Evaluating the feasibility and acceptability of an adapted fencing intervention in breast cancer surgery post-operative care: the RIPOSTE pilot randomized trial.

Background: Adapted physical activity programs have shown promising results in reducing the physical, social and psychological side effects associated with breast cancer, but the extent to which they can be effectively adopted, implemented and maintained is unclear. The aim of this study is to use the framework to guide the planning and evaluation of programs according to the 5 following keys: Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate a fencing program under the French acronym RIPOSTE (Reconstruction, Image de soi, Posture, Oncologie, Santé, Thérapie, Escrime) literally in English (Reconstruction, Self-Image, Posture, Oncology, Health, Therapy, Fencing). This program is an innovative intervention focused on improving the quality of life (QoL) of breast cancer surgery patients through fencing. Methods: A convergent mixed methods pilot study was conducted to preliminary evaluate the different RE-AIM dimension of the pilot program. Twenty-four participants who have just undergone surgery for invasive breast cancer were randomly allocated in two groups: one group started immediately after their inclusion (Early RIPOSTE group) and the other started 3 months following their inclusion (Delayed RIPOSTE group). Participants answered a questionnaire at inclusion and at the end of the program on QoL, shoulder functional capacity, fatigue, anxiety-depression and physical activity. Results: RIPOSTE program was able to reach mainly young and dynamic participants, attracted by the originality of fencing and keen to improve their physical condition. Regarding effectiveness, our results suggest a trend to the improvement of QoL, shoulder functional capacity, fatigue and anxiety-depression state, even without any significant differences between the Early RIPOSTE group and the Delayed RIPOSTE group. Discussions: The cooperation, exchanges and cohesion within the group greatly facilitated the adoption of the program, whereas interruptions during school vacations were the main barriers. The intervention was moderately well implemented and adherence to the protocol was suitable. Conclusion: RIPOSTE is an acceptable and effective program for involving breast cancer survivors in physical activity, that needs to be tested at a larger scale to investigate its effectiveness, but has the potential to be transferred and scaled up worldwide.

Roux-en-Y Gastric Bypass Surgery Leading to Postprandial Hypoglycemia: A Case Report.

Postprandial hypoglycemia is a rare complication after Roux-en-Y gastric bypass (RYGB). The underlying pathophysiology remains to be fully understood. We present a case of a 49-year-old woman with a past medical history of mesenteric thrombosis due to prothrombin-related thrombophilia, which culminated in RYGB 10 years prior to presentation. The patient had been given anticoagulation treatment for several years, which she abandoned one year prior to presentation. She presented to our consultation with episodes of postprandial hypoglycemia and severe anemia due to iron and vitamin B12 deficiencies. Dietary adjustments were set in place to prevent hypoglycemia and neuroglycopenic symptoms. Intravenous iron and intramuscular vitamin B12 supplementation led to full recovery of hemoglobin levels, allowing restart of oral anticoagulation to prevent recurrence of thrombotic events.

Portuguese honeys as antimicrobial agents against Candida species.

BACKGROUND AND AIM: Honey has been recognized worldwide for its antioxidant, anti-tumor, anti-inflammatory and antimicrobial properties. Among them, the antifungal properties associated to honey make it an attractive alternative treatment for Candida-associated infections, particularly for topical application to the mucous membranes and skin. In this sense, the main purpose of this work was to evaluate physicochemical properties of five Portuguese honeys and Manuka honey (an Australian honey with well recognized medical proprieties, used as control) and to evaluate the antifungal activity in Candida species planktonic and biofilm assays. EXPERIMENTAL PROCEDURE: Pollen analysis, pH determination, color, concentration of protein and methylglyoxal, conductivity, total phenolics and flavonoids, hydrogen peroxide concentration, and characterization by differential scanning calorimetry in honey samples were determined. Additionally, the effect of honeys on planktonic growth of Candida was initially evaluated by determination of the minimum inhibitory concentrations. Then, the same effect of those honeys was evaluated in biofilms, by Colony Forming Units enumeration. RESULTS AND CONCLUSION: It has been shown that Portuguese heather (Erica cinereal) honey presented the most similar physicochemical properties to manuka honey (specially phenolic and flavonoids contents). The five Portuguese honeys under study, presented in general a potent activity against planktonic multi-resistant yeast pathogens (several clinical isolates and reference strains of Candida species) and S. aureus and P. aeruginosa bacteria cultures. Additionally, it was also concluded that Portuguese heather honey (50% and 75% (w/v)) can also act as a good Candida species biofilm reducer, namely for C. tropicalis.

