Evaluation of Bauhinia ungulata Essential Oil as a New Acetylcholinesterase Inhibitor from an in silico and in vitro Perspective in the Northern Amazon of Brazil.

The Bauhinia ungulata, also known by its common name "pata de vaca", is one of the species used in Brazil for medicinal purposes, and is commonly used for the treatment of diabetes. In this study, the authors studied the interaction between the chemical constituents which are present in the essential oil of Bauhinia ungulata (EOBU), collected in Boa Vista-RR, Legal Amazon, and their effects on the enzyme acetylcholinesterase (AChE) in the essential oil. The analysis that we perform includes proton magnetic resonance ( 1H NMR), enzymatic inhibition, molecular docking, in silico toxicity prediction, enrichment analysis, and target prediction for biological interactions. According to the tests performed on the essential oil, it obtained 100% inhibition of the enzyme AChE. During 1H NMR experiments, it was found that α- Bisabolol, one of the main components, had a significant alteration in its chemical shift. A molecular docking analysis confirmed that this compound binds to the AChE enzyme, which confirms the 1H NMR analysis. The results of this work showed that the major component of EOBU acted as a possible inhibitor of AChE enzyme in vitro and in silico assays. These results show that EOBU could be potentially applied in Alzheimer's disease treatment.

In Vitro and In Silico Antioxidant Activity and Molecular Characterization of Bauhinia ungulata L. Essential Oil.

Bauhinia ungulata is an antioxidant medicinal plant that has been manipuled in Brazil to lower glycemic index as well is for alternative treatment for diabetes. Therefore, the present hearch has aimed to investigates the antioxidant effects of the essential oil of Bauhinia ungulata L. (EOBU) collected in Amazon region better specified in Boa Vista, Roraima, Brazil, located in the Amazon region. Gas chromatography had been used to characterize the components, and antioxidant assays such as DPPH, TAC, reducing power, Fe2+ chelation, and total phenols had also been performed. The major constituents had molecularly anchored with the human catalase (CAT) enzyme, and maltol has showed as a positive control. Among the 25 revealed components, the main ones have been α-bisabolol (27.2 %), ß-Caryophyllene (12.5 %) and Epi-γ-eudesmol (13.6 %). The EOBU has comproved a TAC value of 618.79 mg of ascorbic acid equivalent, free radical scavenging capacity (DPPH) around 53.7 % and 65.27 %, Fe2+ chelation capacity of 161±6 and 126.7±39.6, for 0.1 mg.mL-1 and 0.5 mg.mL-1 , respectively. The power around the EOBU has appeared percentages equals to 28.66 %, 44.6 %, and 77.03 % in the concentrations tested. As well as, 96.5 % of total phenols. The compounds α-bisabolol (-5.7±0.4 Kcal.mol-1 ) and ß-caryophyllene (-6.1±0.5 Kcal.mol-1 ) have showed good interaction with CAT compared to Maltol (-4.4±0.4 Kcal.mol-1 ). The present work has demonstrated that EOBU functions as a potent antioxidant, capable of scavenging free radicals and reducing oxidative stress damage.

A new strategy for risk assessment of PM2.5-bound elements by considering the influence of wind regimes.

For regulatory purposes, air pollution has been reduced to management of air quality control regions (AQCR), by inventorying pollution sources and identifying the receptors significantly affected. However, beyond being source-dependent, particulate matter can be physically and chemically altered by factors and elements of climate during transport, as they act as local environmental constraints, indirectly modulating the adverse effects of particles on the environment and human health. This case study, at an industrial site in a Brazilian coastal city - Joinville, combines different methodologies to integrate atmospheric dynamics in a strategic risk assessment approach whereby the influence of different wind regimes on environmental and health risks of exposure to PM2.5-bound elements, are analysed. Although Joinville AQCR has been prone to stagnation/recirculation events, distinctly different horizontal wind circulation patterns indicate two airsheds within the region. The two sampling sites mirrored these two conditions and as a result we report different PM2.5 mass concentrations, chemical profiles, geo-accumulation, and ecological and human health risks. In addition, feedback mechanisms between the airsheds seem to aggravate the air quality and its effects even under good ventilation conditions. Recognizably, the risks associated with Co, Pb, Cu, Ni, Mn, and Zn loadings were extremely high for the environment as well as being the main contributors to elevated non-carcinogenic risks. Meanwhile, higher carcinogenic risks occurred during stagnation/recirculation conditions, with Cr as the major threat. These results highlight the importance of integrating local airshed characteristics into the risk assessment of PM2.5-bound elements since they can aggravate air pollution leading to different risks at a granular scale. This new approach to risk assessment can be employed in any city's longer-term development plan since it provides public authorities with a strategic perspective on incorporating environmental constraints into urban growth planning and development zoning regulations.

