Kikuchi-Fujimoto Disease: A Case of SARS-CoV-2 Infection Triggering the Rare Disease.

Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis, is a rare, benign, and self-limited disease caused by subacute necrotizing regional lymphadenopathy. The etiology is unknown, although virus and autoimmune mechanisms have been proposed. Patients develop enlarged lymph nodes, fever, and, less frequently, extranodal signs. No specific laboratory test contributes to the diagnosis, and lymph node biopsy is the gold standard to define the diagnosis. The treatment is generally with supportive therapy and usually is spontaneously resolved within six months.  In this article, the authors present the case of a 41-year-old female with mild SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection 10 weeks before she was admitted to the emergency department (ED) due to cervical lymphadenopathies and fever lasting over three weeks. Physical examination revealed multiple lymphadenopathies on the submandibular and jugular regions, cutaneous rash, and hepatosplenomegaly. Blood tests showed elevated acute phase proteins, thrombocytopenia, and increased transaminases and lactate dehydrogenase (LDH). Computed tomography (CT) of the neck showed multiple adenopathies at levels I, II, III, and IV according to the Classification for Lymph Nodes from the American Head and Neck Society and American Academy of Otolaryngology on the right side. Excision biopsy was performed and histopathological examination confirmed KFD. A comprehensive analysis performed was unrevealing of an infectious or autoimmune cause and was assumed to be most likely triggered by SARS-CoV-2 infection given the timeframe correlation. KFD diagnosis is challenging and there are few reported cases of association with SARS-CoV-2 in the literature. Although further investigation is still needed to better understand the relation between them, it is important that physicians take SARS-CoV-2 infection and vaccination into consideration in KFD's differential diagnosis.

Genotype-first approach to identify associations between CDH1 germline variants and cancer phenotypes: a multicentre study by the European Reference Network on Genetic Tumour Risk Syndromes.

BACKGROUND: Truncating pathogenic or likely pathogenic variants of CDH1 cause hereditary diffuse gastric cancer (HDGC), a tumour risk syndrome that predisposes carrier individuals to diffuse gastric and lobular breast cancer. Rare CDH1 missense variants are often classified as variants of unknown significance. We conducted a genotype-phenotype analysis in families carrying rare CDH1 variants, comparing cancer spectrum in carriers of pathogenic or likely pathogenic variants (PV/LPV; analysed jointly) or missense variants of unknown significance, assessing the frequency of families with lobular breast cancer among PV/LPV carrier families, and testing the performance of lobular breast cancer-expanded criteria for CDH1 testing. METHODS: This genotype-first study used retrospective diagnostic and clinical data from 854 carriers of 398 rare CDH1 variants and 1021 relatives, irrespective of HDGC clinical criteria, from 29 institutions in ten member-countries of the European Reference Network on Tumour Risk Syndromes (ERN GENTURIS). Data were collected from Oct 1, 2018, to Sept 20, 2022. Variants were classified by molecular type and clinical actionability with the American College of Medical Genetics and Association for Molecular Pathology CDH1 guidelines (version 2). Families were categorised by whether they fulfilled the 2015 and 2020 HDGC clinical criteria. Genotype-phenotype associations were analysed by Student's t test, Kruskal-Wallis, χ2, and multivariable logistic regression models. Performance of HDGC clinical criteria sets were assessed with an equivalence test and Youden index, and the areas under the receiver operating characteristic curves were compared by Z test. FINDINGS: From 1971 phenotypes (contributed by 854 probands and 1021 relatives aged 1-93 years), 460 had gastric and breast cancer histology available. CDH1 truncating PV/LPVs occurred in 176 (21%) of 854 families and missense variants of unknown significance in 169 (20%) families. Multivariable logistic regression comparing phenotypes occurring in families carrying PV/LPVs or missense variants of unknown significance showed that lobular breast cancer had the greatest positive association with the presence of PV/LPVs (odds ratio 12·39 [95% CI 2·66-57·74], p=0·0014), followed by diffuse gastric cancer (8·00 [2·18-29·39], p=0·0017) and gastric cancer (7·81 [2·03-29·96], p=0·0027). 136 (77%) of 176 families carrying PV/LPVs fulfilled the 2015 HDGC criteria. Of the remaining 40 (23%) families, who did not fulfil the 2015 criteria, 11 fulfilled the 2020 HDGC criteria, and 18 had lobular breast cancer only or lobular breast cancer and gastric cancer, but did not meet the 2020 criteria. No specific CDH1 variant was found to predispose individuals specifically to lobular breast cancer, although 12 (7%) of 176 PV/LPV carrier families had lobular breast cancer only. Addition of three new lobular breast cancer-centred criteria improved testing sensitivity while retaining high specificity. The probability of finding CDH1 PV/LPVs in patients fulfilling the lobular breast cancer-expanded criteria, compared with the 2020 criteria, increased significantly (AUC 0·92 vs 0·88; Z score 3·54; p=0·0004). INTERPRETATION: CDH1 PV/LPVs were positively associated with HDGC-related phenotypes (lobular breast cancer, diffuse gastric cancer, and gastric cancer), and no evidence for a positive association with these phenotypes was found for CDH1 missense variants of unknown significance. CDH1 PV/LPVs occurred often in families with lobular breast cancer who did not fulfil the 2020 HDGC criteria, supporting the expansion of lobular breast cancer-centred criteria. FUNDING: European Reference Network on Genetic Tumour Risk Syndromes, European Regional Development Fund, Fundação para a Ciência e a Tecnologia (Portugal), Cancer Research UK, and European Union's Horizon 2020 research and innovation programme.

