Stabilization of ginger essential oil Pickering emulsions by pineapple cellulose nanocrystals.

Pickering emulsions (PE) are systems made up of two incompatible fluids, these are stabilized by solid organic or inorganic particles located on their interface. Cellulose nanocrystals (CNCs) are sustainable and biocompatible value-added naturally occurring biomolecules which are being investigated as PE stabilizers in the cosmetic, food, and pharmaceutical industries. The objective of this research was to investigate the efficacy of pineapple cellulose nanocrystals as stabilizers for a ginger essential oil-in-water Pickering emulsion. Anionic pineapple cellulose nanocrystals were prepared by acid hydrolysis. Ginger essential oil-in-water emulsions were prepared by ultrasonication. Pineapple CNC produced stable Pickering emulsions with surface average droplet size of 4.3 µm-6.2 µm, high negative zeta potential, high viscosity, and high adsorption at the interface. Pickering emulsions by ultrasonication were stable against droplet coalescence, phase separation, and droplet flocculation for at least 8 weeks at 25 °C or 40 °C at various droplet sizes. The emulsion droplet size and volume density (droplet size distribution) were evaluated by varying the particle concentration (CNC 0.25 g/100 ml or 0.50 g/100 ml) and/or oil fraction (10-20 g/100 ml). At constant oil fraction, the emulsion viscosity increased as the nanocrystal concentration increased. The cellulose nanocrystal-stabilized ginger oil-Pickering emulsions exhibited shear-thinning characteristics of a pseudo-plastic fluid. Pineapple nanocellulose crystal -stabilized ginger oil-Pickering emulsions exhibited high stability with a creaming index of zero. CNC was found to be an effective Pickering stabilizer for oil-in-water emulsions in various food applications.

Radial Nerve Supracondylar Block Versus Fracture Hematoma Block. Comparison of Their Efficacy in Cases of Fractures of the Distal Third of the Radius / Bloqueio supracondilar de nervo radial versus bloqueio de hematoma de fratura. Comparativo de sua eficácia em casos de fraturas do terço distal do rádio

Abstract Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.

Resumo Objetivo O estudo compara a eficácia analgésica de duas técnicas para realizar redução incruenta: o bloqueio de hematoma da fratura e o bloqueio supracondilar de nervo radial. Métodos Quarenta pacientes com fraturas do terço distal do rádio, que necessitassem redução, foram selecionados em um ensaio clínico quasi-randomizado, para receber uma das técnicas anestésicas. Todos os pacientes assinaram o termo de consentimento ou assentimento, com exceção daqueles que não desejassem participar do estudo, tivessem lesão neurológica, com contraindicação ao procedimento na sala de emergências, ou com contraindicação ao uso da lidocaína. Para aferir a analgesia foi utilizada a escala numérica da dor em quatro momentos distintos: pré-bloqueio, pós-bloqueio, durante a redução e após a redução; em seguida, foram calculadas três diferenças: a primeira entre antes e após o bloqueio; a segunda entre durante a redução e após o bloqueio; e a terceira entre antes do bloqueio e após a redução. Resultados Os grupos do bloqueio de hematoma de fratura e bloqueio supracondilar apresentaram respectivamente os seguintes valores médios: 3.90 (1-10) e 3.50 (-6-10) na diferença 1; 4.35 (-5-10) e 5.00 (-3-10) na diferença 2; e 4.65 (1-10) e 3.80 (-3-10) na diferença 3. Conclusão As duas técnicas se provaram eficientes para analgesia, com discreta superioridade do bloqueio de hematoma, mas sem significância estatística.

Reactivity Differences of Trigonal Pyramidal Nonheme Iron(IV)-Oxo and Iron(III)-Oxo Complexes: Experiment and Theory.

High-valent metal-oxo species play critical roles in enzymatic catalysis yet their properties are still poorly understood. In this work we report a combined experimental and computational study into biomimetic iron(IV)-oxo and iron(III)-oxo complexes with tight second-coordination sphere environments that restrict substrate access. The work shows that the second-coordination sphere slows the hydrogen atom abstraction step from toluene dramatically and the kinetics is zeroth order in substrate. However, the iron(II)-hydroxo that is formed has a low reduction potential and hence cannot do OH rebound favorably. The tolyl radical in solution then reacts further with alternative reaction partners. By contrast, the iron(IV)-oxo species reacts predominantly through OH rebound to form alcohol products. Our studies show that the oxidation state of the metal influences reactivities and selectivities with substrate dramatically and that enzymes will likely need an iron(IV) center to catalyze C-H hydroxylation reactions.

