Cardiac surgery in infective endocarditis and predictors of in-hospital mortality. / Cirurgia cardíaca na endocardite infeciosa e preditores da mortalidade intra­hospitalar.

INTRODUCTION: Infective endocarditis (IE) is a serious disease with significant in-hospital mortality (15-30%) despite advances in medical and surgical therapy. AIMS: To perform a clinical characterization of patients undergoing cardiac surgery for IE and to identify factors that predict in-hospital mortality. METHODS: We retrospectively analyzed 145 patients with IE admitted between January 2006 and October 2017. RESULTS: The median age was 72 years. IE was acquired mainly in the community (69%), and involved the native aortic valve in 54% of patients, biological prosthetic valves in 22.1% and mechanical valves in 10.3%. Staphylococcus spp. (31.0%) were the most frequent etiological agents. Cardiac surgery was emergent in 29 patients, urgent in 108, and elective in eight. The main indications were heart failure (57.9%), large vegetations (20%), systemic embolism (17.2%) and valve dysfunction (15.2%). Overall, biological valves were implanted in 62.1% of patients and mechanical valves in 37.2%. A total of 19 patients (13.1%) died. Predictors of mortality were preoperative atrial fibrillation and lower left ventricular ejection fraction, postoperative severe valve regurgitation associated with cardiogenic shock, sepsis, septic shock associated with cardiogenic shock, cardiac tamponade, need for renal replacement therapy and, although without statistical significance, emergent surgery. CONCLUSIONS: There is a need for better indicators to enable early identification of surgical candidates for IE, implementation of a heart team, and better surgical strategies, including more rapid intervention, more specific postoperative care, and optimal antibiotic therapy.

Método não invasivo para avaliação da movimentação embrionária de Caiman yacare (Daudin, 1802) / Non-invasive method for evaluation of embrionic moviment of Caiman yacare (Daudin, 1802)

This study aimed to evaluate the viability of using a non-invasive digital monitor to monitor heart rate (HR) and motility during the embryonic development of Pantanal alligator (Caiman yacare) using Egg Buddy ® , at different incubation temperatures. The collection of the eggs followed the Ranching system and egg identification, transportation, and incubation were performed with the required care; all eggs were incubated with 90% humidity at 29°C for the first 45 days. Thereafter, the incubation temperature was either maintained at 29°C, increased to 33°C or maintained at 29°C and embryos simultaneously treated with 4-aminopyridine on days 46, 47, 48, and 49 (29°C-4AP). Embryo movement was measured with a digital non-invasive monitor on days 30, 35, 42, 49, 56, and 60, at which point embryos were sacrificed. In the statistical analysis no differences were observed between the groups for the temperature (33°C and 29°C); for motility, a difference was observed at day 49 for the 29°C-4AP group. This revealed that the non-invasive evaluation method can be used to verify embryonic motility and HR effectively in Caiman yacare embryos.(AU)

Microbiota bacteriana de ovos de jacaré-do-pantanal incubados naturalmente / Bacterial microbiota of the Pantanal caiman eggs incubated in nature

A cadeia produtiva do Caiman yacare tem-se destacado no Mato Grosso com a exportação de 143.386 peles em 2015, cujo sistema de manejo (ranching) implica a incubação artificial dos ovos. Nesse processo, a contaminação bacteriana de ovos influencia a taxa de eclosão. O conhecimento da microbiota de ovos incubados naturalmente orienta o manejo sanitário adequado no incubatório. No presente estudo, são apresentadas informações sobre essa microbiota e sua correlação com a de outros crocodilianos, apontando-se as espécies com potencial patogênico. Amostras de 20 ninhos de C. yacare foram coletadas e semeadas em ágar sangue e ágar Mac Conckey. A colônia condizente com Salmonella sp. foi confirmada pela técnica de reação em cadeia de polimerase. Das 22 espécies bacterianas isoladas, 59% pertencem à família Enterobacteriaceae e 41% a outros táxons bacterianos. A semelhança dos achados com as bactérias isoladas na microbiota oral e/ou intestinal/cloacal de crocodilianos foi de 77,27%. As bactérias mais e menos frequentes foram, respectivamente, Bacillus cereus, Flavobacterium multivorum, Citrobacter freundii, Escherichia hermannii, Hafnia alvei, Morganella, morganni, Salmonella sp., Serratia marcescens e Shigella sonnei. Das bactérias isoladas, 86,36% têm potencial patogênico para crocodilianos. A origem materna e a ambiental da microbiota de ovos incubados naturalmente são, respectivamente, de 77,27% e 27,27%.(AU)

