Establishment of a transparent soil system to study Bacillus subtilis chemical ecology.

Bacterial secondary metabolites are structurally diverse molecules that drive microbial interaction by altering growth, cell differentiation, and signaling. Bacillus subtilis, a Gram-positive soil-dwelling bacterium, produces a wealth of secondary metabolites, among them, lipopeptides have been vastly studied by their antimicrobial, antitumor, and surfactant activities. However, the natural functions of secondary metabolites in the lifestyles of the producing organism remain less explored under natural conditions, i.e. in soil. Here, we describe a hydrogel-based transparent soil system to investigate B. subtilis chemical ecology under controllable soil-like conditions. The transparent soil matrix allows the growth of B. subtilis and other isolates gnotobiotically and under nutrient-controlled conditions. Additionally, we show that transparent soil allows the detection of lipopeptides production and dynamics by HPLC-MS, and MALDI-MS imaging, along with fluorescence imaging of 3-dimensional bacterial assemblages. We anticipate that this affordable and highly controllable system will promote bacterial chemical ecology research and help to elucidate microbial interactions driven by secondary metabolites.

Brazilian guide to nutrition in bariatric and metabolic surgery.

PURPOSE: Brazilian nutrition recommendations for bariatric and metabolic surgery aim to provide knowledge, based on scientific evidence, on nutritional practices related to different surgical techniques in the surgical treatment of obesity and metabolic diseases. MATERIALS AND METHODS: A systematic literature search was carried out with the appropriate MeSH terms using Medline/Pubmed/LiLACS and the Cochrane database, with the established criteria being based on the inclusion of articles according to the degree of recommendation and strength of evidence of the Classification of Recommendations, Evaluation, Development, and Evaluation System (GRADE). RESULTS: The recommendations that make up this guide were gathered to assist in the individualized clinical practice of nutritionists in the nutritional management of patients with obesity, including nutritional management in the intragastric balloon; pre and postoperative nutritional treatment and supplementation in bariatric and metabolic surgeries (adolescents, adults, elderly, pregnant women, and vegetarians); hypoglycemia and reactive hyperinsulinemia; and recurrence of obesity, gut microbiota, and inflammatory bowel diseases. CONCLUSION: We believe that this guide of recommendations will play a decisive role in the clinical practice of nutritionists who work in bariatric and metabolic surgery, with its implementation in health services, thus promoting quality and safety in the treatment of patients with obesity. The concept of precision nutrition is expected to change the way we understand and treat these patients.

Use of Next-Generation Sequencing to Support the Diagnosis of Familial Interstitial Pneumonia.

Familial interstitial pneumonia (FIP) is defined as idiopathic interstitial lung disease (ILD) in two or more relatives. Genetic studies on familial ILD discovered variants in several genes or associations with genetic polymorphisms. The aim of this study was to describe the clinical features of patients with suspected FIP and to analyze the genetic variants detected through next-generation sequencing (NGS) genetic testing. A retrospective analysis was conducted in patients followed in an ILD outpatient clinic who had ILD and a family history of ILD in at least one first- or second-degree relative and who underwent NGS between 2017 and 2021. Only patients with at least one genetic variant were included. Genetic testing was performed on 20 patients; of these, 13 patients had a variant in at least one gene with a known association with familial ILD. Variants in genes implicated in telomere and surfactant homeostasis and MUC5B variants were detected. Most variants were classified with uncertain clinical significance. Probable usual interstitial pneumonia radiological and histological patterns were the most frequently identified. The most prevalent phenotype was idiopathic pulmonary fibrosis. Pulmonologists should be aware of familial forms of ILD and genetic diagnosis.

Tipos de processamento no consumo alimentar de alunos universitários / Types of processing in the food consumption of university students