A Spectroscopically Observed Iron Nitrosyl Intermediate in the Reduction of Nitrate by a Surface-Conjugated Electrocatalyst.

We report an iron-based graphite-conjugated electrocatalyst (GCC-FeDIM) that combines the well-defined nature of homogeneous molecular electrocatalysts with the robustness of a heterogeneous electrode. A suite of spectroscopic methods, supported by the results of DFT calculations, reveals that the electrode surface is functionalized by high spin (S = 5/2) Fe(III) ions in an FeN4Cl2 coordination environment. The chloride ions are hydrolyzed in aqueous solution, with the resulting cyclic voltammogram revealing a Gaussian-shaped wave assigned to 1H+/1e- reduction of surface Fe(III)-OH surface. A catalytic wave is observed in the presence of NO3-, with an onset potential of -1.1 V vs SCE. At pH 6.0, GCC-FeDIM rapidly reduces NO3- to ammonium and nitrite with 88 and 6% Faradaic efficiency, respectively. Mechanistic studies, including in situ X-ray absorption spectroscopy, suggest that electrocatalytic NO3- reduction involves an iron nitrosyl intermediate. The Fe-N bond length (1.65 Å) is similar to that observed in {Fe(NO)}6 complexes, which is supported by the results of DFT calculations.

Hydrocarbon Oxidation by an Exposed, Multiply Bonded Iron(III) Oxo Complex.

The iron oxo unit, [Fe=O] n+ is a critical intermediate in biological oxidation reactions. While its higher oxidation states are well studied, relatively little is known about the least-oxidized form [FeIII=O]+. Here, the thermally stable complex PhB(AdIm)3Fe=O has been structurally, spectroscopically, and computationally characterized as a bona fide iron(III) oxo. An unusually short Fe-O bond length is consistent with iron-oxygen multiple bond character and is supported by electronic structure calculations. The complex is thermally stable yet is able to perform hydrocarbon oxidations, facilitating both C-O bond formation and dehydrogenation reactions.

Reversible Switching of Organic Diradical Character via Iron-Based Spin-Crossover.

Organic diradicals are uncommon species that have been intensely studied for their unique properties and potential applicability in a diverse range of innovative fields. While there is a growing class of stable and well-characterized organic diradicals, there has been recent focus on how diradical character can be controlled or modulated with external stimuli. Here we demonstrate that a diiron complex bridged by the doubly oxidized ligand tetrathiafulvalene-2,3,6,7-tetrathiolate (TTFtt2-) undergoes a thermally induced Fe-centered spin-crossover which yields significant diradical character on TTFtt2-. UV-vis-near-IR, Mössbauer, NMR, and EPR spectroscopies with magnetometry, crystallography, and advanced theoretical treatments suggest that this diradical character arises from a shrinking TTFtt2- π-manifold from the Fe(II)-centered spin-crossover. The TTFtt2--centered diradical is predicted to have a singlet ground state by theory and variable temperature EPR. This unusual phenomenon demonstrates that inorganic spin transitions can be used to modulate organic diradical character.

Hydrosilylation of an Iron(IV) Nitride Complex.

The nitride ligand in iron(IV) complex PhB(MesIm)3Fe≡N reacts with excess H3SiPh to afford PhB(MesIm)3Fe(µ-H)3(SiHPh) as the major product, which has been structurally and spectroscopically characterized. Bulkier silane HaSiPh2 provides iron(II) amido complex PhB(MesIm)3FeN(H)(SiHPh2) as the initial product of the reaction, with excess H2SiPh2 affording diamagnetic PhB(MesIm)3Fe(µ-H)3(SiPh2) as the major product. Unobserved iron(II) hydride PhB(MesIm)3Fe-H is implicated as an intermediate in this reaction, as suggested by the results of the reaction between iron(II) amido PhB(MesIm)3FeN(H)tBu and H3SiPh, which provides PhB(MesIm)3Fe(H)(µ-H)2(Si(NHtBu)Ph) as the sole product.

A Dimeric Hydride-Bridged Complex with Geometrically Distinct Iron Centers Giving Rise to an S = 3 Ground State.