Correlation between hepatopulmonary syndrome and oxygen saturation pulse oximetry in cirrhotic patients.

OBJECTIVE: Hepatopulmonary Syndrome (HPS) is a complication of cirrhosis that worsens the disease's prognosis, pre and post liver transplant. The objective of this study is to analyze the prevalence of HPS in cirrhotic patients at our service and to correlate it with oxygen saturation (SatO2) using a pulse oximeter to evaluate if this is useful as a screening test for HPS. A prospective study was conducted in patients with hepatic cirrhosis conventionally selected from 2014 to 2016. All the patients underwent an echocardiogram with microbubbles and oxygen saturation measurement by pulse oximetry. Those with intrapulmonary shunt were submitted to arterial blood gas analysis. The relationship between oxygen saturation and HPS was assessed by the multivariate model of binary logistic regression. We analyzed 77 patients, and 23.3% (18 patients) had all criteria for HPS. The relationship between HPS and SatO2 did not show statistical significance, even after the variables were adjusted for sex, age, and smoking. Oxygen saturation alone was not able to detect HPS in the sample of cirrhotic patients. More accurate methods for screening and diagnosis of the syndrome should be used.

Correlation between hepatopulmonary syndrome and oxygen saturation pulse oximetry in cirrhotic patients

SUMMARY Hepatopulmonary Syndrome (HPS) is a complication of cirrhosis that worsens the disease's prognosis, pre and post liver transplant. The objective of this study is to analyze the prevalence of HPS in cirrhotic patients at our service and to correlate it with oxygen saturation (SatO2) using a pulse oximeter to evaluate if this is useful as a screening test for HPS. A prospective study was conducted in patients with hepatic cirrhosis conventionally selected from 2014 to 2016. All the patients underwent an echocardiogram with microbubbles and oxygen saturation measurement by pulse oximetry. Those with intrapulmonary shunt were submitted to arterial blood gas analysis. The relationship between oxygen saturation and HPS was assessed by the multivariate model of binary logistic regression. We analyzed 77 patients, and 23.3% (18 patients) had all criteria for HPS. The relationship between HPS and SatO2 did not show statistical significance, even after the variables were adjusted for sex, age, and smoking. Oxygen saturation alone was not able to detect HPS in the sample of cirrhotic patients. More accurate methods for screening and diagnosis of the syndrome should be used.

RESUMO A Síndrome Hepatopulmonar (SHP) é uma complicação da cirrose que piora o prognóstico da doença pré e pós-transplante hepático. O objetivo do trabalho é analisar a prevalência de SHP em pacientes cirróticos de nosso serviço e correlacioná-la com a saturação de oxigênio (SatO2) pelo oxímetro de pulso, e avaliar se este seria útil como um exame de triagem no diagnóstico de SHP. Foi realizado um estudo prospectivo em pacientes portadores de cirrose hepática no período de 2014 a 2016. Todos os pacientes foram submetidos a um ecocardiogama com microbolhas e a saturação de oxigênio pela oximetria de pulso. Aqueles com shunt intrapulmonar foram submetidos a gasometria arterial. A relação entre a saturação de oxigênio e SHP foi avaliada pelo modelo multivariado de regressão logística binário. Foram analisados 77 pacientes, destes 23,3% (18 pacientes) apresentaram todos os critérios para SHP. A relação entre a SHP com a SatO2 não obteve significância estatística, mesmo após as variáveis terem sido ajustadas pelo sexo, idade e tabagismo atual ou passado. A saturação de oxigênio, de forma isolada, não foi capaz de distinguir a SHP na amostra de pacientes cirróticos em nosso estudo. Deve-se utilizar métodos mais acurados para a triagem e diagnóstico dessa síndrome.