Objetivo Avaliar universitários através de questionário de frequência alimentar (quantitativo e qualitativo) e classificar a ingestão de alimentos de acordo com o tipo de processamento. Métodos Trata-se de um estudo transversal observacional, em que foi enviado um questionário para os alunos dos cursos de Nutrição, Educação Física, Enfermagem, Administração, Farmácia, Psicologia, Engenharia Civil e Fisioterapia da Instituição de Ensino Superior Universidade Salgado de Oliveira, Rio de Janeiro. Foram coletadas as seguintes informações: curso, sexo e o consumo alimentar nas refeições diárias, separadas por porções: desjejum, colação, almoço, lanche da tarde, jantar e ceia. Em seguida, os alimentos que os estudantes relataram consumir foram separados em quatro categorias: in natura; minimamente processado; processado e ultraprocessado, baseando-se nas nomenclaturas do Guia Alimentar Brasileiro. Resultados Foram coletados dados de 201 alunos, o equivalentes a 5% dos alunos matriculados nos cursos de Nutrição, Educação Física, Enfermagem, Administração, Farmácia, Psicologia, Engenharia Civil e Fisioterapia da Universidade Salgado de Oliveira. Observou-se um alto consumo de alimentos processados na amostra como um todo, porém de forma mais expressiva pelos alunos do curso de Engenharia Civil. Em contrapartida, o maior consumo de alimentos in natura e minimamente processados foi declarado pelos alunos do curso de Educação Física. Conclusão As análises mostraram que o consumo alimentar dos alunos do curso de Educação Física era mais saudável em termos de processamento, possivelmente devido ao cuidado maior desses alunos com a saúde física. Já os alunos do curso de Engenharia Civil consumiam mais alimentos ultraprocessados. O consumo prolongado de alimentos ultraprocessados e processados aumenta o risco de desenvolvimento de doenças crônicas não transmissíveis, levando a um maior risco de mortalidade em longo prazo.

Objective To evaluate university students with a food frequency questionnaire (quantitative and qualitative), and classify the intake according to food processing. Methods This is a cross-sectional observational study, in which a questionnaire was sent to students from the following undergraduate courses: Nutrition, Physical Education, Nursing, Business Management, Pharmacy, Psychology, Civil Engineering and Physiotherapy of the Higher Education Institution at Salgado de Oliveira University, in Rio de Janeiro. The following information was collected: the undergraduate course, gender and food consumption separated by portions in daily meals: breakfast, mid-morning snack, lunch, afternoon snack, dinner and supper. Then, the foods were separated into four categories: fresh; minimally processed; processed; ultra-processed, based on the nomenclatures of the "Brazilian Food's Guide". Results The data were collected from 201 students, equivalent to 5% of the courses in Nutrition, Physical Education, Nursing, Business Management, Pharmacy, Psychology, Civil Engineering and Physiotherapy at Salgado de Oliveira University. It was observed a higher consumption of processed foods in the sample as a whole, however, the highest intake was in the Civil Engineering Course. On the other hand, the highest consumption of fresh and minimally processed foods was found in Physical Education Course students. Conclusion The analyzes showed that food consumption of Physical Education students proved to be healthier in terms of processing, possibly due to the greater care with the physical health of these students, while the students of Civil Engineering course consumed a worrisome diet with more ultra-processed and less fresh foods. The prolonged consumption of ultra-processed and processed foods increases the risk of developing chronic non-communicable diseases, worsening the population's quality of life, leading to a higher risk of long-term mortality.

Reduction of Serum Concentrations and Synergy between Retinol, ß-Carotene, and Zinc According to Cancer Staging and Different Treatment Modalities Prior to Radiation Therapy in Women with Breast Cancer.

The procedures used for breast cancer treatment are able to increase the level of oxidative stress and cause depletion of antioxidants. OBJECTIVES: To investigate the relationship between serum concentrations of retinol, ß-carotene, and zinc, according to breast cancer staging, considering different treatment modalities prior to radiation therapy and the synergistic action between these micronutrients. METHODS: This is a cross-sectional observational study comprising a cohort of patients with breast cancer which was carried out prior to radiation therapy. Patients were divided into 3 groups: G1 comprised women who had undergone breast-conserving surgery, G2 comprised those who had undergone chemotherapy, and G3 those who had undergone breast-conserving surgery and chemotherapy. Serum concentrations of retinol, ß-carotene, and zinc were quantified. Breast cancer staging was based on the TNM (Tumor, Node, Metastasis) classification of malignant tumors, a type of staging tool for different cancers. RESULTS: A total of 230 patients were assessed. A decrease of the serum concentrations of the micronutrients assessed as the staging level of the disease increased was observed. Surgery alone had a greater negative impact on serum concentrations of retinol. Considering the treatments prior to radiotherapy, patients undergoing surgery alone and chemotherapy associated with surgery had higher percentages of deficiency of ß-carotene and retinol. There was a positive correlation between the concentrations of zinc, retinol, and ß-carotene, showing a synergy between these micronutrients. CONCLUSION: A significant reduction in the serum concentrations of the assessed micronutrients was observed, according to the increase in breast cancer staging. The synergy between the micronutrients must be considered in order to maximize the benefits and minimize the adverse effects of irradiation to normal cells.