Structural and spectroscopic characterization of the dimeric iron hydride complex [Ph2B(tBuIm)2FeH]2 reveals an unusual structure in which a tetrahedral iron(II) site (S = 2) is connected to a square planar iron(II) site (S = 1) by two bridging hydride ligands. Magnetic susceptibility reveals strong ferromagnetic coupling between iron centers, with a coupling constant of J = +110(12) cm-1, to give an S = 3 ground state. High-frequency and -field electron paramagnetic resonance (HFEPR) spectroscopy confirms this model. A qualitative molecular orbital analysis of the electronic structure, as supported by electronic structure calculations, reveals that the observed spin configuration results from the orthogonal alignment of two geometrically distinct four-coordinate iron fragments held together by highly covalent hydride ligands.

Evaluación del riesgo cardiovascular en pacientes con diabetes mellitus tipo 2 / Evaluation of cardiovascular risk in patients with type 2 diabetes mellitus

Es ampliamente conocido que la principal causa de morbi ­ mortalidad en pacientes con Diabetes Mellitus (DM) tipo 2 es la enfermedad cardiovascular en sus diferentes formas. Desde hace mucho tiempo se han diseñado herramientas de cálculo de dicho riesgo, basadas en información estadística obtenida de estudios poblacionales que correlacionan los factores de riesgo cardiovascular con la probabilidad de que los pacientes con diabetes Mellitus presenten complicaciones cardiovasculares. Sin embargo, todas y cada una de dichas herramientas presentan pros y contras para su aplicación en diferentes poblaciones y diferentes contextos clínicos. En el presente trabajo se discute la importancia de la evaluación del riesgo cardiovascular en los pacientes con diabetes Mellitus tipo 2 así como las diferentes opciones disponibles para el cálculo de dicho riesgo...(AU)

It is widely known that the main cause of morbidity and mortality in patients with type 2 Diabetes Mellitus (DM) is a cardiovascular disease in various forms. Since some time ago, tools have been designed for calculating this risk, based on statistical data obtained from population studies that correlate cardiovascular risk factors with the likelihood that patients with diabetes mellitus present cardiovascular complications. However, each and every one of these tools have pros and cons for application in different populations and different clinical settings. In this paper the importance of cardiovascular risk assessment in patients with type 2 diabetes mellitus and the various options available to calculate this risk are discussed...(AU)

Intuitive weights of harm for therapeutic decision making in smear-negative pulmonary Tuberculosis: an interview study of physicians in India, Pakistan and Bangladesh.

BACKGROUND: To estimate the amount of regret and weights of harm by omission and commission during therapeutic decisions for smear-negative pulmonary Tuberculosis. METHODS: An interviewer-administered survey was done among young physicians in India, Pakistan and Bangladesh with a previously used questionnaire. The physicians were asked to estimate probabilities of morbidity and mortality related with disease and treatment and intuitive weights of omission and commission for treatment of suspected pulmonary Tuberculosis. A comparison with weights based on literature data was made. RESULTS: A total of 242 physicians completed the interview. Their mean age was 28 years, 158 (65.3%) were males. Median probability (%) of mortality and morbidity of disease was estimated at 65% (inter quartile range [IQR] 50-75) and 20% (IQR 8-30) respectively. Median probability of morbidity and mortality in case of occurrence of side effects was 15% (IQR 10-30) and 8% (IQR 5-20) respectively. Probability of absolute treatment mortality was 0.7% which was nearly eight times higher than 0.09% reported in the literature data. The omission vs. commission harm ratios based on intuitive weights, weights calculated with literature data, weights calculated with intuitive estimates of determinants adjusted without and with regret were 3.0 (1.4-5.0), 16 (11-26), 33 (11-98) and 48 (11-132) respectively. Thresholds based on pure regret and hybrid model (clinicians' intuitive estimates and regret) were 25 (16.7-41.7), and 2(0.75-7.5) respectively but utility-based thresholds for clinicians' estimates and literature data were 2.9 (1-8.3) and 5.9 (3.7-7.7) respectively. CONCLUSION: Intuitive weight of harm related to false-negatives was estimated higher than that to false-positives. The mortality related to treatment was eightfold overestimated. Adjusting expected utility thresholds for subjective regret had little effect.