The Pantanal caiman productive chain has grown in Mato Grosso with the exportation of 143.383 leather pieces in 2015, whose management system (ranching) implies the artificial incubation of eggs. In this process, the bacterial contamination of the eggs influences the hatching rate. Knowledge of the naturally incubated microbiota of eggs guides the appropriate sanitary management in the incubator room. Here we present information about this microbiota and correlate it with that of other crocodilians, indicating the species with pathogenic potential. Samples were collected in 20 nests at Pantanal, and sown in blood and Mac Conckey agar. Salmonella sp. was confirmed through polymerase chain reaction technique. From the twenty-two different species of bacteria isolated, 59% are from the Enterobacteriaceae Family and 41% from other bacterial taxonomies. The similarity of findings to isolated bacteria in the crocodilians oral and/or intestinal/cloacal microbiota was of 77,27%. The most and least frequent bacteria were, respectively, Bacillus cereus, Flavobacterium multivorum and Citrobacter freundii and Escherichia hermannii, Hafnia alvei, Morganella, morganni, Salmonella sp., Serratia marcescens and Shigella sonnei. Among the isolated bacteria, 86,36% are pathogenic for crocodilians. The maternal and environmental origin of the microbiota of eggs naturally incubated is, respectively, of 77,27% and 27,27%.(AU)

Cytotoxic cell involvement in human cutaneous leishmaniasis: assessments in active disease, under therapy and after clinical cure.

Cutaneous leishmaniasis (CL) is an important public health issue worldwide. The control of Leishmania infection depends on cellular immune mechanisms, and the inflammatory response may contribute to pathogenesis. A beneficial role of CD8(+) T lymphocytes has been proposed; nevertheless, other studies suggest a cytotoxic role of CD8(+) T lymphocytes involved in tissue damage, showing controversial role of these cells. The goal of the current study was to understand the immunopathology of CL and determine the profile of cytotoxic cells--such as CD4(+) T, natural killer and natural killer T cells--that might be involved in triggering immunological mechanisms, and may lead to cure or disease progression. The frequencies of cytotoxic cell populations in peripheral blood, obtained from patients with active disease, during treatment and after clinical healing, were assessed by flow cytometry. Cytotoxicity could not be related to a deleterious role in Leishmania braziliensis infection, as patients with active CL showed similar percentages of degranulation to healthy individuals (HI). Cured patients exhibited a lower percentage of degranulating cells, which may be due to a downregulation of the immune response. The understanding of the immunopathological mechanisms involved in CL and the commitment of cytotoxic cells enables improvements in therapeutic strategies.

Bases ósseas e musculares dos cortes comerciais da cauda de jacaré-do-Pantanal (Caiman yacare Daudin 1802) / Bone and muscular bases of commercial cuts from the Yacare Caiman (Caiman yacare, Daudin 1802) tail

A exploração comercial de jacaré-do-Pantanal (Caiman yacare) constitui importante cadeia produtiva no Estado de Mato Grosso. As características nutricionais e representatividade na massa corporal de crocodilianos tornaram a região da cauda objeto de estudos morfofisiológicos, evolutivos e tecnológicos. Como inexiste a caracterização anatômica dos músculos e ossos que constituem os cortes comerciais dessa região, objetivou-se descrever os músculos e correspondentes bases ósseas da cauda. Na descrição óssea, foram utilizados um exemplar adulto e seis juvenis. Para caracterização muscular, 24 espécimes juvenis foram conservados em freezer e dissecados a fresco, em ambos os antímeros, para verificação de simetria de ocorrência, fixações musculares, relacões de sintopia, forma e arquitetura muscular. As vértebras caudais são procélicas, exceto a primeira da série, e possuem na superfície ventral do corpo áreas para articulação com os processos hemais, exceto a primeira e as quatro ou cinco últimas. Os cortes comerciais da região são o filé de cauda, composto pelos músculos semiespinhal caudal, longuíssimo caudal, ilioisquiocaudal, caudofemoral longo, transverso e profundo da cauda, enquanto o corte ponta de cauda é constituído pelos músculos longuíssimo caudal e ilioisquiocaudal, com as cinco ou seis últimas vértebras caudais.

The commercial exploitation of the Yacare Caiman (Caiman yacare) has become a relevant commodity in the state of Mato Grosso, Brazil. Crocodilian's tail muscles nutritional characteristics and representativeness in body mass became the object of morphophysiological technological and evolutionary studies. The aim of this research was to report, for the first time, the anatomical characterization of muscle and bone bases of Pantanal Caiman meat cuts obtained from the tail. To describe the bones, we used one adult and six juvenile specimens of Pantanal Caiman. In order to study the muscle, 24 juvenile individuals were slaughtered and skinned, preserved in a -20oC freezer and thawed at the time of use, without any fixation. After evisceration, the specimens were dissected on both sides to verify structural symmetry, muscle attachments, sintopy relations, shape and muscular architecture. Caudal vertebrae are procoelous, except for the first of the series, and have sites on the ventral surface of their body where the hemal processes articulate, with the exception of the first and the last four or five vertebrae. The commercial meat cuts of the tail are the tail sirloin, composed of semispinal caudal, longissimus caudal, ilioischiocaudal, long caudofemoral, transverse and deep of the tail muscles, and also the tail tip, consisting of the longissimus caudal and ilioischiocaudal muscles, based on the last five or six caudal vertebrae.