Self-perceived oral health among the elderly: a household-based study / Autopercepção de saúde bucal em idosos: estudo de base domiciliar

Abstract Objective: to evaluate the self-perceived oral health status of elderly persons and its relation to self-care practices, the use of public oral health services, denture use, dental complaints and impact on everyday activities. Method: The 95 subjects of this quantitative, analytical and cross-sectional study were from Fortaleza, a state capital in the northeast of Brazil. They were aged 60 years or over and were mentally capacitated according to the Mini-Mental State Examination. The study parameters included gender, age group, race/ethnic background, level of schooling, household income, self-care practices, use and need for dentures, dental complaints, impact on everyday activities, access to oral health services, and access to information. The outcome parameter was self-perceived oral health. To verify the association between the study parameters and the outcome parameter, prevalence ratios were calculated and submitted to the Chi-squared test, the Fisher's exact test, the Mann-Whitney test and multivariate regression analysis. Result: self-perceived oral health was described as good/excellent significantly more often by women than by men (p=0.044). Oral health had a negative impact on everyday activities among nearly one third of the sample (n=29; 30.5%). The mean and median values of dental complaints and impact on everyday activities were significantly lower for subjects reporting good/excellent oral health than for subjects reporting poor/fair oral health. Conclusion: it is expected that these results will strengthen oral health care for elderly persons, in order to maintain their quality of life during this stage of life. AU

Resumo Objetivo: investigar a aupercepção da saúde bucal de idosos e sua relação com medidas de autocuidado, uso de próteses e de serviços odontológicos, assim como queixas odontológicas e o impacto na vida cotidiana. Método: Estudo transversal analítico, de abordagem quantitativa, realizado em Fortaleza CE, baseado numa amostra de 95 idosos com 60 anos ou mais de idade, capacitados mentalmente conforme avaliação pelo Miniexame de Estado Mental. Os parâmetros do estudo incluiram: sexo, grupo etário, raça, escolaridade, renda familiar, práticas de autocuidado, uso e necessidade de próteses, queixas odontológicas, impacto na vida cotidiana, acesso a serviços odontológicos e acesso a informação. O parâmetro de desfecho foi a autopercepção em saúde bucal. Para testar a associação entre os parâmetros do estudo e o parâmetro de desfecho calculou-se a razão de prevalência e aplicaram-se os Testes qui-quadrado, exato de Fisher e Mann-Whitney, além de regressão multivariadal. Resultado: A autoperceção de saúde bucal ótima/boa foi mais frequente entre mulheres que homens (p=0,044). A saúde bucal tinha um impacto negativo sobre a vida cotidiana em quase um terço dos sujeitos (n=29; 30,5%). O número mediano dos parâmetros queixas odontológicas e impacto na vida cotidiana foram significantemente menores em sujeitos com autopercepção ótima/boa do que em sujeitos com autopercepção regular/ruim. Conclusão: Espera-se que os resultados deste estudo possam fortalecer a atenção odontológica em idosos, de modo que se possam manter as condições de saúde bucal necessárias para que estes possam viver essa etapa da vida com qualidade. AU

Retinol, β-carotene and oxidative stress in systemic inflammatory response syndrome / Retinol, β-caroteno e estresse oxidativo na síndrome da resposta inflamatória sistêmica.

Objective: patients suffering systemic inflammatory response syndrome (SIRS) constitute a group susceptible to elevated levels of oxidative stress. This study’s aim is to evaluate the state of oxidative stress and levels of serum retinol and β-carotene in these patients. Methods: forty-six patients were divided into 2 groups: those those without diet (G1; n=18) and those with enteral nutritional support (G2; n=28). Serum levels of retinol and total carotenoids were measured. C-reactive protein (CRP) levels and Apache scores were also calculated. Oxidative stress was estimated by measuring thiobarbituric acid reactive substance (TBARS) levels. Results: the patients’ median age was 66.9 (SD=19.3) years. Lower concentrations of retinol and carotenoids were found in 68.6 and 66.7% of G1, respectively. In G2, despite average vitamin A levels being 8078 + 4035, retinol and β-carotene were considered insufficient (31.2 and 33.4%, respectively). No difference was noted between the 2 groups, according to the variables studied, with the exception being PCR and β-carotene (p=0.002; p=0.01). Conclusion: the data presented in this study supports the need to establish/revise clinical practices in treating SIRS patients, in light of this micronutrient’s role in the immune system and antioxidant defense without it interfering with its toxicity. .