Evolution of household availability of regional foods in Amazonas / Evolução da disponibilidade domiciliar de alimentos regionais no Amazonas

ABSTRACT OBJECTIVE To evaluate the evolution of household availability of regional foods in the state of Amazonas, their distribution according to sociodemographic characteristics, and potential differences when compared to the remaining areas of Brazil. METHODS Data on food acquisition for home consumption from the 2002-2003, 2008-2009, and 2017-2018 Pesquisa de Orçamentos Familiares (POFs - Consumer Expenditure Surveys) were analyzed, covering, respectively, 48,470, 55,970, and 57,920 households in Brazil, of which 1,075, 1,344, and 1,833 are in Amazonas. Foods were categorized into three groups: cassava and its derivatives, freshwater fish, and regional fruits. The study analyzed the amount of regional food purchased, expressed in relative household caloric share, for the entire area of Amazonas. Additionally, the data was stratified and analyzed according to sociodemographic variables, with differences assessed through the overlapping of 95% confidence intervals. FINDINGS The household caloric share of the total regional foods in Amazonas was 22.54% in 2002-2003, 18.18% in 2008-2009, and 6.49% in 2017-2018. Across Brazil, those percentages were much lower in the same period: 3.67%, 3.34%, and 1.82%, respectively. Changes in Amazonas were primarily attributed to the steep drop in the cassava and derivatives group, which decreased from 14.30% in 2002-2003 to 12.74% in 2008-2009 and further declined to 3.09% in 2017-2018. Additionally, there was a gradual decline in household availability of freshwater fish, decreasing from 7.30% in 2002-2003 to 4.85% in 2008-2009 and reaching 2.90% in 2017-2018. Households in rural areas and with lower per capita income presented a higher proportion of calories from total regional foods; this particular stratum also experienced the most significant reductions in their consumption. CONCLUSION During the study period, there was a significant decrease in the consumption of regional foods in Amazonas, particularly in lower income households in rural areas. Among them, the family reference person was typically a younger male with a lower educational background.

RESUMO OBJETIVO Avaliar a evolução da disponibilidade domiciliar de alimentos regionais no Amazonas, sua distribuição segundo características sociodemográficas e potenciais diferenças em relação ao restante do Brasil. MÉTODOS Foram analisados dados de aquisição de alimentos para consumo domiciliar das Pesquisas de Orçamentos Familiares (POFs) de 2002-2003, 2008-2009 e 2017-2018, que estudaram, respectivamente, 48.470, 55.970 e 57.920 domicílios no Brasil, dos quais 1,075, 1.344 e 1.833 estão no Amazonas. Os alimentos foram reunidos em três grupos: macaxeira e derivados, peixes de água doce, e frutos regionais. A quantidade de alimento regional adquirido, expressa em participação calórica relativa domiciliar, foi analisada para o Amazonas como um todo e segundo variáveis sociodemográficas (diferenças avaliadas pela sobreposição dos intervalos de confiança de 95%). RESULTADOS A participação calórica domiciliar do total de alimentos regionais no Amazonas foi de 22,54% em 2002-2003, 18,18% em 2008-2009 e 6,49% em 2017-2018. No Brasil, estes percentuais foram bem menores no mesmo período: 3,67%, 3,34% e 1,82%, respectivamente. As mudanças no Amazonas ocorreram, principalmente, pela drástica redução do grupo de macaxeira e derivados (de 14,30% em 2002-2003 para 12,74% em 2008-2009 e 3,09% em 2017-2018) e pelo declínio gradativo da disponibilidade domiciliar de peixes de água doce (de 7,30% em 2002-2003 para 4,85% 2008-2009 e 2,90% em 2017-2018). Domicílios do meio rural e com menor renda per capita tiveram maior participação calórica do total de alimentos regionais, estratos que também tiveram as maiores reduções. CONCLUSÃO Houve redução significativa da presença de alimentos regionais no Amazonas no período estudado, atingindo principalmente os domicílios da zona rural e com menor renda, cuja pessoa de referência da família era do sexo masculino, mais jovem e com menor escolaridade.