Missão e valores organizacionais da assistência à saúde dos institutos federais de educação, ciência e tecnologia do Rio Grande do norte / Mission and organizational values of federalinstitutes of education, science and technology of Rio Grande do Norte's health assistance

Introdução:Os valores de uma organização permitem predizer o seu funcionamento e o comportamento organizacional dos seus membros. As organizações se mantêm pelos seus produtos elaborados. No caso das organizações de saúde, o produto seria a atenção dispensada ao usuário. Assim, o tipo e qualidade da atenção ofertada estariam relacionados aos valores que orientam à instituição.Objetivo:Avaliar os valores organizacionais que orientam os processos de trabalho nos serviços de saúde dos diversos campi do IFRN no ano de 2014 a partir da percepção dos servidores da assistência estudantil, verificando se os valores organizacionais estão relacionados à perspectiva de trabalho em equipe, atenção pautada no cuidado e gestão participativa.Metodologia:Estudo seccional do tipo avaliação para gestão onde o Inventário de Valores Organizacionais (IVO), questionário constituído por 36 valores distribuídos em três dimensões bipolares: autonomia x conservadorismo, hierarquia x igualitarismo e domínio x harmonia, foi respondido por 41 servidores da assistência à saúde do IFRN, selecionados por conveniência, de um universo de 104 servidores.Foram realizadas as frequências absolutas e relativas e as medidas de tendência central das variáveis, bem como teste de diferença de média (t student pareado) entre as dimensões bipolares. Resultados:Dentre os valores organizacionais, o conservadorismo e a hierarquia são os mais relevantes vivenciados na vida organizacional do IFRN. O perfil axiológico do IFRN revela uma instituição mais centrada em si mesma do que na valorização dos seus membros.Conclusão:Ainda são necessários mecanismos para disseminar valores que promovam o alcance dos objetivos e metas pretendidos pela instituição e que esses sejam reconhecidos por todos que compõem a instituição (AU).

Introduction: The values of an organization allows topredict the functioning of the organization and the organizational behavior of its members. The organizations keep their elaborate products. In the case of healthcare organizations, the product would be the attention paid to the user. Thus, the type and quality of care offered wouldbe related to the values that guide the institution.Objective: To evaluate the organizational values that guide the work processes in the health services of the various IFRN campuses in the year 2014, based on the perception ofthe servants of the student assistance, verifying if the organizational values are relatedto the perspective of teamwork, attention based on participatory care and management.Methodology: An evaluation for the management of health services Sectional Study which The Organizational Values Inventory (IVO), questionnaire consisting of 36 values distributed in three bipolar dimensions: autonomy x conservatism, hierarchy x egalitarianism and domain x harmony, was answered by 41 IFRN health care providers, selected by a non-probabilistic sample, from a universe of 104 health care providers. The absolute and relative frequencies and the measures of central tendency of the variables were performed, as well as the mean difference test (t student paired) between the bipolar dimensions.Results: Among these organizational values, conservatism and hierarchy are the most relevant values lived in the organizational life of the IFRN. The axiological profile of the IFRN reveals a more self-centered institution than the value of its members.Conclusion: It was observed that mechanisms are still needed to disseminate values that promote the achievement of the objectives and goals sought by the institution and that their importance is recognized by all that make up the institution (AU).

Gestão em centro cirúrgico sob a perspectiva da educação permanente em saúde / Management in a surgical center from the perspective of permanent health education

