Comparing the Efficacy of Two Cognitive Screening Tools in Identifying Gray and White Matter Brain Damage among Older Adults.

Background: Ageing is associated with structural changes in brain regions and functional decline in cognitive domains. Noninvasive tools for identifying structural damage in the brains of older adults are relevant for early treatment. Aims: This study aims to evaluate and compare the accuracy of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA©) in identifying gray and white matter brain damage in older individuals with varying degrees of cognitive impairment. Methods: Ninety older adults (62 women) with an average age of 69 ± 7 years were enrolled and categorized as having no cognitive impairment (NCI), mild cognitive impairment (MCI), or moderate cognitive impairment (MoCI). Magnetic resonance imaging (MRI) was utilized to assess the number, volume, and distribution of brain damage. The Fazekas and Scheltens scales were applied to the brain MRIs, and inferential statistics were employed to compare variables among the groups. Results: Cognitive impairment was observed in 56.7% of the participants (95% confidence interval (CI): 46.4-66.4%), with thirty-six older adults (40%) classified as MCI and 15 (17%) as MoCI. Cognitive impairment and medial temporal lobe (MTL) atrophy were found to be associated (p=0.001), exhibiting higher mean volume scales of the MTL atrophied area in the MoCI group (p < 0.001). The MMSE accurately revealed MTL atrophy based on the Scheltens (p < 0.05) and Fazekas (p < 0.05) scales. At the same time, the MoCA accurately identified periventricular white matter (PWM) abnormalities according to the Fazekas scale (p < 0.05). Conclusions: The MMSE and MoCA screening tools effectively identified gray and white matter brain damage in older adults with varying degrees of cognitive impairment. Lower MMSE scores are associated with MTL atrophy and lesions, and lower MoCA scores are related to PWM lesions. The concurrent use of MMSE and MoCA is recommended for assessing structural changes in distinct brain regions.

Effects of photobiomodulation on pain, lactate and muscle performance (ROM, torque, and EMG parameters) of paretic upper limb in patients with post-stroke spastic hemiparesis-a randomized controlled clinical trial.

The objective of the study was to investigate the impact of photobiomodulation (PBM) on the paretic upper limb in post-stroke patients with spastic hemiparesis and to understand the potential of PBM as a long-term non-invasive therapy for reducing the side effects caused by spasticity in the hemiparetic upper limb after a stroke. This is a double-blind randomized clinical trial constituted of 27 participants, being Control group (CG = 12 healthy individuals) and PBM group (PBMG = 15 post-stroke individuals). In the CG, the baseline blood lactate (BL) was evaluated, followed by the evaluation of the IC torque of the biceps and triceps muscles, with the isokinetic dynamometer associated with surface electromyography (EMG) and, subsequently, a new measurement of BL. The PBMG received 10 sessions of treatment with PBM (780 nm, Power: 100 mV, Power Density: 3.18 W/cm2, Energy: 4 J, Fluency: 127.4 J/cm2, Time: 40 s per point and 1.280 s total, Spot: 0.0314 cm2, 32 Points: 16 points (brachial biceps) and 16 points (brachial triceps) applied with contact at 90°, Total Energy: 64 J), which in the pre-treatment evaluation measured BL, the visual analogue scale (VAS) of pain; torque and EMG of the same muscles in the IC, subsequently, a new measurement of VAS and BL, and measurement of range of motion (ROM) during the reaching movement. At the conclusion of the ten sessions, all participants underwent a reassessment, wherein all tests originally administered during the initial evaluation were repeated. Subsequently, the data were analyzed using the Shapiro-Wilk normality test. For related data, the paired t-test was used for normal distributions and the Wilcoxon test for non-normal data. For unrelated data, the t test was used for normal distributions and the Mann-Whitney test for non-normal data. Muscle torque was higher for the CG, with a significant difference (CGxPBMG = p < 0.0001). There was no significant difference between the EMG values of the CG in relation to the Pre-PBM phase and with the Post-PBM phase of the PBMG (p > 0.05). On the other hand, there was a 38% reduction in pain reported by hemiparetic patients (p = 0.0127) and a decrease in BL in the PBMG. Post-PBM ROM increased by 46.1% in the elbow extension of the paretic limb. In conclusion, Photobiomodulation (PBM) demonstrated significant improvements in muscle performance, reducing fatigue and pain levels, and enhancing range of motion in post-stroke patients with spastic hemiparesis. These findings support the potential integration of PBM into rehabilitation protocols, but further research and clinical trials are needed to validate and expand upon these promising outcomes.

Transcranial photobiomodulation therapy associated with cardiorespiratory rehabilitation in spastic subjects.

The objective of this study was to evaluate the effects of cardiorespiratory rehabilitation (CR) and transcranial photobiomodulation (tPBM) on exercise tolerance (ET), heart rate variability (HRV), and peripheral muscle activity in individuals with spasticity. Fifteen participants with spasticity were randomly assigned to two groups: the tPBM group (tPBMG) consisted of eight volunteers who underwent tPBM (on mode) and CR, while the control group (CG) consisted of seven volunteers who underwent simulated tPBM (off mode) and CR. The CR program included 12 weeks of treatment, twice a week for one hour, involving aerobic exercises and lower limb strengthening. For tPBM, a cluster with three lasers (λ = 680 nm, 808 nm), with a power of 100 mW/laser and energy of 36 J, applied to the F7, F8, and Fpz points. The following parameters were evaluated after 8 and 12 weeks: ET, HRV, and surface electromyography (EMG) of the rectus femoris muscle during orthostasis (ORT), isometric squatting (ISOM), and isotonic squatting (ISOT). Both groups showed a 40% increase in ET for the CG and a 30% increase for the tPBMG. The CG had more pronounced parasympathetic modulation alterations during post-exercise effort and recovery compared to the tPBMG. The EMG results showed that the tPBMG exhibited progressive improvement in muscle activity during ISOM and ISOT, as well as a decrease in the interlimb difference. In conclusion, both CR and tPBMG demonstrated improvements in ET. However, tPBMG specifically showed promising effects on HRV modulation and peripheral muscle electrical activity, providing additional benefits compared to CR alone.