Screening Health-Promoting Compounds for Their Capacity to Induce the Activity of FOXO3.

Several chemical compounds including natural products have been suggested as being effective against age-related diseases or as beneficial for a healthy life. On the other hand, forkhead box O (FOXO) proteins are emerging as key cellular components associated with extreme human longevity. FOXO proteins are mainly regulated by posttranslational modifications and as these modifications are reversible, activation and inactivation of FOXO are attainable through pharmacological treatment. Here, we questioned whether a panel of compounds with known health-beneficial properties has the capacity to induce the activity of FOXO factors. We show that resveratrol, a phytoalexin present in grapes and other food products, the amide alkaloid piperlongumine found in the fruit of the long pepper, and the plant-derived ß-carboline compound harmine induced nuclear translocation of FOXO3. We also show that piperlongumine and harmine but not resveratrol activate FOXO-dependent transcription. We determined the half maximal effective concentration (EC50) values for resveratrol, piperlongumine, and harmine for FOXO translocation, and analyzed their inhibitory impact on chromosomal maintenance 1 (CRM1)-mediated nuclear export and the production of reactive oxygen species (ROS). We also used chemical biology approach and Western blot analysis to explore the underlying molecular mechanisms. We show that harmine, piperlongumine, and resveratrol activate FOXO3 independently of phosphoinositide 3-kinase (PI3K)/AKT signaling and the CRM1-mediated nuclear export. The effect of harmine on FOXO3 activity is at least partially mediated through the inhibition of dual-specificity tyrosine (Y) phosphorylationregulated kinase 1A (DYRK1A) and can be reverted by the inhibition of sirtuins (SIRTs).

Naïve human pluripotent stem cells respond to Wnt, Nodal and LIF signalling to produce expandable naïve extra-embryonic endoderm.

Embryonic stem cells (ESCs) exist in at least two states that transcriptionally resemble different stages of embryonic development. Naïve ESCs resemble peri-implantation stages and primed ESCs the pre-gastrulation epiblast. In mouse, primed ESCs give rise to definitive endoderm in response to the pathways downstream of Nodal and Wnt signalling. However, when these pathways are activated in naïve ESCs, they differentiate to a cell type resembling early primitive endoderm (PrE), the blastocyst-stage progenitor of the extra-embryonic endoderm. Here, we apply this context dependency to human ESCs, showing that activation of Nodal and Wnt signalling drives the differentiation of naïve pluripotent cells toward extra-embryonic PrE, or hypoblast, and these can be expanded as an in vitro model for naïve extra-embryonic endoderm (nEnd). Consistent with observations made in mouse, human PrE differentiation is dependent on FGF signalling in vitro, and we show that, by inhibiting FGF receptor signalling, we can simplify naïve pluripotent culture conditions, such that the inhibitor requirements closer resemble those used in mouse. The expandable nEnd cultures reported here represent stable extra-embryonic endoderm, or human hypoblast, cell lines.This article has an associated 'The people behind the papers' interview.