Pleural Effusion Secondary to Obstructive Uropathy: A Case of Urinothorax.

Urinothorax is a rare type of pleural effusion and usually the result of genitourinary tract disease. An accurate and early diagnosis is crucial as resolution of the underlying pathology is the mainstay of treatment. We report the case of a 69-year-old man who was admitted to the Internal Medicine ward due to obstructive acute kidney injury of unknown origin. The patient was submitted to urinary catheterization and to right percutaneous nephrostomy. Two weeks after admission he developed a large left pleural effusion; a left urinoma was also visible on computed tomography. After thoracentesis, pleural fluid analysis demonstrated a paucicellular transudate with pH <7.40 and pleural fluid/serum creatinine ratio >1.0. The diagnosis of urinothorax was made and further study allowed the diagnosis of prostate cancer as the aetiology of the obstruction. When bilateral percutaneous nephrostomy was performed, resolution of the urinothorax and normalization of renal function occurred. LEARNING POINTS: Urinothorax is a rare and possibly under-recognized cause of transudative pleural effusion; over the last five decades, fewer than 60 cases have been reported in the English literature worldwide.Diagnosis of urinothorax depends upon a high index of clinical suspicion and on pleural fluid analysis, but imaging can also support the diagnosis, for example by showing the presence of a urinoma.Clinicians should recognize urinothorax early in its clinical course as favourable outcomes are often achieved after correction of the underlying genitourinary tract pathology.

Teatro-debate: uma modalidade de teatro espontâneo / Debate-theater: a modality of spontaneous theater / Teatro-debate: una modalidad de teatro espontáneo

Este texto visa apresentar o potencial da modalidade de Teatro Espontâneo, nomeada Teatro-Debate (T-D), desenvolvida pelo psicodramatista Moysés C. de Aguiar Netto e outros profissionais da época, aplicada e difundida pela Companhia do Teatro Espontâneo, também criada pelo próprio autor no Brasil. Assim, discorre-se aqui perspectivas acerca do Teatro Espontâneo, do Teatro-Debate e também é apresentado um breve relato da experiência de um Teatro-Debate realizado no espaço educacional com um público, em sua maioria, não psicodramatista.

This text aims to present the potential of the Spontaneous Theater modality, named Debate-Theatre (T-D), developed by the psychodramatist Moysés C. de Aguiar Netto and other professionals of the time, applied and diffused by the Companhia do Teatro Espontâneo, also created by the author in Brazil. Thus, perspectives on the Spontaneous Theater and the Debate-Theatre are discussed here and then a brief report of the experience of a Debate-Theatre carried out in the educational space is presented with a mostly non-psychodramatist audience.

Este texto presentará el potencial de la modalidad de Teatro Espontáneo, llamada Teatro-Debate (T-D), desarrollada por el psicodramatista Moysés C. de Aguiar Netto y otros profesionales contemporaneos al mismo, aplicado y difundido por la Companhia do Teatro Espontâneo, también creada por el própio autor del T-D en Brasil. Así, se discuten aquí perspectivas acerca del Teatro Espontáneo, del Teatro-Debate y, luego, se presenta un breve relato de experiencia de un Teatro-Debate hecho en un espacio educativo con un público, en su mayoría, no psicodramatista.

Antimicrobial and Anti-Adherent in vitro Activity of Tannins Isolated from Anacardium occidentale Linn. (Cashew) on Dental Biolfilm Bacteria

Objective:To evaluate the antimicrobial and ant-adherent in vitro activity of tannins isolated from Anacardium occidentale Linn. (Cashew) on dental biofilm bacteria. Material and Methods:Streptococcus mutans ATCC 25175, Streptococcus mitis ATCC 903, Streptococcus sanguis ATCC 15300, Streptococcus oralis ATCC 10557, Streptococcus salivarius ATCC 7073 and Lactobacillus casei ATCC 9595 samples were used in this study. The tests were performed by the solid medium dilution method to determine the Minimum Inhibitory Concentration (MIC). The Minimum Inhibitory Concentration of Adherence (MICA) of bacteria to glass was determined in the presence of 5% sucrose. As a positive control, 0.12% chlorhexidine gluconate was used. The substances were tested at concentrations of 1:1 (pure solution) up to 1:512. Data were analyzed using descriptive statistics and the SPSS software,version 15.0. Results:Tannins isolated from Anacardium occidentale Linn. (cashew) formed inhibition halos ranging from 11 to 17 mm in diameter and were capable of inhibiting the growth of bacteria tested at concentrations of 1:4 (S mutans), 1:16 (S mitis), 1:8 (Ssanguis), 1:4 (S oralis), 1:8 (S salivarius) and 1:2 (L casei). The tannin solution was effective in inhibiting the adherence of microorganisms to glass, and its effect on Streptococcus sanguis (1:512) and Lactobacillus casei (1:512) stood out, showing ant-adherent effect at all concentrations tested. Conclusion:Tannin isolates produced in vitro antimicrobial and ant-adherent activity on dental biofilm-forming bacteria and can be considered as an alternative treatment in infectious processes in clinical dentistry