Objetivo: pacientes que apresentam a síndrome da resposta inflamatória sistêmica (SIRS) constituem um grupo suscetível a níveis elevados de estresse oxidativo. O objetivo do presente estudo é avaliar o estado de estresse oxidativo e os níveis séricos de retinol e β-caroteno nesses pacientes. Métodos: quarenta e seis pacientes foram divididos em dois grupos: aqueles sem dieta (G1; n = 18) e aqueles com suporte nutricional enteral (G2, n = 28). Foram investigadas as concentrações séricas de retinol e carotenoides totais, proteína C reativa, estresse oxidativo e escore Apache. O estresse oxidativo foi avaliado por dosagem da peroxidação lipídica e estimado por meio da dosagem de TBARS (substâncias reativas ao ácido tiobarbitúrico). Resultados: a média de idade dos pacientes foi de 66,9 (±19,3). Baixas concentrações de retinol e carotenoides foram encontradas em 68,6 e 66,7% do G1, respectivamente. No G2, a concentração sérica média de vitamina A foi de 8078 (± 4035), e o retinol e o β-caroteno apresentaram percentual de inadequação de 31,2 e 33,4%, respectivamente. Não foi observada nenhuma diferença entre os dois grupos, de acordo com as variáveis estudadas, com exceção do PCR e do β-caroteno (p=0,002; p=0,01). Conclusão: os dados apresentados neste estudo indicam a necessidade de estabelecer/rever práticas clínicas no tratamento de pacientes com SIRS, tendo em conta o papel desse micronutriente no sistema imunológico e na defesa antioxidante, sem que isso interfira na sua toxicidade. .

Sistema de informação da atenção básica: revisão integrativa de literatura / Sistema de información de atención primaria: revisión integradora de la literatura / Information system of primary care: integrative review of literature

Objectives: To identify the scientific production on the Information System of Primary Care - SIAB, and critically analyze the scientific production outlining the themes relevant to their applicability to the service. Method: exploratory research descriptive, qualitative approach. The literature review was performed by the Virtual Health Library (VHL) in databases BDENF, SciELO and LILACS. The descriptors used were: Information System, Primary Health and Family Health. We selected seven potential bibliographies. Results: After reading the articles revealed three categories: SIAB as a tool in the planning of health actions with primary care, use of SIAB professionals in primary health care, the difficulty of completing the farm SIAB. Conclusion: it was discovered the difficulty of understanding the relevance of the data, since they are not passed to reliably records information system, in spite of health professionals and community health workers know their importance.

Objetivos: Identificar as produções científicas sobre o Sistema de Informação da Atenção Básica - SIAB, e analisar criticamente as produções científicas pertinentes delineando os temas abordados com suas aplicabilidades ao serviço. Método: pesquisa exploratória descritiva, de abordagem qualitativa. O levantamento bibliográfico foi realizado através Biblioteca Virtual de Saúde (BVS), nas bases BDENF, SciELO e LILACS. Os descritores utilizados foram: Sistema de Informação, Atenção primária em saúde e Saúde da Família. Foram selecionadas sete bibliografias potenciais.Resultados: Diante da leitura dos artigos emergiram três categorias: SIAB como ferramenta no planejamento das ações em saúde na atenção primária, utilização do SIAB pelos profissionais na atenção básica de saúde, a dificuldade do preenchimento das fichas do SIAB. Conclusão: detectou-se a dificuldade de compreensão da relevância dos dados, visto que os mesmos não são passados de forma fidedigna às fichas do sistema de informação, apesar dos profissionais de saúde e os agentes comunitários de saúde saberem de sua importância.

Objetivos: Identificar la producción científica sobre el Sistema de Información de Atención Primari - SIAB, y analizar críticamente la producción científica delineando los temas relevantes para su aplicabilidad en el servicio. Método: investigación exploratoria enfoque descriptivo y cualitativo. La revisión de la literatura fue realizada por la Biblioteca Virtual en Salud (BVS), en la base de datos BDENF, SciELO y LILACS. Los descriptores utilizados fueron los siguientes: Sistema de Información, Atención Primaria y Salud Familiar. Hemos seleccionado siete bibliografías potenciales. Resultados: Después de leer los artículos revelaron tres categorías: SIAB como una herramienta en la planificación de las acciones de salud con el uso de la atención primaria de la SIAB por los profesionales de atención primaria de salud, la dificultad de completar el SIAB granja.Conclusión: se descubrió la dificultad de comprender la relevancia de los datos, ya que no se pasan al sistema de información de forma fiable los registros, a pesar de los profesionales de la salud y trabajadores comunitarios de salud saben de su importancia.