A pesquisa teve por objetivo analisar a Educação Permanente em Saúde como ferramenta de gestão em um centro cirúrgico (CC) de um hospital público. Estudo do tipo exploratório de abordagem qualitativa realizado em 2017. A investigação aconteceu com 21 trabalhadores que atuam no centro cirúrgico de um hospital público universitário de grande porte, situado no município do Rio de Janeiro. Foram convidados a participar de entrevistas gestores, docentes, residentes e trabalhadores da assistência, sendo incluídos no estudo os trabalhadores com no mínimo um ano de atuação no hospital onde estavam em pleno exercício profissional no setor e excluídos os que se encontravam em licença médica e férias durante o período de produção de dados. Os dados foram transcritos e submetidos à análise temática, sendo categorizados na perspectiva da análise qualitativa. O estudo acusou que a educação permanente não compõe estratégia da gestão do CC no hospital envolvido e que este apresenta dificuldades na condução de questões ligadas a conflitos interprofissionais. A experiência da gestão tripartite, porém, da qual participou a pesquisadora revelou que a complexidade do cuidado prestado em um centro cirúrgico fica favorecida quando a educação permanente em saúde é compreendida como estratégia de gestão. Os encontros periódicos promovidos agregaram profissionais e setores e estimularam a construção coletiva do conhecimento, revelando-se como uma possibilidade no trabalho cotidiano no centro cirúrgico e no hospital. Como fatores intervenientes facilitadores da gestão em um CC: competência técnica e a experiência dos profissionais; parcerias firmadas; a interação com o chefe; a presença do gestor; pessoal qualificado; e grupo coeso. Por outro lado, os fatores que dificultam a gestão de um CC: falta de organização do processo de trabalho; falta de educação permanente e de um espaço para a educação; relações de poder; falta de escuta; falta de respeito; e desgaste das relações. Por fim, indicam a falta de apoio da direção geral e a crise com a falta de pagamento dos salários e a falta de insumos e identificam vícios de funcionários antigos e ausência de zelo com patrimônio público

La investigación tuvo por objetivo analizar la Educación Permanente en Salud como herramienta de gestión en un centro quirúrgico (CQ) de un hospital público. Estudio del tipo exploratorio de abordaje cualitativo realizado en 2017. La investigación tuvo lugar con 21 trabajadores que actúan en el centro quirúrgico de un hospital público universitario de gran porte, situado en el municipio de Río de Janeiro. Se invita a participar en entrevistas gestoras, docentes, residentes y trabajadores de la asistencia, siendo incluidos en el estudio a los trabajadores con al menos un año de actuación en el hospital donde estaban en pleno ejercicio profesional en el sector y excluidos los que se encontraban en licencia médica y vacaciones durante el período de producción de datos. Los datos fueron transcritos y sometidos al análisis temático, siendo categorizados en la perspectiva del análisis cualitativo. El estudio acusó que la educación permanente no compone estrategia de gestión del CQ en el hospital involucrado y que éste presenta dificultades en la conducción de cuestiones relacionadas con conflictos interprofesionales. La experiencia de la gestión tripartita, sin embargo, de la que participó la investigadora reveló que la complejidad del cuidado prestado en un centro quirúrgico se ve favorecida cuando la educación permanente en salud es comprendida como estrategia de gestión. Los encuentros periódicos promovidos agregaron profesionales y sectores y estimularon la construcción colectiva del conocimiento, revelándose como una posibilidad en el trabajo cotidiano en el centro quirúrgico y en el hospital. Como factores intervinientes facilitadores de la gestión en un CQ: competencia técnica y la experiencia de los profesionales; asociaciones firmadas; la interacción con el jefe; la presencia del gestor; personal cualificado; y el grupo cohesivo. Por otro lado, los factores que dificultan la gestión de un CQ: falta de organización del proceso de trabajo; falta de educación permanente y de un espacio para la educación; relaciones de poder; falta de escucha; falta de respeto; y el desgaste de las relaciones. Por último, indican la falta de apoyo de la dirección general y la crisis con la falta de pago de los salarios y la falta de insumos e identifican vicios de funcionarios antiguos y ausencia de celo con patrimonio público

Gestão hospitalar e educação permanente: um estudo descritivo e exploratório / Hospital management and permanent education: a descriptive and exploratory study

Objetivos: investigar a Educação Permanente em Saúde, como ferramenta de gestão, em um centro cirúrgicode um hospital público universitário de grande porte situado no município do Rio de Janeiro (RJ), Brasil;contribuir para a reflexão sobre ações educativas dirigidas aos trabalhadores, com enfoque na gestãohospitalar. Método: trata-se de um estudo qualitativo, descritivo e exploratório, com participantes gestores,docentes e trabalhadores da assistência que tiverem, pelo menos, um ano de pleno exercício profissional nocentro cirúrgico. Os dados serão coletados a partir de entrevistas norteadas por um roteiro semiestruturado,transcritas e submetidas à técnica de Análise de Conteúdo, na modalidade Análise Temática. Resultadosesperados: contribuir para uma nova abordagem de gestão, em centro cirúrgico, na perspectiva da EducaçãoPermanente em Saúde.