Effect of high-fat diets on body composition, lipid metabolism and insulin sensitivity, and the role of exercise on these parameters

Dietary fat composition can interfere in the development of obesity due to the specific roles of some fatty acids that have different metabolic activities, which can alter both fat oxidation and deposition rates, resulting in changes in body weight and/or composition. High-fat diets in general are associated with hyperphagia, but the type of dietary fat seems to be more important since saturated fats are linked to a positive fat balance and omental adipose tissue accumulation when compared to other types of fat, while polyunsaturated fats, omega-3 and omega-6, seem to increase energy expenditure and decrease energy intake by specific mechanisms involving hormone-sensitive lipase, activation of peroxisome proliferator-activated receptor α (PPARα) and others. Saturated fat intake can also impair insulin sensitivity compared to omega-3 fat, which has the opposite effect due to alterations in cell membranes. Obesity is also associated with impaired mitochondrial function. Fat excess favors the production of malonyl-CoA, which reduces GLUT4 efficiency. The tricarboxylic acid cycle and beta-oxidation are temporarily uncoupled, forming metabolite byproducts that augment reactive oxygen species production. Exercise can restore mitochondrial function and insulin sensitivity, which may be crucial for a better prognosis in treating or preventing obesity.

[Thoracic splenosis]. / Esplenose Torácica.

Thoracic splenosis is a rare clinical condition consisting in the heterotopic autotransplantation of pieces of splenic tissue into the chest, following a previous trauma, with spleen and diaphragm laceration. In this paper, the authors report the clinical case of a thoracic splenosis in a 26 years old male, who had suffered a severe thoraco-abdominal trauma in childhood, leading to an emergency splenectomy. The patient, with the previous diagnosis of malignancy, namely pleural fibrotic tumors, underwent surgical management for removal of some nodular tumors of the pleura. Pathological studies confirmed the diagnosis of thoracic splenosis. The clinical diagnosis of thoracic splenosis should be suspicious facing asymptomatic patients, with a history of previous thoraco-abdominal trauma and nodular peripheral tumors in the chest x-rays.

Determination of threshold dose of photodynamic therapy to measure superficial necrosis.

BACKGROUND DATA: Photodynamic therapy (PDT) involves the photoinduction of cytotoxicity using a photosensitizer agent, a light source of the proper wavelength, and the presence of molecular oxygen. A model for tissue response to PDT based on the photodynamic threshold dose (D(th)) has been widely used. In this model cells exposed to doses below D(th) survive while at doses above the D(th) necrosis takes place. OBJECTIVE: This study evaluated the light D(th) values by using two different methods of determination. One model concerns the depth of necrosis and the other the width of superficial necrosis. MATERIALS AND METHODS: Using normal rat liver we investigated the depth and width of necrosis induced by PDT when a laser with a gaussian intensity profile is used. Different light doses, photosensitizers (Photogem, Photofrin, Photosan, Foscan, Photodithazine, and Radachlorin), and concentrations were employed. Each experiment was performed on five animals and the average and standard deviations were calculated. RESULTS: A simple depth and width of necrosis model analysis allows us to determine the threshold dose by measuring both depth and surface data. Comparison shows that both measurements provide the same value within the degree of experimental error. CONCLUSION: This work demonstrates that by knowing the extent of the superficial necrotic area of a target tissue irradiated by a gaussian light beam, it is possible to estimate the threshold dose. This technique may find application where the determination of D(th) must be done without cutting the tissue.

Complete remission of epileptic psychosis after temporal lobectomy: case report.

We report a case of a female patient with refractory complex partial seizures since 15 years of age, recurrent postictal psychotic episodes since 35 which evolved to a chronic refractory interictal psychosis and MRI with right mesial temporal sclerosis (MTS). After a comprehensive investigation (video-EEG intensive monitoring, interictal and ictal SPECT, and a neuropsychological evaluation including WADA test) she was submitted to a right temporal lobectomy. Since then, she has been seizure-free with remission of psychosis, although with some persistence of personality traits (hiperreligiosity, viscosity) which had been present before surgery. This case supports the idea that temporal lobectomy can be a safe and effective therapeutic measure for patients with MTS, refractory epilepsy and recurrent postictal epileptic psychosis or interictal epileptic psychosis with postictal exacerbation.

[Knowledge, attitudes, and practice regarding occupational risk of exposure to HIV among medical students at the Medical School of the Federal University of Minas Gerais]. / Conhecimento, atitudes e comportamentos frente ao risco ocupacional de exposição ao HIV entre estudantes de Medicina da Faculdade de Medicina da Universidade Federal de Minas Gerais.

The objectives of this study were to evaluate the occupational risk of medical students, their knowledge and practice of universal biosafety measures and hepatitis B immunization coverage. A specific questionnaire was applied to 136 medical students of the Universidade Federal de Minas Gerais: 87 (64%) students were involved in surgical procedures, 68 (50%) had been exposed to blood, 90 (66.2%) knew the universal biosafety measures and 33 (24.3%) knew the procedure in case of blood exposure. Thus, this population has a high risk of blood exposure and although there is a low formal knowledge about universal biosafety measures, most of these were generally used. New strategies, such as formal teaching of universal biosafety measures, in loco supervision, and biosafety teams, are necessary to change this situation.