Lactate as predictor of mortality in polytrauma.

BACKGROUND: The lactate is a product of anaerobic metabolism; it can be used as a marker on demand and availability of oxygen. Changes in lactate levels can be effectively used as a marker in resuscitation maneuvers, even in patients with stable vital signs. AIM: To verify the lactate clearance as a predictor of mortality in trauma patients, in need of intensive care. METHOD: A total of 851 patients were admitted in ICU, in which 146 were victims of multiple trauma; due to the exclusion criteria, were included 117. RESULTS: Patients were 87% male, mean age 32.4 years, motorcycle drivers, Glasgow coma scale between 3-8, affected by cranial trauma, followed by abdominal trauma. Was verified mortality up to 48 h and global mortality, that did not show statistical relationship between lactate clearance and mortality (p=0.928). CONCLUSION: There is no correlation between admission lactate or lactate clearance and mortality in patients treated with multiple trauma.

LACTATE AS PREDICTOR OF MORTALITY IN POLYTRAUMA / LACTATO COMO PREDITOR DE MORTALIDADE EM POLITRAUMATIZADO

Background:The lactate is a product of anaerobic metabolism; it can be used as a marker on demand and availability of oxygen. Changes in lactate levels can be effectively used as a marker in resuscitation maneuvers, even in patients with stable vital signs.Aim:To verify the lactate clearance as a predictor of mortality in trauma patients, in need of intensive care.Method:A total of 851 patients were admitted in ICU, in which 146 were victims of multiple trauma; due to the exclusion criteria, were included 117.Results: Patients were 87% male, mean age 32.4 years, motorcycle drivers, Glasgow coma scale between 3-8, affected by cranial trauma, followed by abdominal trauma. Was verified mortality up to 48 h and global mortality, that did not show statistical relationship between lactate clearance and mortality (p=0.928).Conclusion:There is no correlation between admission lactate or lactate clearance and mortality in patients treated with multiple trauma.

Racional:O lactato, produto do metabolismo anaeróbio, pode ser utilizado como marcador entre a demanda e disponibilidade do oxigênio. Mudanças nos níveis de lactato podem ser utilizadas como marcador de efetividade nas manobras de ressuscitação, mesmo em pacientes com sinais vitais estáveis.Objetivo:Verificar o clearance de lactato como preditor da mortalidade entre vítimas de politraumatismo com necessidade de tratamento intensivo.Método:Um total de 851 pacientes foram admitidos em UTI, sendo que 146 vítimas de politraumatismo, e destes foram incluídos 117 indivíduos, os demais excluídos. As amostras eram homogêneas entre os grupos de sobreviventes e óbitos.Resultados:Os pacientes eram 87% homens, idade media 32,4 anos, motociclistas, Glasgow entre 3 a 8, acometidos por traumatismo crânio encefálico, seguido de trauma abdominal. Verificada a mortalidade, foi ela dividida em precoce (até e inclusive 48 h) e tardia (após 48 h), sem demonstrar relação estatística entre clearance de lactato e mortalidade (p=0,928).Conclusão:Não há correlação entre lactato de admissão ou clearance de lactato e mortalidade nos pacientes atendidos com politraumatismo.

Detection, accumulation, distribution, and depletion of furaltadone and nifursol residues in poultry muscle, liver, and gizzard.