The relationship between serum vitamin A and breast cancer staging before and after radiotherapy.

INTRODUCTION: Several adverse effects of radiotherapy have been associated with the process of increased oxidative stress in the organism. In this context, vitamin A noteworthy for its important role in combating oxidative stress, in addition to its chemoprotective effect. OBJECTIVE: To assess the serum levels of vitamin A (retinol and ß-carotene) and their relationship to breast cancer staging in patients before and after radiotherapy. METHODS: This is a prospective study of women with breast cancer who were evaluated from October 2011 to September 2012 before (T0) and after radiotherapy (T1-7 days). Serum retinol and ß-carotene levels were analyzed using High Performance Liquid Chromatography. The assignment of breast cancer stages was based on the classification of malignant tumors that has been proposed by the International Union Against Cancer. RESULTS: 230 patients (mean age 63.6 years, SD ± 9.38) were evaluated. There was a significant reduction in the serum retinol (45.1 ± 18.2 µg/dL at T0 to 27.1 ± 11.7 µg/dL at T1, p < 0.001) and ß-carotene (209.0 ± 153.6 µg/L at T0 to 47.7 ± 25.5 µg/L at T1, p < 0.001). There was also a significant difference in serum retinol (p < 0.001) and ß-carotene (p = 0.003) levels based on the disease stage. CONCLUSIONS: It is recommended the early establishment of adequation serum concentrations of retinol and beta-carotene, offering nutritional assistance for those patients with deficiencies, in order to minimize the harmful effects of radiation.

Effects of supplementation of antioxidant vitamins and lipid peroxidation in critically ill patients.

INTRODUCTION: Critical patients present systemic inflammatory process that can be followed by decrease in plasma concentrations of antioxidant vitamins. OBJECTIVE: [corrected] The aim of this study was to evaluate the effect of the supplementation of antioxidant vitamins in critical patients and their relation with lipid peroxidation. METHODS: 23 patients went on a standard diet (G1) and 11 went on a diet with daily supplementation of 10,000 IU of vitamin A, 400 mg of vitamin E and 600 mg of vitamin C (G2). The APACHE II score was made. Serum concentrations of retinol, ß-carotene, vitamins C and E, malondialdehyde (MDA) and C-reactive protein was measured before (T0) and on the 8th day after the beginning of the nutritional therapy (T1). The groups had been monitored on T0, T1 and T2, (at discharges or death) on the following parameters: mechanical ventilation; hospitalization days; mortality; infection incidence. RESULTS: Serum concentrations of MDA and vitamin E were significantly lower in G2 after intervention and strong tendency to increase vitamin C. There were not significant differences between the groups regarding the clinical parameters. CONCLUSIONS: The doses of vitamin A, C and E that were indicated were effective for the current lipid peroxidation reduction.

Introducción: Los pacientes críticos presentan un proceso inflamatorio sistémico que puede seguirse por un descenso en las concentraciones plasmáticas de vitaminas antioxidantes. Objetivo: El objetivo de este estudio fue evaluar el efecto de la suplementación de vitaminas antioxidantes en los pacientes críticos y su relación con la peroxidación lipídica. Métodos: 23 pacientes realizaron una dieta estándar (G1) y 11 una dieta con suplementación diaria de 10.000 UI de vitamina A, 400 mg of vitamina E y 600 mg de vitamina C (G2). Se realizó la puntuación APACHE II. Las concentraciones séricas de retinol, alfa-caroteno, vitaminas C y E, malondialdehído (MDA) y proteína C reactiva se midieron antes (T0) y al octavo día de comenzar con la terapia nutricional (T1). Se monitorizaron los siguientes parámetros en los grupos en T0, T1 y T2, (en el momento del alta o del fallecimiento): ventilación mecánica; días de hospitalización; mortalidad; incidencia de infección. Resultados: Las concentraciones séricas de MDA y vitamina E fueron significativamente menores en el grupo G2 tras la intervención con una fuerte tendencia a aumentar la vitamina C. No hubo diferencias significativas entre los grupos con respecto a los parámetros clínicos. Conclusiones: Las dosis de vitaminas A, C y E que se indicaron fueron eficaces en la reducción actual de la peroxidación lipídica.