Hipoglicemia y su relación con mortalidad en pacientes de encamamiento y unidad de cuidados intensivos de medicina interna / Hypoglycemia and its relationship with mortality in patients bedridden and Intensive Care Unit of Internal Medicine

La Diabetes Mellitus representa un problema de salud mundial y nacional, y la hipoglicemia es unade sus más temidas complicaciones. Existe controversia en cuanto a los rangos glicémicos ideales,ya que se ha demostrado mayor mortalidad en pacientes que desarrollan hipoglicemia.Materiales y Métodos: El objetivo del presente estudio fue determinar la incidencia dehipoglicemia en pacientes en la Unidad de Cuidados Intensivos y Encamamiento de MedicinaInterna del Hospital Roosevelt y determinar su mortalidad, comparándola con un grupo control sinhipoglicemia. Es un estudio observacional de casos y controles. Se incluyó como grupo de estudioa 35 pacientes en quienes se documentó hipoglicemia, del 1 de enero al 30 de junio del 2011. Porcada sujeto de estudio se tomó un control que no desarrolló hipoglicemia. Se determinó lamortalidad intra-hospitalaria y a los seis meses de cada grupo.Resultados: Intrahospitalariamente fallecieron 10 pacientes (28.6%) del grupo de hipoglicemia y 3(8.6%) del grupo control (RR 3.33; 95% CI, 1.00 – 11.09; P=0.0496). A los seis meses habíanfallecido 15 pacientes (42.9%) del grupo de hipoglicemia, y 7 (20.0%) del grupo control (RR 2.14; CI0.997 – 4.605; P=0.0509). Tres pacientes (8.6%) del grupo de hipoglicemia desarrollaron infecciónnosocomial durante el estudio, y ninguno del grupo control (RR 7.00; CI 0.37 – 130.70; P=0.1926).Se documentaron 10 re-hospitalizaciones en el grupo de hipoglicemia y 9 en los controles.Conclusión: Este estudio demuestra que hay mayor riesgo de morir en pacientes que desarrollanhipoglicemia durante su estancia hospitalaria comparado con quienes no la realizan.

Síndrome de Poems: reporte de un caso clínico / Poems syndrome: a case report

El Síndrome de POEMS (polineuropatía, organomegalia, endocrinopatía, pico gamma monoclonal ycambios en la piel) es una discrasia de células plasmáticas que se manifiesta con un característicoconjunto de trastornos para neoplásicos. Los cambios en la piel, como hiperpigmentación cutáneageneralizada, son debidos al aumento en la secreción del factor de crecimiento del endotelio vascular.Se reporta el caso de una mujer de 67 años de edad que se presentó con astenia, adinamia y uncuadro importante de anemia, asociados a diabetes mellitus, hipotiroidismo y polineuropatía motora ysensitiva de moderada intensidad. Sus cambios en la piel consistieron en hiperpigmentación, manchasvioláceas en los labios y acentuación de los pliegues de las manos. Los estudios subsecuentesevidenciaron el pico gamma monoclonal y la polineuropatía axonal sensitivo-motora en elelectromiograma. Se brindó el tratamiento quimioterapéutico correspondiente pero sufriócomplicaciones mielosupresoras por esta razón, desarrollo una neumonía intrahospitalaria y falleció aconsecuencia.

The POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein and skin changes)is a rare atypical plasma cell dyscrasia with characteristic para neoplastic manifestations. The skinchanges, as generalized skin hyperpigmentation, are related with elevated levels of vascularendothelial growth factor. We report a clinical case of 67 years old woman who presented withasthenia, adynamia and important anemia, associated to diabetes mellitus, hypothyroidism and amoderated intensity motor-sensitive polyneuropathy. The skin changes presented by this patientwere hyperpigmentation, violet spots in the lips and accentuation of the lines in the palm of the hand.Subsequent analysis showed the M–protein and the electromyography showed a motor-sensitivepolyneuropathy in both legs. Adequate chemotherapy was given but mielosuppressive effects wereshown, she acquired nosocomial pneumonia and died as consequence.

Neuroimmunological findings of Angiostrongylus cantonensis meningitis in ecuadorian patients / Hallazgos neuroinmunologicos en meningitis por Angiostrongylus cantonesis en pacientes ecuatorianos

Meningitis caused by Angiostrongylus cantonensis has recently been reported in patients resulting from the first outbreaks in subtropical regions of Ecuador. METHOD: Eight young adult patients from the two outbreaks were studied. IgA, IgM, IgG and albumin in cerebrospinal fluid and serum were quantified and plotted in cerebrospinal fluid/serum quotient diagrams (Reibergrams). The anamnesis on the patients included asking about any consumption of raw snails, symptoms and harm caused. RESULTS: Mean eosinophilia of 7.5 percent and 26 percent in serum and cerebrospinal fluid respectively was observed, as well as a moderate increase in total proteins. The most frequent pattern of intrathecal synthesis was observed in three classes of immunoglobulins. Intrathecal synthesis of IgM was observed in all cases two weeks after the first symptoms appeared. CONCLUSION: The intrathecal synthesis patterns of eosinophilic meningitis due to Angiostrongylus cantonensis, facilitated by cerebrospinal fluid analysis, were similar to those of previous cases from abroad.