Nitrofurans were broadly used as an extremely effective veterinary antibiotic especially in pig and poultry production farms. Because of fears of the carcinogenic effects on humans, the nitrofurans were banned from use in livestock production in many countries, including the European Union. The present study examines the accumulation, distribution, and depletion of furaltadone and nifursol and of their tissue-bound metabolites [3-amino-5-morpholinomethyl-2-oxazolidinone (AMOZ) and 3,5-dinitro-salicylic acid hydrazine (DNSAH), respectively, in poultry edible tissues (muscle, liver, and gizzards) following administration to chickens of therapeutic and subtherapeutic concentrations of both compounds. Nitrofurans determination was performed by high-performance liquid chromatography-diode array detection and liquid chromatography-tandem mass spectrometry, respectively, for feeds and for poultry tissues. Furaltadone and nifursol, in very low concentrations, were found in samples of muscle, liver, and chicken's gizzard collected from slaughtered animals after 5 weeks of treatment and no withdrawal time period. When a withdrawal time period of 3 weeks was respected, no detectable nitrofuran parent compounds was observed in all of the studied matrices. For AMOZ, concentrations of 270 µg/kg in meat, 80 µg/kg in liver, and 331 µg/kg in gizzard were determined after administration of a medicated feed with furaltadone (132 mg/kg), 3 weeks after withdrawal of treatment. For DNSAH, the concentration values obtained are much lower than those observed for AMOZ. For meat, liver, and gizzard, DNSAH concentrations of 2.5, 6.4, and 10.3 µg/kg, respectively, were determined, after administration of a medicated feed with nifursol (98 mg/kg), 3 weeks after withdrawal of treatment. The gizzard could be considered a selected matrix for nitrofuran residues evaluation in poultry, due to its capacity of retaining either nitrofuran parent compounds or metabolites in higher concentrations, regardless of the administered dose or of the respected withdrawal time period.

Lesões supurativas intracranianas / Intracranial suppurative lesions

Este artigo apresenta revisão sobre as lesões supurativas intracranianas. A maioria dessas afecções são resultado de infecções, traumas ou cirurgias. Os pacientes geralmente manifestam um largo espectro de sintomas inespecíficos, o que exige alto grau de suspeição. Exames de imagem são indispensáveis para confirmação do diagnóstico. O tratamento se baseia em antibioticoterapia intensiva e abordagem neurocirúrgica. Diagnóstico precoce e tratamento agressivo são essenciais para um bom prognóstico.

Presents review of Intracranial Suppurative Lesions. These affections are consequence of infections, trauma or surgery. Patients usually manifest a large unspecific spectrum of clinical symptoms, so, a high level of suspicion is required. Imaging exams are indispensable to confirm the diagnosis. The treatment is based on intensive antibiotic therapy and surgical evacuation. Early diagnosis with aggressive medical and surgical management are essential to improved outcome.

Complicações intracranianas de rinossinusite / Intracranials complications of rhinosinusitis

Apresenta-se caso de abscesso epidural intracraniano associado a um empiema subdural como complicações de rinossinusite. O diagnóstico foi feito pela clínica em conjunto com a tomografia computadorizada. O paciente foi tratado com antibioticoterapia tríplice e intervenção cirúrgica para drenagem de empiema, evoluindo para a cura.

Report a case of intracranial epidural abscess associated with subdural empyema as a complication of a rhinosinusitis. The diagnosis was made by the clinical course and computerized tomography. The patient was treated with antibiotic therapy of wide spectrum and surgical treatment to drain the empyema, going to cure.

Occurence of parasites in lettuce (Lactuca sativa) commercializaed in the street markets and supermarkets of Campo Mourão, state of Paraná, Brazil - DOI: 10.4025/actascibiolsci.v26i4.1514 / Avaliação parasitológica de alfaces (Lactuca sativa) comercializadas em feiras livres e supermercados do município de Campo Mourão, Estado do Paraná - DOI: 10.4025/actascibiolsci.v26i4.1514

This work researched and compared the contamination by enteroparasites in lettuce (Lactuca sativa) commercialized in the supermarkets and street markets of Campo Mourão, State of Paraná. 150 samples of lettuce were analyzed through sedimentation method (Hoffmam), being 75 samples from supermarkets and 75 from street markets. The sediment was analyzed in optic microscope. The supermarkets samples showed contamination by parasites of 56% (42/75); while contamination of street markets samples showed 58.7% (44/75). The principal parasites observed in supermarkets samples were: Ascaris spp 54.7%, Toxocara spp 2.4%, Strongyloides spp 4.8%, Entamoeba spp 35.7% and Taenia spp 2.4%. Important parasites observed in street markets were: Ascaris spp 13.6%, Strongyloides spp 11.4%, Entamoeba spp 47.7%, Ancylostoma spp 9.1%, Taenia spp 2.3%, Fasciola hepatica 6.8% and Trichuris spp 9.1%. These results indicate that the samples of lettuce are in disagreement with current law and point out the necessity of a sanitary education program for vegetable producers and vegetable manipulators