Micronutrientes com ação antioxidante em neonatos / Antioxidant micronutrients in neonates

OBJETIVO: Apresentar uma revisão atualizada e crítica sobre o estresse oxidativo em neonatos, bem como o efeito de micronutrientes com ação antioxidante direcionado ao grupo em questão. FONTES DE DADOS: Pesquisa bibliográfica nos bancos de dados Medline e LILACS (1997-2009), selecionando os artigos escritos em inglês, português ou espanhol, a partir dos descritores "neonato" e "micronutrientes", em combinação com "antioxidantes" e "estresse oxidativo". Foram examinados 90 artigos e 34 deles selecionados. SÍNTESE DOS DADOS: O nascimento, por si só, representa um estresse oxidativo para o recém-nascido, o que se agrava nos casos de prematuridade e quando existem doenças associadas. A agressão oxidativa sofrida pelo neonato a termo é contrabalançada pela maturação eficaz dos mecanismos antioxidantes; porém, no caso dos prematuros, isto não é evidente, uma vez que altas concentrações de antioxidantes só ocorrem no final da gestação. Diversos estudos foram realizados no intuito de avaliar as concentrações de antioxidantes em neonatos a termo e pré-termo, assim como propor doses de suplementação que possam ser eficazes em combater o estresse oxidativo. CONCLUSÕES: O estresse oxidativo está presente em neonatos, em especial nos prematuros, aumentando a demanda de nutrientes antioxidantes. É consenso que estes devem ser administrados de forma combinada, de modo a prevenir danos celulares. São necessários estudos longitudinais e com maiores casuísticas que avaliem as concentrações desses micronutrientes antioxidantes, com o intuito de traçar recomendações apropriadas para neonatos a termo e pré-termo.

OBJECTIVE: To present a critical review about the oxidative stress in neonates, as well as the effect of antioxidant micronutrients in this group. DATA SOURCES: Bibliographic research in the databases Medline and Lilacs (1997-2009), selecting articles written in English, Spanish or Portuguese, with the descriptors: "neonate" and "micronutrients" combined with "antioxidants" and "oxidative stress". We examined 90 articles and 34 of them were selected. DATA SYNTHESIS: The birth is an oxidative stress which is intensified in cases of prematurity and associated diseases. Oxidative injury suffered by the term neonate is offset by the maturation of effective antioxidant mechanisms, but in preterm infants, this does not accur, since a high concentrations of antioxidants is achieved only at the end of pregnancy. Several studies have been conducted in order to evaluate the concentration of antioxidants in mature and premature neonates and to propose effective supplementation against the oxidative stress. CONCLUSIONS: Oxidative stress is present in neonates, especially in preterm infants, increasing the demand for antioxidant nutrients. There is a consensus that they should be administered in order to avoid cellular damage. Longitudinal studies with larger samples and measuring the concentrations of antioxidant micronutrients are needed in order to outline appropriate recommendations for their supplementation in term and preterm neonates.

[Tuberous sclerosis with pulmonary involvment]. / Esclerose tuberosa com envolvimento pulmonar.

Tuberous sclerosis (TS) is a rare, sporadic or autosomal dominant disease characterized by the triad of seizures, mental retardation and angiofibromas. Lungs are rarely involved in TS, and pulmonary involvement is almost always found in females. We report the case of a 52 year -old female, nonsmoker, with a history of seizures in childhood and renal angiomyolipomas. She presented no complaints and her physical exam was normal. Chest CT performed for the evaluation of the disease detected thin-walled pulmonary cysts in both lungs. Lung function tests were normal. Cortical tubers and calcified subependymal nodules were seen in cerebral magnetic resonance. Tuberous sclerosis was diagnosed (lymphangioleiomyomatosis, cortical tubers, calcified subependymal nodules and angiomyio- lipomas). The authors present this case because of its rarity and the existence of pulmonary involvement, while still asymptomatic.

[Bronchoscopic dilation techniques and topical application of mitomycin-C in the treatment of tracheal stenosis post intubation - two case reports]. / Técnicas de dilatação broncoscópica e aplicação tópica de mitomicina C no tratamento da estenose traqueal pós -entubação - A propósito de dois casos clínicos.

Tracheal stenosis follows any injury to the airway mucosa, such as ischaemic, traumatic and other injuries. The treatment of tracheal stenosis remains a challenging problem despite all the advances in endoscopic and surgical techniques. Scar formation and reestenosis are the main causes of treatment failure. The authors present two cases of successful treatment of a tracheal stenosis after tracheal injury from prolonged oro -tracheal intubation / tracheostomy following dilatation with rigid broncoscope and laser therapy, associated with topical application of mitomycin C as an adjuvant treatment.