Alimentação no Amazonas: evolução da participação dos alimentos regionais e percepção da satisfação com o consumo no domicílio / Feeding in Amazonas: evolution of regional food participation and perception of satisfaction with consumption at home

A adoção de uma abordagem sistêmica da alimentação que respeite a diversidade e a sustentabilidade vem corroborar os preceitos da Segurança Alimentar e Nutricional. A alimentação vem sofrendo forte influência do fenômeno da globalização, originando um comportamento alimentar padronizado. A transição alimentar no Amazonas ainda não está claramente identificada. Nesse cenário de mudanças, a presença dos alimentos regionais precisa ser entendida. Assim, esse estudo, teve como objetivo, analisar a alimentação no Amazonas por meio da disponibilidade domiciliar de alimentos, avaliando a evolução da participação dos alimentos regionais e identificando a relação entre a percepção da satisfação com o consumo domiciliar com padrões de aquisição de alimentos. No primeiro manuscrito foram utilizados dados de aquisição alimentar da Pesquisa de Orçamento Familiar (POF) 2002-2003 e 2008- 2009. Os alimentos regionais do Amazonas foram reunidos em sete grupos : farinha de mandioca, goma de tapioca e produtos, raízes e tubérculos, peixes de água doce, carnes de caça, frutas regionais e oleaginosas. A quantidade de alimento regional adquirido expressa em participação calórica relativa (%) per capita foi analisada segundo as variáveis sociodemográficas por comparação das médias, utilizando intervalos de confiança de 95%. No segundo manuscrito foram utilizados dados de aquisição alimentar referentes aos domicílios do Amazonas urbano da edição da POF 2008-2009, a partir dos quais foram identificados padrões alimentares por meio da análise fatorial exploratória, utilizando a extração por componentes principais. A percepção da satisfação com o consumo domiciliar foi avaliada por comparação das médias dos scores dos padrões alimentares e as categorias das variáveis, utilizando intervalos de confiança de 95%. Foram identificadas importantes informações sobre a alimentação no Amazonas. Houve redução significativa da presença de alimentos regionais no Amazonas no referido período, atingindo principalmente os domicílios da zona rural e com menor renda, bem como, as famílias cuja pessoa de referência era do sexo masculino, mais jovem e com menor escolaridade. Foram identificados quatro padrões alimentares: tradicional misto, regional e fast food. A maior satisfação com a quantidade e a qualidade do alimento consumido no domicílio ocorreu entre as famílias com adesão ao padrão misto. Famílias com maior adesão ao padrão tradicional estavam insatisfeitas com a quantidade. Assim como, aquelas aderidas ao padrão regional apresentaram insatisfação com a qualidade. O estudo revelou que a alimentação no Amazonas possui peculiaridades, sugerindo que a transição alimentar em nível local pode não estar ocorrendo da mesma forma que no cenário nacional. Ações que visem promover alimentação saudável devem considerar os perfis de comportamento alimentar existentes e a percepção em relação aos alimentos consumidos, para que as boas práticas sejam de fato aceitas e incorporadas pela população

The adoption of a systemic approach to food that respects diversity and sustainability corroborates the precepts of Food and Nutrition Security. Food has been strongly influenced by the phenomenon of globalization, resulting in a standardized food behavior. The food transition in Amazonas has not yet been clearly identified. In this scenario of changes, the presence of regional foods needs to be understood. The purpose of this study was to analyze food in Amazonas through household availability of food, assessing the evolution of regional food participation and identifying the relationship between the perception of satisfaction with household consumption and patterns of food acquisition. In the first manuscript, food acquisition data from the Family Budget Survey (POF) 2002-2003 and 2008-2009 were used. The regional foods of Amazonas were grouped into seven groups: cassava flour, tapioca gum and products, roots and tubers, freshwater fish, game meat, regional fruits and oilseeds. The amount of regional food purchased expressed as relative (%) per capita caloric intake was analyzed according to sociodemographic variables by comparison of means, using 95% confidence intervals. In the second manuscript, food acquisition data referring to the households of the urban Amazonas of the edition of POF 2008-2009 were used, from which food patterns were identified through exploratory factorial analysis, using main component extraction. The perception of satisfaction with home consumption was evaluated by comparing the means of the scores of the food standards and the categories of the variables, using 95% confidence intervals. Important information on feeding in Amazonas was identified. There was a significant reduction in the presence of regional foods in Amazonas in the period, reaching mainly the rural households with lower income, as well as the families whose reference person was male, younger and with less schooling. Four food standards were identified: traditional mixed, regional and fast food. The greatest satisfaction with the quantity and quality of food consumed at home occurred among families with adherence to the mixed pattern. Families with greater adherence to the traditional pattern were dissatisfied with the quantity. Likewise, those adhering to the regional standard showed dissatisfaction with quality. The study revealed that food in Amazonas has peculiarities, suggesting that the food transition at the local level may not be occurring in the same way as in the national scenario. Actions aimed at promoting healthy eating should consider existing eating behavior patterns and perceptions of food consumption, so that good practices are actually accepted and incorporated by the population