La meningitis provocada por Angiostrongylus cantonensis ha sido reportada recientemente en pacientes procedentes de los primeros brotes reportados en regiones subtropicales de Ecuador. MÉTODO: Ocho adultos jóvenes procedentes de dos brotes fueron estudiados. Se cuantificó IgA, IgM, IgG y albúmina en suero y líquido cefalorraquídeo y fueron colocados en los gráficos de las razones líquido cefalorraquídeo/suero (reibergramas). La anamnesia incluía ingestión de caracoles crudos, los síntomas y los daños provocados. RESULTADOS: Una eosinofílica promedio de 7,5 y 26 por ciento en suero y líquido cefalorraquídeo fue observada al igual que un moderado incremento en las proteínas totales. El patrón de síntesis intratecal predominante fue de tres clases de inmunoglobulinas. La síntesis intratecal de IgM se observó en todos los casos a las dos semanas después del inicio de los síntomas. CONCLUSIÓN: El patrón de síntesis intratecal de la meningitis eosinofílica por Angiostrongylus cantonensis facilitado por el análisis del líquido cefalorraquídeo fue similar a los casos previos reportados fuera del país.

Structural and functional studies indicating altered redox properties of hemoglobin E: implications for production of bioactive nitric oxide.

Hemoglobin (Hb) E (ß-Glu26Lys) remains an enigma in terms of its contributions to red blood cell (RBC) pathophysiological mechanisms; for example, EE individuals exhibit a mild chronic anemia, and HbE/ß-thalassemia individuals show a range of clinical manifestations, including high morbidity and death, often resulting from cardiac dysfunction. The purpose of this study was to determine and evaluate structural and functional consequences of the HbE mutation that might account for the pathophysiology. Functional studies indicate minimal allosteric consequence to both oxygen and carbon monoxide binding properties of the ferrous derivatives of HbE. In contrast, redox-sensitive reactions are clearly impacted as seen in the following: 1) the ∼2.5 times decrease in the rate at which HbE catalyzes nitrite reduction to nitric oxide (NO) relative to HbA, and 2) the accelerated rate of reduction of aquometHbE by L-cysteine (L-Cys). Sol-gel encapsulation studies imply a shift toward a higher redox potential for both the T and R HbE structures that can explain the origin of the reduced nitrite reductase activity of deoxyHbE and the accelerated rate of reduction of aquometHbE by cysteine. Deoxy- and CO HbE crystal structures (derived from crystals grown at or near physiological pH) show loss of hydrogen bonds in the microenvironment of ßLys-26 and no significant tertiary conformational perturbations at the allosteric transition sites in the R and T states. Together, these data suggest a model in which the HbE mutation, as a consequence of a relative change in redox properties, decreases the overall rate of Hb-mediated production of bioactive NO.

Estudo radiológico do valor angular da cifose torácica em adolescentes / Estudio radiológico del valor angular de la cifosis torácica en adolescentes / Radiological study of the angular value of thoracic kyphosis in adolescents

OBJETIVO: determinar a diferença dos valores angulares da cifose torácica utilizando como vértebra terminal cranial diferentes níveis (T2 a T5). MÉTODOS: foram avaliadas radiografias em perfil de cem adolescentes voluntários saudáveis da Escola Industrial do Serviço Social da Indústria (SESI) de Ribeirão Preto (SP), com prévia autorização dos pais ou responsáveis. Foram excluídas as radiografias de dez indivíduos por falhas na qualidade. Os parâmetros avaliados foram: mensuração da cifose torácica pelo método de Cobb, utilizando T2, T3, T4 ou T5 como vértebra terminal cranial e T12 como vértebra terminal caudal. RESULTADOS: foram avaliados 90 indivíduos (46 do sexo masculino e 44 do feminino), com idade variando de 13 a 15 anos (média 14±6). O valor angular da cifose torácica nos diferentes níveis variou entre 45º (T2-T12) e 35º (T5-T12) no sexo masculino, e valor angular entre 43º(T2-T12) e 30º (T5-T12) no sexo feminino. CONCLUSÃO: foi observada diferença constante de aproximadamente 5º quando comparados os valores angulares da cifose torácica utilizando diferentes níveis (T2 a T5) como vértebra terminal cranial.