Punção venosa periférica em quimioterapia: dispositivos de punção x acesso venoso

O câncer é considerado um problema de saúde pública por sua elevada incidência, refletindo nos índices de morbi-mortalidade. As modalidades terapêuticas acerca dessa patologia, entre elas, a quimioterapia antineoplásica, culminam na complexidade técnico científico, que exige dos profissionais competências e habilidades específicas. Portanto, este estudo teve como objetivo identificar os critérios de escolha dos dispositivos venosos periféricos pelo enfermeiro durante o atendimento à pacientes adultos em tratamento quimioterápico ambulatorial e discutir as barreiras para a escolha dos dispositivos venosos para o atendimento à pacientes adultos em tratamento quimioterápico ambulatorial. Trata-se de um estudo descritivo, exploratório, com abordagem qualitativa, cuja amostra será com uma população composta por enfermeiros especialistas em oncologia, ou que tenham dois anos de prática com pacientes em tratamento quimioterápico. O cenário do estudo será o Centro de Quimioterapia de uma instituição pública, no município do Rio de Janeiro. A coleta de dados será através de um questionário semi-estruturado, respeitando os aspectos éticos e legais da Resolução n. 196/96, acerca da participação de seres humanos em pesquisas. Os dados serão agrupados segundo aspectos relevantes da pesquisa, e posteriormente analisados. .

[Chylothorax - case report]. / Quilotórax: A propósito de um caso clínico.

Chylothorax is the occurrence of lymph in the pleura due to damage or obstruction of the thoracic duct. High content of triglycerides and the presence of chylomicrons make the diagnosis of chylothorax. Its aetiology can be divided in traumatic and non-traumatic. Traumatic rupture occurs after accidents or surgery. Within non-traumatic aetiology, lymphoma is the most common and in the presence of a chylothorax of unknown origin this should be the first suspicion, being non-Hodgkin type the most frequent. The authors present a case report of a patient with chylothorax due to non-Hodgkin lymphoma, discuss the particularities of chylothorax as well as the investigation and its treatment options.

Treatment of advanced non small cell lung cancer with erlotinib. Two clinical cases. / Erlotinib no tratamento do carcinoma pulmonar de não pequenas células, doença avançada. A propósito de dois casos clínicos.

Early studies with tirosine kinase inhibitors (TKI), namely Erlotinib and Gefitinib, in patients with non small cell lung cancer (NSCLC), showed that although most patients did not respond radiologically, a small percentage of those patients (about 10%) had an excellent response to treatment, with radiological regression and clinical response duration. Four patient populations are known as having better response to TKI as opposed to other patients: adenocarcinoma patients, non-smokers, women and asians. Nevertheless, a good general status remains a predictive factor for treatment response. The discovery of the EGFR mutation in NSCLC patients' tumors and its association with clinical response to Erlotinib and Gefitinib, confirmed by a considerable number of retrospective and prospective studies, showed that response rates are between 75-80% in patients carrying this mutation. Although several mutations have been identified, the two commonest (approximately 90%) are located in exons 19 and 21. The authors present two patients studied and treated at the Pulmonology Department's Lung Oncology Unit of CHVNGaia, where Erlotinib was used as 3(rd) line treatment: in one patient, which was part of the population with good response to TKI, a classic exon 19 was identified, and was treated with Erlotinib for twenty months with clinical stability; the other patient did not belong to the above mentioned population and an Exon 20 mutation was identified (a mutation not yet described in literature, being not clear its association with response to treatment with TKI) - treatment was stopped after 7.4months due to disease progression. Rev Port Pneumol 2008; XIV (Supl 3): S43-S51.

