nipple-sparing mastectomy (NSM) for local relapse treatment. We evaluated the outcomes of patients with indications for mastectomy who chose to undergo NSM for ipsilateral breast tumor recurrence (IBTR). Methods Between January 2001 and December 2018, we evaluated 24 women who underwent NSM for local relapse after conservative surgery. Results Thepatientswere followedupfor amean time of132months since thefirst surgery. After the NSM, 5 (20.8%) patients were diagnosed with local recurrence and only 1 (4.2%) patient died. The patients presented 4.8% (2) of partial and 2.4% (1) of total nipple necrosis. Conclusion In this long-term follow-up since the first surgery, we observed low rates of complication and good survival, although associated with high local recurrence in patients diagnosed with IBTR undergoing NSM as salvage surgery.We demonstrated that NSMmay be considered after IBTR for patients who did not want to undergo total mastectomy.

Resumo Objetivo Há poucos estudos sobre a segurança de se realizar adenomastectomia (nipple-sparing mastectomy, NSM, em inglês) para tratamento de recidiva local. O objetivo deste estudo foi avaliar os resultados de pacientes com indicação para mastectomia que optaram por se submeter a NSM para o tratamento de recorrência local. Métodos Foram analisadas 24 pacientes submetidas a NSM para tratamento de recidiva local após tratamento conservador entre janeiro de 2001 e dezembro de 2018. Resultados As pacientes foramacompanhadas por um períodomédio de 132meses a partir da primeira cirurgia. Após a NSM, 5 (20,8%) pacientes foram diagnosticadas com recorrência local, e apenas 1 paciente foi a óbito. As pacientes apresentaram 4,8% de necrose parcial e 2,4% de necrose total do mamilo. Conclusão Em um longo período de acompanhamento desde a primeira cirurgia, foram observadas baixas taxas de complicação pós-operatória e boa sobrevida, porém, associadas comuma alta taxa de recorrência local em pacientes submetidas a NSM para tratamento de recidiva local após cirurgia conservadora. Neste estudo, demonstrou-se que a NSM pode ser considerada uma opção cirúrgica para pacientes que não querem se submeter a mastectomia total.

Nipple-sparing Mastectomy with Immediate Implant-based Reconstruction for Patients with Pure Ductal Carcinoma in Situ / Mastectomia preservadora demamilo com reconstrução imediata baseada em implante para pacientes com carcinoma ductal puro in situ

Abstract Objective The presence of an extensive intraductal component is associated to an increasing risk of relapse in the nipple-areola complex. The aim of the present study was to evaluate the outcomes of patients diagnosed with ductal carcinoma in situ (DCIS) who underwent nipple-sparing mastectomy (NSM) with immediate breast reconstruction using silicone implants. Methods We retrospectively analyzed the postoperative complications and oncological safety of 67 breast cancer patients diagnosed with pure DCIS who underwent NSM with immediate breast reconstruction using silicone implants between 2004 and 2018. Results Among the 127 NSM procedures performed, 2 hematomas (1.5%) and 1 partial nipple necrosis (0.7%) were observed. After a mean follow-up of 60months, the local recurrence rate was of 8.9%, the disease-free survival rate was of 90%, and 1 of the patients died. Conclusion Despite the local recurrence rate, we showed that NSM with immediate breast reconstruction using silicone implants is a feasible surgical approach, with a low rate of complications and high survival rates for patients with a diagnosis of pure DCIS when breast-conserving surgery is not an option.