Mixoma auricular: uma causa rara de acidente vascular cerebral isquêmico / Atrial myxoma: a rare cause of ischemic stroke

O mixoma auricular é uma causa rara de acidente vascular cerebral isquêmico, sendo mais frequente em mulheres jovens. Sua etiologia é desconhecida, e as manifestações clínicas ocorrem por obstrução valvular, embolismo ou sintomas constitucionais. Descrevemos o caso de uma mulher de 62 anos com hemiparesia esquerda e ataxia da marcha, com evidência de lesões isquêmicas bilaterais na ressonância magnética craniencefálica. No ecocardiograma, identificou-se massa auricular esquerda sugestiva de mixoma, submetida à ressecção cirúrgica e confirmação histológica. Posteriormente, foi diagnosticada fibrilação auricular, sendo esta a complicação pós-operatória mais comum. Na suspeita de causa cardiogênica, o ecocardiograma deve ser prontamente realizado, pois o mixoma é potencialmente tratável e tem baixo risco de recorrência após a ressecção cirúrgica. Este caso realça a importância do estudo complementar no acidente vascular cerebral isquêmico e a necessidade de excluir uma fonte embólica proximal na presença de isquemia cerebral em territórios vasculares diferentes.(AU)

The atrial myxoma is a rare cause of ischemic stroke, and is more common in young women. Its etiology is unknown, and clinical manifestations occur due to valve obstruction, embolism or constitutional symptoms. We describe the case of a 62-year-old woman with left hemiparesis and gait ataxia, with evidence of bilateral ischemic lesions on brain magnetic resonance imaging. On the echocardiogram, a left atrial mass suggestive of myxoma was identified; it was resected, and histologically confirmed. Later, an atrial fibrillation was diagnosed, which is the most common postoperative complication. On suspicion of a cardiogenic cause, the echocardiogram should be promptly performed because the myxoma is potentially treatable with a low risk of recurrence after surgical resection. This case highlights the importance of complementary study in ischemic stroke, and the need to rule out a proximal embolic source in the presence of cerebral ischemia in different vascular territories.(AU)

Chronic coffee consumption and respiratory disease: A systematic review.

PURPOSE: The widespread consumption of coffee means that any biological effects from its use can lead to significant public health consequences. Chronic pulmonary diseases are extremely prevalent and responsible for one of every six deaths on a global level. METHODS: Major medical databases for studies reporting on the effects of coffee or caffeine consumption on a wide range of non-malignant respiratory outcomes, including incidence, prevalence, evolution or severity of respiratory disease in adults were searched. Studies on lung function and respiratory mortality were also considered. RESULTS: Fifteen studies, including seven cohort, six cross-sectional, one case control and one randomized control trial were found. Coffee consumption was generally associated with a reduction in prevalence of asthma. The association of coffee with natural honey was an effective treatment for persistent post-infectious cough. One case-control study found higher risk of chronic obstructive pulmonary disease (COPD) with coffee consumption. No association was found with the evolution of COPD or sarcoidosis. Coffee was associated with a reduction in respiratory mortality, and one study found improved lung function in coffee consumers. Smoking was a significant confounder in most studies. CONCLUSIONS: Coffee consumption was associated with some positive effects on the respiratory system. There was however limited available evidence, mostly from cross sectional and retrospective studies. The only prospective cohort studies were those reporting on respiratory mortality. These results suggest that coffee consumption may be a part of a healthy lifestyle leading to reduced respiratory morbidity.

Randomized controlled trial of an intervention to change cardiac misconceptions in myocardial infarction patients.