Perfil de consumo de nutrientes antioxidantes em pacientes com síndrome metabólica / Profile of antioxidant nutrient intake in patients with metabolic syndrome

Objetivo Descrever a ingestão dietética de nutrientes antioxidantes em pacientes com Síndrome Metabólica atendidos em uma Unidade Básica de Saúde no Município do Rio de Janeiro. Métodos O diagnóstico da síndrome metabólica foi realizado segundo os critérios do Education Program Adult Treatment Pane. A avaliação da ingestão dietética se deu por meio de questionário de freqüência de consumo alimentar semi-quantitativo e do recordatório de 24 horas, comparados aos valores de ingestão recomendados pelo Institute of Medicine. Foram aferidos a circunferência abdominal, o peso e a estatura. O índice de massa corporal foi calculado e classificado segundo o World Health Organization. Foram dosados perfil lipídico e glicemia de jejum. Resultados A amostra foi composta de 57 pacientes, com média de idade 49 ± 7,7 anos. Dentre os fatores de risco da síndrome metabólica, o mais prevalente foi inadequação da circunferência abdominal (91,2%), seguido da hipertrigliceridemia (89,5%), hipertensão arterial sistêmica (87,7%), hiperglicemia (64,9%) e inadequação da lipoproteína de alta densidade (48,9%). Verificou-se inadequação na ingestão de vitamina A, E e cobre em 100,0% da amostra, vitamina C (93,0%), zinco (54,4%) e selênio (21,1%). Conclusão Observou-se alta prevalência de inadequação dietética de nutrientes antioxidantes. Recomenda-se maior ênfase no planejamento dietético, não apenas de macronutrientes, mas também de micronutrientes, tendo em vista o envolvimento destes na proteção antioxidante, essencial para pacientes que apresentam fatores de risco para doença cardiovascular.

Objective The objective of this study was to describe the dietary intake of antioxidant nutrients in patients with metabolic syndrome seen at a Basic Healthcare Unit in the city of Rio de Janeiro. Methods Metabolic syndrome diagnosis was done according to the Education Program Adult Treatment Pane criteria. Dietary intake was assessed by a semi-quantitative food frequency questionnaire and 24-hour recall and compared with the intake amounts recommended by the Institute of Medicine. Abdominal circumference, weight and height were measured. The body mass index was calculated and classified according to the World Health Organization criteria. Lipid profile and fasting glucose were also determined. Results The sample consisted of 57 patients with a mean age of 49 ± 7.7 years. Among the risk factors for metabolic syndrome, inadequate abdominal circumference (91.2%) was the most prevalent, followed by hypertriglyceridemia (89.5%), systemic hypertension (87.7%), hyperglycemia (64.9%) and inadequate high density lipoprotein-c (48.9%). Inadequate intakes of vitamin A, E and copper were observed in 100% of the sample; inadequate intakes of vitamin C (93.0%), zinc (54.4%) and selenium (21.1%) were also observed. Conclusion There was a high prevalence of inadequate dietary intake of antioxidant nutrients. More emphasis is needed in dietary planning, not only of macronutrients but also of micronutrients given their role in antioxidant protection, essential for patients who are at risk of cardiovascular disease.

Aspectos antropométricos, bioquímicos e sintomatológicos em mulheres com tuberculose pulmonar / Anthropometric and biochemical aspects, signals and symptoms in female patients with pulmonary tuberculosis

Avaliar a existência de desnutrição energético-protéica em pacientes do sexo feminino com tuberculose pulmonar e correlacionar com dados antropométricos, bioquímicos e sintomatologia. Métodos: Foram avaliados, no período de quatro meses, pacientes do sexo feminino internados com diagnóstico de tuberculose pulmonar no Instituto Estadual deDoenças do Tórax Ary Parreiras, Rio de Janeiro. Foram calculados índices de massa corporal, circunferência muscular do braço e contagem total de linfócitos. Foram investigados os principais sinais e sintomas da doença na internação.Resultados: De 31 pacientes estudadas, 61,3% tinham desnutrição energético-protéica e, pela circunferência muscular do braço, 71,0% dos pacientes apresentavam depleção de massa magra. Houve correlação significativa dos índices de massa corporal com contagem total de linfócitos (p=0,007) e com a circunferência muscular do braço (p<0,0001), e da circunferência muscular do braço com a contagem total de linfócitos (p=0,005). Houve diferença estatisticamentesignificativa (p<0,05) quando se comparou a presença de dispnéia, hemoptise e hiporexia entre os eutróficos e desnutridos. Conclusão:Os resultados deste estudo sugerem forte associação da tuberculose pulmonar com a desnutrição energético-protéica, em que os sintomas como a dispnéia, hemoptise e hiporexia podem ser co-fatores para o agravamento da tuberculose pulmonar. Tais achados demonstram necessidade de maior atenção ao consumo alimentar das pacientes portadoras de tuberculose pulmonar, de modo a reverter ou minimizar o quadro de desnutrição energético-protéica diagnosticado nainternação e melhorar a sobrevida destas pacientes.