Resumo Objetivo A presença de componente intraductal extenso é associada ao risco aumentado de recorrência no complexo aréolo-mamilar. O objetivo deste estudo foi avaliar os resultados de pacientes diagnosticados com carcinoma ductal in situ (CDIS)submetidas a adenomastectomia (nipple-sparing mastectomy, NSM, em inglês) com reconstrução mamária imediata utilizando prótese de silicone. Métodos Restrospectivamente, foramanalisadas as complicações pós-operatórias e a segurança oncológica de 67 pacientes com câncer de mama diagnosticadas com CDIS puro, e submetidas a NSM com reconstrução mamária imediata utilizando prótese de silicone, entre 2004 e 2018. Resultados Entre os 127 procedimentos realizados, 2 hematomas (1,5%) e 1 necrose parcial de mamilo (0,7%) foram observados. Após um período médio de 60 meses de seguimento, a taxa de recorrência local foi de 8,9%, a sobrevida livre de doença, de 90%, e apenas 1 paciente foi a óbito. Conclusão Apesar da taxa de recorrência local, demostrou-se que NSM com reconstrução mamária imediata comprótese de silicone é umprocedimento viável, combaixa taxa de complicação e alta sobrevida para pacientes com diagnóstico de CDIS puro quando a cirurgia conservadora da mama não é uma opção.

Are seizures associated with neuroschistosomiasis mansoni? An exploratory survey in an endemic area of Brazil.

BACKGROUND: Deposition of Schistosoma mansoni eggs in the brain of patients with hepatosplenic schistosomiasis (HS-SM) is frequent and usually asymptomatic. However, it is questioned whether it could cause seizures. Thus, we investigated the occurrence of seizures in these patients and also searched for parameters associated with this disorder. METHODS: In a cross-sectional survey, we compared 128 patients with HS-SM with 102 patients with portal hypertension due to compensated chronic hepatic disease of other etiologies. A standardized questionnaire, emphasizing epilepsy-related parameters, was applied to all participants. RESULTS: Eight (6.3%) patients with HS-SM had a history of seizures, whereas this condition was reported by three (2.9%) individuals from the comparison group (p=0.354). None of the variables were associated with the occurrence of seizures, either in univariate or in multivariate analysis. CONCLUSIONS: The frequency of seizures was similar in both study groups. However, it was higher than that described in population-based studies. Thus, we hypothesize that HS-SM individuals may have a higher frequency of seizure. The lack of difference between the two study groups may be explained by the inclusion of cases of HS-MS overlapping other chronic liver diseases in the comparison group, because this finding is relatively common in schistosome-endemic areas.

Salvage Nipple-sparing Mastectomy for Patients with Breast Cancer Recurrence: A Case Series of Brazilian Patients.

OBJECTIVE: Few studies analyzed the safety of salvage nipple-sparing mastectomy (NSM) for local relapse treatment. We evaluated the outcomes of patients with indications for mastectomy who chose to undergo NSM for ipsilateral breast tumor recurrence (IBTR). METHODS: Between January 2001 and December 2018, we evaluated 24 women who underwent NSM for local relapse after conservative surgery. RESULTS: The patients were followed up for a mean time of 132 months since the first surgery. After the NSM, 5 (20.8%) patients were diagnosed with local recurrence and only 1 (4.2%) patient died. The patients presented 4.8% (2) of partial and 2.4% (1) of total nipple necrosis. CONCLUSION: In this long-term follow-up since the first surgery, we observed low rates of complication and good survival, although associated with high local recurrence in patients diagnosed with IBTR undergoing NSM as salvage surgery. We demonstrated that NSM may be considered after IBTR for patients who did not want to undergo total mastectomy.

OBJETIVO: Há poucos estudos sobre a segurança de se realizar adenomastectomia (nipple-sparing mastectomy, NSM, em inglês) para tratamento de recidiva local. O objetivo deste estudo foi avaliar os resultados de pacientes com indicação para mastectomia que optaram por se submeter a NSM para o tratamento de recorrência local. MéTODOS: Foram analisadas 24 pacientes submetidas a NSM para tratamento de recidiva local após tratamento conservador entre janeiro de 2001 e dezembro de 2018. RESULTADOS: As pacientes foram acompanhadas por um período médio de 132 meses a partir da primeira cirurgia. Após a NSM, 5 (20,8%) pacientes foram diagnosticadas com recorrência local, e apenas 1 paciente foi a óbito. As pacientes apresentaram 4,8% de necrose parcial e 2,4% de necrose total do mamilo. CONCLUSãO: Em um longo período de acompanhamento desde a primeira cirurgia, foram observadas baixas taxas de complicação pós-operatória e boa sobrevida, porém, associadas com uma alta taxa de recorrência local em pacientes submetidas a NSM para tratamento de recidiva local após cirurgia conservadora. Neste estudo, demonstrou-se que a NSM pode ser considerada uma opção cirúrgica para pacientes que não querem se submeter a mastectomia total.