Down syndrome: Prevalence and distribution of congenital heart disease in Brazil.

CONTEXT AND OBJECTIVE: Down syndrome is the most common genetic disorder, affecting 1/700 live births. Among the clinical findings, one constant concern is the high prevalence of congenital heart disease. The objective of this study was to determine the prevalence and profile of congenital heart disease among patients attended at a Down syndrome outpatient clinic in southern Brazil between 2005 and 2013. DESIGN AND SETTING: Cross-sectional study conducted in a referral center. METHODS: Data were retrospectively gathered from the medical files of 1,207 patients with Down syndrome, among whom 604 (50.0%) had been diagnosed with congenital heart disease. These data were subjected to descriptive analysis using the Statistica software. RESULTS: Among the 604 patients with congenital heart disease, 338 (55.8%) were male and 269 (44.5%) were female. The most common heart diseases were atrial septal defect in 254 patients (42.1%); total atrioventricular septal defect in 91 (15.1%); atrial septal defect and ventricular septal defect in 88 (14.6%); ventricular septal defect in 77 (12.7%); patent ductus arteriosus in 40 (6.6%); patent foramen ovale in 34 (5.6%) patients; tetralogy of Fallot in 12 (2%); and other diseases in 8 (1.3%). Pulmonary hypertension was present in 57 (9.4%). Out of the total, 150 patients (24.8%) underwent cardiac surgery. CONCLUSION: The high prevalence of congenital heart disease among the patients at the Down syndrome outpatient clinic (50%) was similar to findings from other studies and justifies investigation during the neonatal period, so as to decrease mortality and morbidity.

Down syndrome: Prevalence and distribution of congenital heart disease in Brazil / Síndrome de Down: prevalência e distribuição de cardiopatia congênita no Brasil

ABSTRACT CONTEXT AND OBJECTIVE: Down syndrome is the most common genetic disorder, affecting 1/700 live births. Among the clinical findings, one constant concern is the high prevalence of congenital heart disease. The objective of this study was to determine the prevalence and profile of congenital heart disease among patients attended at a Down syndrome outpatient clinic in southern Brazil between 2005 and 2013. DESIGN AND SETTING : Cross-sectional study conducted in a referral center. METHODS : Data were retrospectively gathered from the medical files of 1,207 patients with Down syndrome, among whom 604 (50.0%) had been diagnosed with congenital heart disease. These data were subjected to descriptive analysis using the Statistica software. RESULTS : Among the 604 patients with congenital heart disease, 338 (55.8%) were male and 269 (44.5%) were female. The most common heart diseases were atrial septal defect in 254 patients (42.1%); total atrioventricular septal defect in 91 (15.1%); atrial septal defect and ventricular septal defect in 88 (14.6%); ventricular septal defect in 77 (12.7%); patent ductus arteriosus in 40 (6.6%); patent foramen ovale in 34 (5.6%) patients; tetralogy of Fallot in 12 (2%); and other diseases in 8 (1.3%). Pulmonary hypertension was present in 57 (9.4%). Out of the total, 150 patients (24.8%) underwent cardiac surgery. CONCLUSION : The high prevalence of congenital heart disease among the patients at the Down syndrome outpatient clinic (50%) was similar to findings from other studies and justifies investigation during the neonatal period, so as to decrease mortality and morbidity.