OBJECTIVE: to determine the difference of the thoracic kyphosis angular values using different levels (T2 a T5) as a terminal cranial vertebra. METHODS: sagittal radiographies of one hundred healthy adolescent volunteers, who study at Escola Industrial do Serviço Social da Indústria (SESI) in Ribeirão Preto SP), were evaluated the sagittal radiographies of one hundred health volunteers adolescent, that studies at Escola Industrial do SESI in Ribeirão Preto (SP), with parents consent. Ten adolescents were excluded because of flaws in the quality. The studied parameters were: the measurement of thoracic kyphosis by the Cobb method, using T2, T3, T4, T5 as a terminal proximal vertebra and T12 as a distal final vertebra. RESULTS: Ninety individuals (46 men and 44 women), aged from 13 to 15 (average of 14±6), were evaluated. The angular value of thoracic kyphosis in the different levels varied from 46º (T2 - T12) to 35º (T5 - T12) in men, and from 44º (T2- T12) to 30º (T5 - T12) in women. CONCLUSION: A constant difference of approximately 5º was observed when comparing the angular values of thoracic kyphosis using different levels (T2 - T5) as a terminal cranial vertebra.

OBJETIVO: determinar la diferencia de los valores angulares de la cifosis torácica usando como vértebra terminal craneal, diferentes niveles (T2 a T5). MÉTODOS: fueron evaluadas radiografías en perfil de cien adolescentes voluntarios saludables de la Escola Industrial do Serviço Social da Indústria (SESI) de Ribeirão Preto (SP), con previa autorización de sus padres o responsables. Fueron excluidas radiografías de diez individuos por fallas de resolución. Los parámetros evaluados fueron: la medida de la cifosis torácica por el método de Cobb, usando T2,T3,T4 y T5 como vértebra terminal craneal y T12 como vértebra terminal caudal. RESULTADOS: fueron evaluados 90 individuos (46 hombres y 44 mujeres), con edades que varían de 13 a 15 años (media 14±6). El valor angular de la cifosis torácica en los diferentes niveles fue de 45º (T2-T12) y 35º (T5-T12) en el sexo masculino, y valor angular de 43º (T2-T12) y 30º (T5-T12) en el sexo femenino. CONCLUSIÓN: fue observada una diferencia constante de aproximadamente 5º cuando los valores angulares de la cifosis torácica fueron comparados, usando diferentes niveles (T2 a T5) como vértebra terminal craneal.

Diagnostic evaluation of people with hypertension in low income country: cohort study of "essential" method of risk stratification.

OBJECTIVES: To explore the predictive power of a risk stratification method for people with hypertension based on "essential" procedures (that is, available in economically less developed areas of the world), comparing it in the same population with the results given by the method suggested by the 1999 World Health Organization-International Society of Hypertension (WHO-ISH) guidelines. DESIGN: Prospective cohort study of outcomes according to cardiovascular risk profile at baseline. SETTING: Primary care in a poor rural area of the Ecuadorian forest. PARTICIPANTS: 504 people with hypertension prospectively monitored for a mean of 6.7 (SD 2.3) years. INTERVENTIONS: Essential data included blood pressure, medical history, smoking, age, sex, and diagnosis of diabetes; the WHO-ISH methods additionally included measurement of fasting blood glucose, total cholesterol, and creatinine, urinalysis, and electrocardiography. MAIN OUTCOME MEASURES: Cardiovascular events and total deaths. RESULTS: With both methods there was a highly significant association between the level of predicted risk and the incidence of cardiovascular events and of total deaths: up to three quarters of all cardiovascular events and two thirds of all deaths were reported among people classified as at high or very high risk with either method. The predictive discrimination of the essential method is comparable with the WHO-ISH with C statistics (95% confidence interval) of 0.788 (0.721 to 0.855) and 0.744 (0.673 to 0.815), respectively, for cardiovascular events and 0.747 (0.678 to 0.816) and 0.705 (0.632 to 0.778) for total mortality. CONCLUSIONS: The risk stratification of patients with hypertension with an essential package of variables (that is, available and practicable even in the economically less developed areas of the world) serves at least as well as the more comprehensive method proposed by WHO-ISH.