There is converging evidence that changing beliefs about an illness leads to positive recovery outcomes. However, cardiac misconceptions interventions have been investigated mainly in Angina or Coronary Heart Disease patients, and less in patients following Myocardial Infarction (MI). In these patients, cardiac misconceptions may play a role in the adjustment or lifestyle changes. This article reports a randomized controlled trial of an intervention designed to reduce the strength of misconceptions in patients after a first MI. The primary outcome was the degree of change in misconceptions and the secondary outcomes were: exercise, smoking status, return to work and mood (anxiety and depression). Patients in the intervention condition (n = 60) were compared with a control group (n = 67) receiving usual care. Both groups were evaluated at baseline and 4, 8 and 12 months after hospital discharge. There was a significant time-by-group interaction for the total score of cardiac misconceptions. Patients in the intervention group significantly decreased their total score of cardiac misconceptions at 4 months compared with the control group and this difference was sustained over time. Patients in the intervention group were also more likely to exercise at the follow-up period after MI than the control group. This intervention was effective in reducing the strength of cardiac misconceptions in MI patients and had a positive impact on health behaviour outcomes. These results support the importance of misconceptions in health behaviours and the utility of belief change interventions in promoting health in patients with Myocardial Infarction.

Cardiac misconceptions among healthy adults: implications for the promotion of health in the community / Crenças erróneas sobre as doenças cardíacas em adultos saudáveis: implicações para a promoção da saúde na comunidade

This study sought to confirm the structure and to investigate the psychometric properties of an experimental Portuguese version of the York Cardiac Beliefs Questionnaire (YCBQ) in a general population sample. It also set out to identify the prevalent misconceptions in the community and to assess the differences according to socio-demographic characteristics. It involved a cross-sectional survey in which both test and validation samples were collected (n = 476), including participants aged between 18 and 40, recruited via e-mail and social networks. The Confirmatory Factor Analysis on both samples suggested a shorter, three factor version of the YCBQ. Also, misconceptions differed significantly according to sociodemographic variables. The validation of the YCBQ for samples in the community constitutes an important starting point to promote research on misconceptions held in the community by specific groups, as well as to provide key points for health promotion.

Este estudo teve como objetivo confirmar a estrutura e investigar as propriedades psicométricas de uma versão experimental portuguesa do York Cardiac Beliefs Questionnaire numa amostra da população geral; identificar as crenças erróneas mais fortes na comunidade; e avaliar as diferenças de acordo com características sociodemográficas. Trata-se de um estudo transversal com uma amostra de teste e outra de validação, incluindo um total de 476 participantes, com idade entre 18 e 40 anos, recrutados via e-mail e nas redes sociais. A Análise Fatorial Confirmatória em ambas as amostras indicou uma versão reduzida do YCBQ de três factores. As crenças erróneas diferiram significativamente de acordo com as variáveis sociodemográficas. A validação do YCBQ para amostras da comunidade constitui um importante ponto de partida para promover a investigação sobre crenças erróneas em grupos específicos da comunidade, assim como fornecer indicadores relevantes para a promoção da saúde.

[Lung abscess and thoracic empyema: retrospective analysis in an internal medicine department]. / Abcesso pulmonar e empiema torácico: análise retrospectiva num serviço de medicina interna.

INTRODUCTION: Lung abscess is a collection of necrotic and suppurated tissue located at the pulmonary parenchyma. Empyema is defined as the presence of pus in the pleural space. OBJECTIVES: To study the clinical and microbiological characteristics, treatment and prognosis of patients with lung abscess and/or empyema admitted to an Internal Medicine ward. METHODS: A retrospective analysis of medical records was performed, including all patients admitted to an Internal Medicine ward for lung abscess or empyema, between 2000 and 2008. RESULTS: Thirty patients were included (22 males/ eight females), accounting for 0.18% of all patients admitted in this ward in the same period. Three patients had pulmonary abscess, 18 empyema, and nine both diseases. The average age was 68.5 years (31 to 90). The most frequent complaints were dyspnoea (90%), fever (73.3%), cough (66.7%), weight loss (60%) and chest pain (53.3%). The most frequent associated disorders were stroke associated disability (46.7%), heart failure (43.3%) and arterial hypertension (33.3%). Thoracentesis was performed in all patients with empyema. In one patient with lung abscess an anaerobic microorganism was identified. In patients with empyema, cultures were positive in 61.1% of cases, with a slight predominance of methicillin-resistant Staphylococcus aureus (27.3%) and Prevotella intermedia (18.2%). In patients with both abscess and empyema, cultures of the abscess were positive in 44.4% and of the pleural fluid in 33.3%, with no predominant microorganism. Empiric antimicrobial therapy was started in all patients and later adapted to the antibiotic sensitivity test results. Surgery was performed in three patients. Seven patients (23.3%) died during admission. The average age of the patients who died was 81.3 years and of those who survived was 64.5 years. CONCLUSION: Lung abscess and empyema are infrequent diseases in an Internal Medicine ward, affect mostly males and have unspecific clinical manifestations. The chest X-ray, computed tomography (CT) and thoracentesis were the main diagnostic tests. Most cultures were negative. Medical treatment was the most frequent choice, with surgery being used in 10% of cases. Older age and multiple associated conditions were associated with a worse prognosis.