RESUMO CONTEXTO E OBJETIVO : A síndrome de Down é a anomalia genética mais comum e afeta 1/700 nascidos vivos. Entre os achados clínicos, uma preocupação constante é a alta prevalência de cardiopatia congênita e o objetivo do presente estudo é determinar a prevalência e o perfil de cardiopatia congênita em pacientes atendidos em um ambulatório de síndrome de Down no período de 2005 a 2013 no sul do Brasil. TIPO DE ESTUDO E LOCAL : Estudo transversal conduzido em um centro de referência. MÉTODOS : Foi realizada coleta retrospectiva de dados de 1.207 prontuários de pacientes com síndrome de Down, com 604 (50,0%) diagnosticados com cardiopatia congênita. Os dados foram submetidos a análise descritiva, utilizando-se o programa Statistica. RESULTADOS : Entre os 604 pacientes com cardiopatia congênita, 338 (55,8%) eram do sexo masculino e 269 (44,5%) do feminino. A cardiopatia mais comum foi comunicação interatrial, observada em 254 (42,1%) pacientes, defeito de septo atrioventricular total, em 91 (15,1%), comunicação interatrial em conjunto com comunicação interventricular, em 88 (14,6%), comunicação interventricular, em 77 (12,7%), persistência do canal arterial, em 40 (6,6%), forame oval patente, em 34 (5,6%), tetralogia de Fallot, em 12 (2%) e outras cardiopatias observadas em oito (1,3%) pacientes. Hipertensão pulmonar esteve presente em 57 (9,4%). Do total, 150 (24,8%) pacientes foram submetidos a cirurgia cardíaca. CONCLUSÃO : A elevada prevalência das cardiopatias congênitas nos pacientes do ambulatório da síndrome de Down, de 50%, semelhante à encontrada em outros estudos, justifica a investigação no período neonatal, com diminuição da mortalidade e morbidade.

Pervaporation of ethanol produced from banana waste.

Banana waste has the potential to produce ethanol with a low-cost and sustainable production method. The present work seeks to evaluate the separation of ethanol produced from banana waste (rejected fruit) using pervaporation with different operating conditions. Tests were carried out with model solutions and broth with commercial hollow hydrophobic polydimethylsiloxane membranes. It was observed that pervaporation performance for ethanol/water binary mixtures was strongly dependent on the feed concentration and operating temperature with ethanol concentrations of 1-10%; that an increase of feed flow rate can enhance the permeation rate of ethanol with the water remaining at almost the same value; that water and ethanol fluxes was increased with the temperature increase; and that the higher effect in flux increase was observed when the vapor pressure in the permeate stream was close to the ethanol vapor pressure. Better results were obtained with fermentation broth than with model solutions, indicated by the permeance and membrane selectivity. This could be attributed to by-products present in the multicomponent mixtures, facilitating the ethanol permeability. By-products analyses show that the presence of lactic acid increased the hydrophilicity of the membrane. Based on this, we believe that pervaporation with hollow membrane of ethanol produced from banana waste is indeed a technology with the potential to be applied.

Prevalência do uso de drogas entre acadêmicos de uma universidade particular do sul do Brasil / Prevalence of drug use among students from a private university from southern Brazil

O objetivo do estudo foi investigar a prevalência e motivos do uso de álcool, tabaco e outras drogas por acadêmicos. A amostra foi composta por 560 estudantes, entre 17 e 74 anos (M = 31,16, DP = 11,10). As substâncias com maior prevalência de uso na vida foram álcool e tabaco. Dentre as drogas ilícitas, a maconha, as anfetaminas e a cocaína ou o crack foram as mais relatadas. O uso de álcool na vida foi mais prevalente em homens do que em mulheres, considerando os últimos três meses. Quanto aos motivos para o uso das substâncias psicoativas, os mais relatados foram diversão ou prazer, curiosidade e alívio de tensão psicológica. Cerca de 90% dos participantes se mostraram receptivos à implementação de um serviço de prevenção ao uso de drogas na universidade avaliada. Os resultados sugerem a necessidade do desenvolvimento de prevenções específicas ao uso de drogas no meio acadêmico.

The aim of the present study was to investigate the prevalence of and motives for consumption of alcohol, tobacco and other drugs by undergraduate students. The sample consisted of 560 students, between 17 and 74 years (M = 31.16, SD = 11.10). Results showed highest lifetime use rates for alcohol and tobacco among substances. Regarding illicit substances, marijuana, amphetamines and cocaine were the most reported. Lifetime alcohol use was more prevalent among men than women, and consumption of amphetamines or ecstasy within the last three months was more prevalent among women than men. Fun or pleasure seeking, curiosity and tension relief were the most frequent motives for using drugs. Although almost 90% of the sample showed positive attitude toward implementing a prevention program in the university, men and substance users were significantly less favorable. Results suggest the need for preventions specifically targeted at reducing substance use in the Brazilian university context.