Surfactants in biorefineries: Role, challenges & perspectives.

The use of lignocellulosic biomass (LCB) as feedstock has received increasing attention as an alternative to fossil-based refineries. Initial steps such as pretreatment and enzymatic hydrolysis are essential to breakdown the complex structure of LCB to make the sugar molecules available to obtain bioproducts by fermentation. However, these steps increase the cost of the bioproduct and often reduces its competitiveness against synthetic products. Currently, the use of surfactants has shown considerable potential to enhance lignocellulosic biomass processing. This review addresses the main mechanisms and role of surfactants as key molecules in various steps of biorefinery processes, viz., increasing the removal of lignin and hemicellulose during the pretreatments, increasing enzymatic stability and enhancing the accessibility of enzymes to the polymeric fractions, and improving the downstream process during fermentation. Further, technical advances, challenges in application of surfactants, and future perspectives to augment the production of several high value-added bioproducts have been discussed.

Liver stiffness is able to differentiate hepatosplenic Schistosomiasis mansoni from liver cirrhosis and spleen stiffness may be a predictor of variceal bleeding in hepatosplenic schistosomiasis.

BACKGROUND: Ultrasonography is limited for differentiating portal hypertension due to liver cirrhosis from that secondary to hepatosplenic schistosomiasis (HSS). We aimed to investigate the role of transient elastography (TE) in differentiating HSS mansoni from cirrhosis and the factors associated with liver and spleen stiffness (LS and SS) in HSS. METHOD: A cross-sectional study was conducted including patients with HSS mansoni (n=29) and liver cirrhosis due to non-alcoholic steatohepatitis (n=23). All patients underwent TE and those with HSS were assessed by the Niamey protocol. RESULTS: HSS subjects presented lower median LS (9.6 vs 21.3 Kpa, p<0.001) and liver controlled attenuation parameter (229 vs 274 dB/m, p=0.010) than cirrhosis subjects, in addition to higher SS (73.5 vs 42.2 Kpa, p=0.002). The area under the receiver operating characteristic curve for detecting cirrhosis by LS was 0.947 (95% CI 0.89 to 1.00, p<0.001), with an optimal cut-off of 11.75 Kpa. In HSS subjects, higher SS was associated with the presence of the following: diabetes mellitus (p=0.036), metabolic syndrome (p=0.043), esophageal varices (p=0.001), portal vein thrombosis (p=0.047) and previous variceal bleeding (p=0.011). In HSS patients without portal vein thrombosis, variceal bleeding was associated with higher SS (p=0.018). Niamey categories were not associated with LS (p=0.676) or SS (p=0.504). CONCLUSION: TE can play a role in differentiating HSS from cirrhosis, especially by LS. SS may be further investigated for predicting complications in HSS.

Dermatopathy caused by Tephrosia noctiflora intoxication in cattle.

An outbreak of a disease characterized by emaciation, dermatitis with erythema, alopecia, foul-smelling exudation, crusting, hyperpigmentation, lichenification, and edema of fore- and hindlimbs, chest and dewlap is described affecting cattle in the State of Alagoas, Northeastern Brazil. Microscopically, the main lesions were characterized by diffuse dermatitis with infiltration of lymphocytes, histiocytes, parakeratotic hyperkeratosis and acanthosis. The plant Tephrosia noctiflora, which exhibited signs of consumption, infested the grazing areas of cattle. To test its toxicity, T. noctiflora was harvested, dried in the shade, crushed and sourced at a concentration of 50% mixed with commercial food for three guinea pigs. The main clinical signs in guinea pigs included weight loss and multifocal, moderate to severe areas of alopecia, diffuse erythema of the skin, vaginal edema and hematuria. Microscopically, lymphocytic and histiocytic dermatitis, parakeratotic hyperkeratosis and acanthosis were noted in guinea pigs. This experiment confirms that T. noctiflora is the cause of outbreaks of dermatitis observed in cattle grazing in areas infested by this plant.