[Mediastinal masses: case series]. / Massas mediastínicas: análise de uma casuística.

INTRODUCTION: Mediastinal masses are tumoral lesions arising from intra-thoracic organs. They are an infrequent diagnostic challenge, requiring a structured clinical and radiological approach. OBJECTIVES: The study of the clinical, radiological and pathological characteristics, treatment and prognosis of patients, with mediastinal masses, admitted to an Internal Medicine ward in an University Hospital. METHODS: A retrospective analysis of the medical records of patients with this diagnosis made between years 2000 and 2008. RESULTS: Twenty-eight patients were included (15F/13M), with a mean age of 55.5 years (17-88). Twenty-six patients presented with symptoms, most frequently, dyspnoea, fatigue, dry cough, chest pain and anorexia. At examination, six exhibited superior vena cava syndrome. Chest X-ray showed pathological changes in 26. Chest CT scan added relevant information in all cases whenever it was performed. Histology was most frequently obtained by mediastinoscopy, open surgical biopsy, percutaneous thoracic biopsy and at necropsy. Histological diagnosis was not possible in ten patients. Final diagnoses included: lymphoma in four patients; sarcoidosis, thymic hyperplasia and undifferentiated squamous carcinoma of unknown origin in two patients each; other diagnosis in single cases were: thyroid teratoma, thymoma, atrial myxoid malignant fibrous histiocytoma, ganglioneuroblastoma, neuroendocrine thymic carcinoma, squamous cell lung cancer and germinative cell tumour. Thirteen patients were submitted to surgery, chemo and/or radiotherapy. Fifteen patients died during admission or when in follow-up. CONCLUSIONS: At our center, mediastinal masses are frequently of a malignant origin, affecting relatively young people; a late diagnosis and an associated poor prognosis was the rule, prompting for early intervention to improve outcome.

Karyotype and genome size of Iberochondrostoma almacai (Teleostei, Cyprinidae) and comparison with the sister-species I. lusitanicum

This study aimed to define the karyotype of the recently described Iberian endemic Iberochondrostoma almacai, to revisit the previously documented chromosome polymorphisms of its sister species I. lusitanicum using C-, Ag-/CMA3 and RE-banding, and to compare the two species genome sizes. A 2n = 50 karyotype (with the exception of a triploid I. lusitanicum specimen) and a corresponding haploid chromosome formula of 7M:15SM:3A (FN = 94) were found. Multiple NORs were observed in both species (in two submetacentric chromosome pairs, one of them clearly homologous) and a higher intra and interpopulational variability was evidenced in I. lusitanicum. Flow cytometry measurements of nuclear DNA content showed some significant differences in genome size both between and within species: the genome of I. almacai was smaller than that of I. lusitanicum (mean values 2.61 and 2.93 pg, respectively), which presented a clear interpopulational variability (mean values ranging from 2.72 to 3.00 pg). These data allowed the distinction of both taxa and confirmed the existence of two well differentiated groups within I. lusitanicum: one that includes the populations from the right bank of the Tejo and Samarra drainages, and another that reunites the southern populations. The peculiar differences between the two species, presently listed as "Critically Endangered", reinforced the importance of this study for future conservation plans.