A large family with Carney complex caused by the S147G PRKAR1A mutation shows a unique spectrum of disease including adrenocortical cancer.

CONTEXT: Most tumors in Carney complex (CNC) are benign, including primary pigmented nodular adrenocortical disease (PPNAD), the main endocrine tumor in CNC. Adrenocortical cancer (AC) has never been observed in the syndrome. Herein, we describe a large Azorean family with CNC caused by a point mutation in the PRKAR1A gene coding for type 1-α (RIα) regulatory subunit of the cAMP-dependent protein kinase A, in which the index patient presented with AC. OBJECTIVE: We studied the genotype-phenotype correlation in CNC. DESIGN AND SETTING: We reported on case series and in vitro testing of the PRKAR1A mutation in a tertiary care referral center. PATIENTS: Twenty-two members of a family were investigated for Cushing syndrome and other CNC components; their DNA was sequenced for PRKAR1A mutations. RESULTS: Cushing syndrome due to PPNAD occurred in four patients, including the proposita who presented with AC and three who had Cushing syndrome and/or PPNAD. Lentigines were found in six additional patients who did not have PPNAD. A base substitution (c.439A>G/p.S147G) in PRKAR1A was identified in the proposita, in the three others with PPNAD, in the proposita's twin daughters who had lentigines but no evidence of hypercortisolism, and in five other family members, including one without lentigines or evidence of hypercortisolism. Unlike in other RIα defects, loss of heterozygosity was not observed in AC. The S147G mutation was compared to other expressed PRKAR1A mutations; it led to decreased cAMP and catalytic subunit binding by RIα and increased protein kinase A activity in vitro. CONCLUSIONS: In a large family with CNC, one amino acid substitution caused a spectrum of adrenal disease that ranged from lack of manifestations to cancer. PPNAD and AC were the only manifestations of CNC in these patients, in addition to lentigines. These data have implications for counseling patients with CNC and are significant in documenting the first case of AC in the context of PPNAD.

Desinfecção de água de chuva por radiação ultravioleta / Disinfection of rainwater by ultraviolet radiation

O objetivo deste trabalho foi avaliar o tratamento de água de chuva, de duas regiões industriais de Joinville (SC), por radiação ultravioleta. O reator operou em processo contínuo, de modo que cada partícula permanecesse sob radiação por 60 segundos. As amostras de água foram analisadas em termos de coliformes totais, coliformes termotolerantes e bactérias heterotróficas antes do tratamento por ultravioleta, após o tratamento e após tratadas e armazenadas por 24, 48 e 72 horas. Verificou-se a eficiência da desinfecção de água de chuva direta e de telhado por radiação ultravioleta com a inativação de 100 por cento dos coliformes totais e dos coliformes termotolerantes e o não recrescimento desses micro-organismos em amostras tratadas e estocados por até 72 horas, no entanto, bactérias heterotróficas persistiram e foram identificadas após 24, 48 e 72 horas ao tratamento.

The objective of this study was to evaluate the treatment of rainwater in two industrial regions in Joinville (SC, Brazil) by ultraviolet radiation. The reactor was operating in continuous process with each particle remaining under radiation for 60 seconds. The samples were evaluated in terms of total coliforms, fecal coliform and heterotrophic bacteria prior to ultraviolet treatment, after treatment and further treated and stored for 24, 48 and 72 hours. The efficiency of disinfection of direct rainwater and that collected from roofing by ultraviolet radiation was verified with 100 percent inactivation of total coliforms and fecal coliform and these microorganisms did not reappear in samples treated and stored for up to 72 hours, however, heterotrophic bacteria persisted and were identified after 24, 48 and 72 hours of treatment.

[Home environment and alterations in the development of children in a community of the outskirts of São Luís - MA]. / Ambiente domiciliar e alterações do desenvolvimento em crianças de comunidade da periferia de São Luís - MA.