Noninvasive predictors of esophageal varices in patients with hepatosplenic schistosomiasis mansoni.

BACKGROUND: No previous study have evaluated transient elastography for predicting esophageal varices in hepatosplenic schistosomiasis. AIM: To investigate noninvasive methods of predicting esophageal varices in patients with hepatosplenic schistosomiasis mansoni. METHODS: Cross-sectional multicentric study included 51 patients with hepatosplenic schistosomiasis. Patients underwent ultrasonography-dopplerfluxometry, upper endoscopy, complete blood cell count and transient elastography (Fibroscan®) for liver and spleen stiffness measurement (LSM and SSM). Noninvasive scores previously established for cirrhotic population were studied: platelet count to spleen diameter ratio (PSR), LSM-spleen diameter to platelet ratio score (LSPS) and varices risk score (VRS). We proposed a version of LSPS and VRS by replacing LSM with SSM and named them SSPS and modified-VRS, respectively. RESULTS: Esophageal varices were detected in 42 (82.4%) subjects. Individuals with varices presented higher SSM (73.5 vs 36.3 Kpa, p = 0.001), splenic vein diameter (10.8 vs 8.0 mm, p = 0.017), SSPS (18.7 vs 6.7, p = 0.003) and modified-VRS (4.0 vs 1.4, p = 0.013), besides lower PSR (332 vs 542, p = 0.038), than those without varices. SSPS was independently associated with varices presence (OR=1.19, 95%CI 1.03-1.37, p = 0.020) after multivariate analysis. In a model excluding noninvasive scores, SSM was independently associated with varices diagnosis (OR=1.09, 95%CI 1.03-1.16, p = 0.004). AUROC was 0.856 (95%CI 0.752-0.961, p = 0.001) for SSM and 0.816 (95%CI 0.699-0.932, p = 0.003) for SSPS (p = 0.551). CONCLUSIONS: Spleen-related variables were predictors of esophageal varices: SSM, splenic vein diameter, SSPS, modified-VRS and PSR. Multivariate models indicated that SSM and SSPS are useful tools for predicting varices in non-cirrhotic portal hypertension by hepatosplenic schistosomiasis and may be used in clinical practice.

Portal vein thrombosis in patients with hepatosplenic schistosomiasis who underwent oesophagogastric devascularization combined with splenectomy.

BACKGROUND: Portal vein thrombosis (PVT) has been described in nearly 50% of patients who underwent oesophagogastric devascularization combined with splenectomy (EGDS), but no previous study has compared its occurrence in surgical and non-surgical groups. This study aimed to investigate PVT in hepatosplenic schistosomiasis (HSS) and its association with EGDS and upper variceal bleeding (UVB). METHODS: Retrospectively, 104 HSS individuals were enrolled. Following EGDS, the occurrence of PVT, mesenteric vein thrombosis (MVT), hospital admissions and UVB were recorded. RESULTS: EGDS was performed in 27 (26%) patients. PVT and MVT were detected in 30 (33%) and 8 (9.8%) patients, respectively. Patients who underwent EGDS were at greater risk of PVT (63% vs 19.7%; odds ratio [OR] 6.12 [95% confidence interval {CI} 2.3 to 16.1], p<0.001) when compared with a non-surgical approach. There was no significant difference in UVB occurrence and ß-blocker usage. PVT was associated with more hospital admissions (p=0.030) and higher alkaline phosphatase levels (p=0.008). UVB occurrence in patients with and without thrombosis was similar. In multivariate analysis, after adjustment, PVT was associated with the surgical approach (OR 4.56 [95% CI 1.55 to 13.38], p=0.006) and age at HSS diagnosis (OR 0.94 [95% CI 0.90 to 0.99], p=0.021). CONCLUSIONS: EGDS was not associated with a decreased frequency of UVB when compared with the non-surgical approach but was an independent risk factor for PVT.

Immunological and bacteriological shifts associated with a flagellin-hyperproducing Salmonella Enteritidis mutant in chickens.