Esforços inovativos de empresas no Brasil: uma análise das indústrias têxtil-vestuário, calçados, móveis e cerâmica / Innovative efforts of firms in Brazil: an analysis of the textile, clothing, footwear, furniture and ceramic tile industries

Este trabalho analisa os esforços inovativos de empresas das indústrias têxtil-vestuário, de calçados, de móveis e de cerâmica que - mesmo tendo como principal fonte de tecnologia as indústrias fornecedoras, como a química e os bens de capital - são responsáveis pelo desenvolvimento de aplicações em produtos e processos capazes de proporcionar importantes vantagens diferenciais aos produtores.

Amebic infections due to the Entamoeba histolytica-Entamoeba dispar complex: a study of the incidence in a remote rural area of Ecuador.

An epidemiologic field study was conducted in the village of Borbòn in Esmeraldas province in northern Ecuador to compare different parasitologic methods in the diagnosis of infection with the Entamoeba histolytica/Entamoeba dispar complex. The results of two stool antigen detection assays (the Prospect Entamoeba histolytica microplate assay and the E. histolytica II assay) were compared with isoenzyme characterization of the amebic isolates. Nearly all (176 of 178, 98.9%) subjects were positive for intestinal parasites on direct microscopic examination, and cysts and/or vegetative forms morphologically consistent with the E. histolytica/E. dispar complex were recorded in 48 of 178 cases (27%). Culture in Robinson's medium was positive for amebic stocks in 89 (50%) of the 178 samples tested. Of the 37 isolates successfully stabilized, cloned, and characterized by zymodeme analysis, seven (18.9%) showed isoenzyme patterns of E. histolytica, whereas 26 (70.3%) showed patterns of E. dispar. The remaining four strains were identified as Entamoeba coli (three isolates; 8.1%) and Dientamoeba fragilis (one strain; 2.7%).The immunochromatographic tests showed different degrees of sensitivity and specificity when compared with isoenzyme characterization as the reference technique. The microplate assay, which does not discriminate between E. histolytica and E.dispar, showed a sensitivity of 54.5% and a specificity of 94% for both these amebic species. In contrast, the second-generation E. histolytica II test had a sensitivity of 14.3% and a specificity of 98.4% for E. histolytica sensu stricto. Our survey clearly demonstrated that more specific and sensitive diagnostic tests, such as stool antigen detection assays and isoenzyme analysis, are needed to establish the actual worldwide distribution of E. histolytica and E. dispar.

Lyme borreliosis: investigation to identify cutaneous features among patients who attend the Rio de Janeiro University Hospital / Investigaçöes para identificar manifestaçöes cutâneas em pacientes que såo atendidos no Hospital Universitário do Rio de Janeiro

Background: Lyme borreliosis (LB) is a systemic disease with dermatological manifestations. We investigated the prevalence of this disease in patients at the Hospital of the Federal University of Rio de Janeiro. Material and methods: A series of 204 suspected patients with clinical symptoms and epidemiological data affirmative for the disease were investigated for LB with serology, histopathology and immunohistochemistry associated. Results: In this group of suspected LB patients, serological positivity with IFABb was 33,50 per cent while it was 29,41 per cent among controls. Positivity with ElisaBb was 35,48 per cent. The "G" statistic test was >0,5. We observed the following clinical manifestations: 33 annular erythemas; 2 benign lymphocytic infiltration of the skin; 3 lymphocytoma cutis; 1 urticaria; 9 morphea; 1 systemic progressive sclerosis; 3 lichen sclerosus et atrophicus; 1 eosniphilic fasciitis; 1 edema; 1 purpuric and pigmented dermatitis; 5 arthralgias; 1 polineuropathy; 3 neuralgias and 1 AV heart block. Histopathological and immunohistochemical examinationsdid not identify the etiological agent Bb in any case. Conclusion: 1 - Cutaneous manifestations were the predominating clinical symptons among suspected patients Lb; 2 - The serological test (IFABb) utilized did not help Lyme disease diagnosis. Our controls are above the percentage in endemic areas, and Rio de Janeiro may be one such area; 3 - Serological tests for syphilis should be done at the same time as the serological antiBb test to detect false positive readings