The main bonds of infants in early childhood are established in the home environment. The home is fundamental for providing stimuli that can influence the development of the child. A cross-sectional study was conducted in a low income community in the outskirts of the city of São Luís to analyze the provision of stimuli in the home environment of 2-year-old children and the potential association with retardation in child development. A random sample of 176 2-year-old children registered in community outpatient healthcare departments was assessed. Two validated instruments were used, namely the Home Observation for Measurement of the Environment (HOME) Inventory and the Gesell Measurement of Development Scale. Data were gathered in the homes. Logistic regressions were carried out taking the Home Inventory (low or average/high) and the Gesell Scale (suspicion of delay/normal) as outcome variables. Low family income, low maternal and paternal schooling, number of residents, number of children < 5 years old and small number of rooms in the house were considered risk factors for low Home scores, which were associated with the suspicion of development delay. The quality and quantity of environmental stimuli in the family context proved to be essential for the development of the children evaluated.

Ambiente domiciliar e alterações do desenvolvimento em crianças de comunidade da periferia de São Luís - MA / Home environment and alterations in the development of children in a community of the outskirts of São Luís - MA

Na primeira infância, os principais vínculos da criança são estabelecidos no ambiente doméstico. Este é fundamental quanto à oferta de estímulos que podem influenciar seu desenvolvimento. Com o objetivo de analisar o ambiente domiciliar de crianças de 2 anos de idade, quanto à oferta de estímulos e à sua relação com suspeitas de atrasos de desenvolvimento, realizou-se estudo transversal, em comunidade de baixa renda na periferia de São Luis. Calculou-se amostra aleatória de 176 crianças de 2 anos de idade cadastradas em unidades de saúde da comunidade. Utilizaram-se dois instrumentos validados: o Inventory Home (medida de estímulos domiciliares) e a Gesell Scale (medida de desenvolvimento). Os dados foram coletados nas próprias casas. Foram realizadas regressões logísticas tendo como variáveis resposta o HOME (baixo ou médio/alto) e Gesell (com suspeita de atraso ou s/atraso). Renda familiar baixa, baixa escolaridade materna e paterna, nº de residentes, nº de filhos < 5 anos e baixo nº de cômodos foram fatores de risco para HOME baixo. Este, por sua vez, associou-se com a suspeita de atraso no desenvolvimento (Gesell baixo). A qualidade e a quantidade de estímulos ambientais presentes no contexto familiar mostraram-se fundamentais para o desenvolvimento global das crianças avaliadas.

The main bonds of infants in early childhood are established in the home environment. The home is fundamental for providing stimuli that can influence the development of the child. A cross-sectional study was conducted in a low income community in the outskirts of the city of São Luís to analyze the provision of stimuli in the home environment of 2-year-old children and the potential association with retardation in child development. A random sample of 176 2-year-old children registered in community outpatient healthcare departments was assessed. Two validated instruments were used, namely the Home Observation for Measurement of the Environment (HOME) Inventory and the Gesell Measurement of Development Scale. Data were gathered in the homes. Logistic regressions were carried out taking the Home Inventory (low or average/high) and the Gesell Scale (suspicion of delay/normal) as outcome variables. Low family income, low maternal and paternal schooling, number of residents, number of children < 5 years old and small number of rooms in the house were considered risk factors for low Home scores, which were associated with the suspicion of development delay. The quality and quantity of environmental stimuli in the family context proved to be essential for the development of the children evaluated.

Leprosy and Kaposi sarcoma presenting as an immune reconstitution inflammatory syndrome in a patient with AIDS.

The simultaneous presence of infectious organisms within cutaneous lesions of Kaposi sarcoma in persons with AIDS has been demonstrated. We describe a patient with concurrent leprosy and Kaposi sarcoma presenting as an immune reconstitution inflammatory syndrome in the setting of AIDS.

Sweet syndrome associated with Hashimoto thyroiditis.

Sweet syndrome was originally described in 1964 by the English dermatologist R. D. Sweet. Nakayama et al. first reported the simultaneous occurrence of this syndrome and Hashimoto thyroiditis in 1993. The role of cytokines in the development of both Hashimoto thyroiditis and Sweet syndrome may be the link between these two conditions.