Salmonella Enteritidis causes infections in humans and animals which are often associated with extensive gut colonization and bacterial shedding in faeces. The natural presence of flagella in Salmonella enterica has been shown to be enough to induce pro-inflammatory responses in the gut, resulting in recruitment of polymorphonuclear cells, gut inflammation and, consequently, reducing the severity of systemic infection in chickens. On the other hand, the absence of flagellin in some Salmonella strains favours systemic infection as a result of the poor intestinal inflammatory responses elicited. The hypothesis that higher production of flagellin by certain Salmonella enterica strains could lead to an even more immunogenic and less pathogenic strain for chickens was here investigated. In the present study, a Salmonella Enteritidis mutant strain harbouring deletions in clpP and fliD genes (SE ΔclpPfliD), which lead to overexpression of flagellin, was generated, and its immunogenicity and pathogenicity were comparatively assessed to the wild type in chickens. Our results showed that SE ΔclpPfliD elicited more intense immune responses in the gut during early stages of infection than the wild type did, and that this correlated with earlier intestinal and systemic clearance of the bacterium.

Fitoterapia no Brejo da Madre de Deus: a atuação do conselho municipal de saúde / Phytotherapy in Brejo da Madre de Deus: the performance of the municipal health council

Trata-se de uma análise documental onde foram analisadas atas de reuniões ordinárias e extraordinárias do Conselho Municipal de Saúde (CMS) do Brejo da Madre de Deus. O marco temporal da pesquisa documental foi de 1995 a 2014. Optou-se por este recorte com objetivo de analisar se houve discussão prévia junto ao conselho sobre o processo de implantação da FAVIAMP inaugurado em 1997, encerrando a pesquisa com dados encontrados no ano de 2014.

Axillary management for patients with breast cancer after neoadjuvant chemotherapy: Results of a survey among Brazilian breast surgeons.

BACKGROUND: Currently, there are broadly differing patterns in the management of the axilla after neoadjuvant chemotherapy (NAC) and no consensus with clinically strong evidence on the subject. A survey was performed to assess the current axillary management after NAC among Brazilian breast cancer surgeons. METHODS: The Brazilian Society of Mastology members were invited by email to complete an anonymous online survey and a total of 426 responses were collected. RESULTS: The majority of responders (67%) indicated performing routine axillary staging by physical exam, ultrasound, and fine needle biopsy in case of a suspicious node before NAC. Among breast surgeons working in the Brazilian Public Unified Health System, 11.3% answered that sentinel lymph node biopsy (SLNB) is not reasonable after NAC in their services. Seventy-seven responders (18.2%) reported performing SLNB instead of axillary lymph node dissection (ALND) only in patients who are clinically node-negative before NAC. Axillary complete pathologic response is necessary to omit ALND for 42.8% of responders. The molecular profile of a breast tumor is not considered when choosing axillary management after NAC for 73.7% of responders. CONCLUSIONS: Our survey highlighted the trend towards de-escalation of axillary surgery and observed high heterogeneity in axillary management after chemotherapy in a group of brazilian breast surgeons.

Trisomy X in a patient with childhood-onset systemic lupus erythematosus.

Childhood-onset systemic lupus erythematosus (cSLE) is a rare, chronic and systemic autoimmune disease generally with a more severe clinical phenotype than the adult-onset SLE. In both conditions, it is known that females are predominantly affected; therefore, the possible overlap of SLE and sex chromosomal abnormalities has attracted attention. Our case report describe the clinical manifestations and immunological profile of a Brazilian female with cSLE and trisomy X. The 22 year-old patient, diagnosed with cSLE at age of 11, present some features related to 47, XXX, such as difficulties at school and communication, although this was not enough to investigate for chromosome abnormalities. Cytoscan HD array screening allowed the comprehensive diagnosis for this patient. We also characterized her ancestral composition, showing that she has 6.2% higher African component than the mean from health subjects from the same geographical area. This report reinforces the role of the X chromosome dose effect for sex bias in SLE, as well as the importance of African ancestry composition in cLES. It also throws lights upon the application of high-throughput molecular analysis in a large scale cohort can be useful to detect the impact of the genomic findings for more accurate epidemiological data.