Este estudo investigou e comparou a contaminação por enteroparasitas em alfaces (Lactuca sativa) comercializadas em supermercados e feiras livres do município de Campo Mourão, Estado do Paraná. Foram analisadas 150 amostras de alfaces, pelo método de sedimentação espontânea (Hoffmann), sendo 75 amostras provenientes de supermercados e 75 amostras de feiras livres. O sedimento foi analisado em microscópio óptico. Das amostras analisadas, 56% (42/75) e 58,7% (44/75) apresentaram contaminação por parasitas, dos supermercados e feiras livres, respectivamente. Os principais parasitas encontrados em supermercados foram: Ascaris spp 54,7%, Toxocara spp 2,4%, Strongyloides spp 4,8%, Entamoeba spp 35,7% e Taenia spp 2,4%; e em feiras livres foram: Ascaris spp 13,6%, Strongyloides spp 11,4%, Entamoeba spp 47,7%, Ancylostoma spp 9,1%, /em>Taenia spp 2,3%, Fasciola hepatica 6,8% e Trichuris spp 9,1%. Esses resultados indicam que as amostras de alfaces estão em desacordo com a legislação vigente e salientam a necessidade de aplicação de um programa de educação sanitária direcionado a horticultores e manipuladores de hortaliças

Avaliação parasitológica de alfaces (Lactuca sativa) comercializadas em feiras livres e supermercados do município de Campo Mourão, Estado do Paraná / Occurence of parasites in lettuce (Lactuca sativa) commercializaed in the street markets and supermarkets of Campo Mourão, state of Paraná, Brazil

Este estudo investigou e comparou a contaminação por enteroparasitas em alfaces (Lactuca sativa) comercializadas em supermercados e feiras livres do município de Campo Mourão, Estado do Paraná. Foram analisadas 150 amostras de alfaces, pelo método de sedimentação espontânea (Hoffmann), sendo 75 amostras provenientes de supermercados e 75 amostras de feiras livres. O sedimento foi analisado em microscópio óptico. Das amostras analisadas, 56 por cento (42/75) e 58,7 por cento (44/75) apresentaram contaminação por parasitas, dos supermercados e feiras livres, respectivamente. Os principais parasitas encontrados em supermercados foram: Ascaris spp 54,7 por cento, Toxocara spp 2,4 por cento, Strongyloides spp 4,8 por cento, Entamoeba spp 35,7 por cento e Taenia spp 2,4 por cento; e em feiras livres foram: Ascaris spp 13,6 por cento, Strongyloides spp 11,4 por cento, Entamoeba spp 47,7 por cento, Ancylostoma spp 9,1 por cento, Taenia spp 2,3 por cento, Fasciola hepatica 6,8 por cento e Trichuris spp 9,1 por cento. Esses resultados indicam que as amostras de alfaces estão em desacordo com a legislação vigente e salientam a necessidade de aplicação de um programa de educação sanitária direcionado a horticultores e manipuladores de hortaliças

Aspectos físico-químicos e microbiológicos do queijo cru de coalho produzido com leite cru e parteurizado no Estado de Ceará / Apects physical-chemical and microbiological of cheeses made with raw and pasteurized milk in the state of Ceará

Queijos de coalho, elaborados com leite cru e pasteurizado/inoculado com 1 por cento de cultura termofilica (Streptococcus thermophylus e Lactobacillus bulgaricus), maturados sob temperatura ambiente (29§C) e temperatura de refrigeraçäo (10§C) foram estudados aos 4, 7, 30, 60 e 90 dias, quanto aos aspectos físico-químicos e microbiológicos. Os valores de pH foram maiores para os queijos produzidos com leite pasteurizado do (QLP) como resultados da açäo das colônias do fermento lático sobre a lactose, implicando em alteraçäo do sabor e textura do queijo. Quanto aos valores de estafilococos coagulase positiva, apesar de ter ocorrido reduçäo no número de colônias/g de queijo, durante a maturaçäo, quase todas as contagens apresentaram-se acima do limite permitido pela legislaçäo, evidenciando más condiçöes do produto.