Efeito de um programa misto de intervenção nutricional e exercício físico sobre a composição corporal e os hábitos alimentares de mulheres obesas em climatério / The effects of a mixed program of nutritional intervention and physical exercise on body composition and feeding habits of obese climacteric women

OBJETIVO: Foi avaliar o efeito de programa misto de intervenção nutricional e exercício físico sobre a composição corporal e hábitos alimentares de mulheres obesas em climatério. MÉTODOS: Trabalhou-se com 2 grupos de 15 pessoas por 40 semanas: Grupo Dieta (intervenção nutricional) e Grupo Exercício (intervenção nutricional e exercício). RESULTADO: As reduções do peso (-2,3kg para Grupo Dieta e -5,3kg para o Grupo Exercício) e da circunferência da cintura (-4,8cm para Grupo Dieta e -7,6cm para Grupo Exercício), foram maiores para o Grupo Exercício. Foi verificada evolução positiva na classificação do índice de Massa Corporal para ambos os grupos, sendo que o Grupo Exercício respondeu melhor ao tratamento. O padrão alimentar foi considerado monótono e com baixo consumo de alimentos regionais. CONCLUSAO: O programa foi efetivo para perda de peso, em maior intensidade na presença de exercício. A educação alimentar proposta foi capaz de acarretar mudanças nos hábitos alimentares.

Memória e experiência: um estudo de relatos de educadoras (1940-1950) / Memory and experience: a study on reports of women teachers (1940-1950)

A presente pesquisa tem como foco central um estudo sobre a memória e a experiência de mulheres educadoras da Escola Caetano de Campos, nas décadas de 40 e 50. Por ser um estudo que privilegia as narrativas orais como recurso metodológico, a pesquisa evidencia os valores de uma geraçäo de mulheres, como também atualiza algumas particularidades inerentes à memória feminina, no que diz respeito à atividade profissional e à vida privada. Além desses aspectos, a pesquisa contribui para a atualizaçäo da memória da Escola Caetano de Campos, como também, apresenta-nos os bastidores e o cotidiano da escola, oferecendo-nos um outro ponto de vista sobre a instituiçäo. E por fim, a pesquisa também desemboca numa série de representaçöes sobre o ofício do educador e concepçöes sobre o ato de educar

Qualidade protéica da dieta consumida por pré-escolares de uma creche de Manaus, Amazonas, Brasil

The protein quality of a diet supplied to kindergarten students at one school in Manaus Amazonas, was evaluated experimentally using Wistar rats. The indexes used to evaluate it were: Chemical Computing, Protein Efficiency Ratio, Net Protein Ratio, Coefficient of Apparent Digestiblity and Protein Digestibility Corrected by Aminoacid Scores. From the chemical and biological point of view, the protein of the tested diet showed lower quality than standard (casein base). Is shows that it is necessary to change or to improve the diet provided to kindergarder to guarantee the essencial aminoacid requirements for their development.

A qualidade protéica da dieta consumida por pré-escolares de uma creche de Manaus (AM) foi avaliada por meio de ensaio experimental com ratos machos da linhagem Wistar, recém-desmamados, por um período de 14 dias. Os índices utilizados foram: Cômputo Químico (CQ), Coeficiente de Eficácia Protéica (CEP), Razão Protéica Líquida (RPL), Coeficiente de Digestibilidade Aparente (CDap) e Digestibilidade Protéica Corrigida pelo Escore Aminoacídico (PDCAAS). Do ponto de vista químico e biológico, a proteína da dieta testada apresentou qualidade inferior à ração padrão à base de caseína, mas ao compará-la com a ração aprotéica, apresentou melhor resultado. Isso indica a necessidade de melhoria na formulação dos cardápios fornecidos, objetivando garantir a oferta adequada de todos os aminoácidos essenciais ao crescimento e desenvolvimento das crianças.

Qualidade protéica da dieta consumida por pré-escolares de uma creche de Manaus, Amazonas, Brasil / Protein quality of diet supplied to kindergarden students at a school in Manaus, Amazonas, Brazil

A qualidade protéica da dieta consumida por pré-escolares de uma creche de Manaus (AM) foi avaliada por meio de ensaio experimental com ratos machos da linhagem Wistar, recém-desmamados, por um período de 14 dias. Os índices utilizados foram: Cômputo Químico (CQ), Coeficiente de Eficácia Protéica (CEP), Razão Protéica Líquida (RPL), Coeficiente de Digestibilidade Aparente (CDap) e Digestibilidade Protéica Corrigida pelo Escore Aminoacídico (PDCAAS). Do ponto de vista químico e biológico, a proteína da dieta testada apresentou qualidade inferior à ração padrão à base de caseína, mas ao compará-la com a ração aprotéica, apresentou melhor resultado. Isso indica a necessidade de melhoria na formulação dos cardápios fornecidos, objetivando garantir a oferta adequada de todos os aminoácidos essenciais ao crescimento e desenvolvimento das crianças