(MeOPhSe)2, a synthetic organic selenium compound, inhibits virulence factors of Candida krusei: Adherence to cervical epithelial cells and biofilm formation.

BACKGROUND: Systemic candidiasis is produced by Candida albicans or non-albicans Candida species, opportunistic fungi that produce both superficial and invasive infections. Despite the availability of a wide range of antifungal agents for the treatment of candidiasis, failure of therapy is observed frequently, which opens new avenues in the field of alternative therapeutic strategies. METHODS: The effects of p,p'-methoxyl-diphenyl diselenide [(MeOPhSe)2], a synthetic organic selenium (organochalcogen) compound, were investigated on virulence factors of C. krusei and compared with its antifungal effects on the virulence factors related to adhesion to cervical epithelial cell surfaces with C. albicans. RESULTS: (MeOPhSe)2, a compound non-toxic in epithelial (HeLa) and fibroblastic (Vero) cells, inhibited the growth in a dose-dependent manner and changed the kinetics parameters of C. krusei and, most importantly, extending the duration of lag phase of growth, inhibiting biofilm formation, and changing the structure of biofilm. Also, (MeOPhSe)2 reduced C. albicans and C. krusei adherence to cervical epithelial cells, an important factor for the early stage of the Candida-host interaction. The reduction was 37.24 ± 2.7 % in C. krusei (p = 0.00153) and 32.84 ± 3.2 % in C. albicans (p = 0.0072) at 20 µM (MeOPhSe)2, and the effect is in a concentration-dependent manner. Surprisingly, the antifungal potential on adhesion was similar between both species, indicating the potential of (MeOPhSe)2 as a promising antifungal drug against different Candida infections. CONCLUSION: Overall, we demonstrated the potential of (MeOPhSe)2 as an effective antifungal drug against the virulence factors of Candida species.

Recrutamento, retenção, presença e adesão de um ensaio clínico aleatorizado para avaliar os efeitos do treino específico da tarefa em indivíduos pós-acidente vascular encefálico / Selección, retención, asistencia y adherencia de un ensayo clínico aleatorizado para evaluar los efectos del entrenamiento específico de tareas en sujetos pos-accidente cerebrovascular / Recruitment, retention, attendance, and adherence of a randomized controlled trial to evaluate the effects of task-specific training with individuals post stroke

RESUMO Indivíduos acometidos pelo acidente vascular encefálico (AVE) se beneficiam de diferentes estratégias terapêuticas que apresentam comprovação da eficácia por meio da condução de ensaios clínicos aleatorizados (ECA) bem delineados. Compreender as etapas do estudo pode auxiliar os pesquisadores na realização de futuros ensaios clínicos. Dessa forma, o objetivo deste estudo foi descrever o processo de recrutamento, retenção, presença e adesão na condução de um ECA realizado com indivíduos pós-AVE na fase crônica na cidade de Belo Horizonte (MG), Brasil, com o propósito de investigar a eficácia do treino específico da tarefa para membros superiores e inferiores na melhora do nível de atividade física e mobilidade. Nos resultados, foi observado que dos 674 potenciais participantes, não foi possível contatar 240; 384 não foram avaliados por não atenderem aos critérios de elegibilidade. Participaram da avaliação presencial 50 indivíduos e 14 não fizeram parte do estudo pelo mesmo motivo. Apenas 36 indivíduos iniciaram as intervenções (taxa de recrutamento de 5,3%). Uma taxa de retenção de 80,6% foi observada. Sete indivíduos abandonaram o estudo, principalmente por desinteresse pelas atividades. A taxa de presença foi de 80,9%, e o principal motivo para ausência nas sessões foi incompatibilidade de horário com as consultas médicas. A taxa de adesão foi de 82,7%, com 180 interrupções durante as sessões, sendo sair mais cedo o motivo mais comum. Esses resultados indicam algumas dificuldades no processo de condução do ECA com indivíduos na fase crônica do AVE envolvendo treino específico da tarefa. Apesar dessas dificuldades, a intervenção proposta pode ser considerada viável.

RESUMEN Las personas afectadas por accidente cerebrovascular (ACV) tienen a su disposición diferentes estrategias terapéuticas que muestran evidencia de eficacia a través de la realización de ensayos clínicos aleatorizados (ECA) bien diseñados. Conocer las etapas del estudio puede ayudar a los investigadores a realizar futuros ensayos clínicos. Así, el objetivo de este estudio fue describir el proceso de selección, retención, asistencia y adherencia de un ECA realizado con individuos post-ACV en fase crónica en la ciudad de Belo Horizonte (Brasil), para investigar la efectividad del entrenamiento específico de tareas para las extremidades superiores e inferiores en la mejora del nivel de actividad física y la movilidad. En los resultados se observó que, de los 674 potenciales participantes, no fue posible contactar a 240; y 384 no fueron evaluados por no cumplir con los criterios de elegibilidad. Cincuenta personas participaron en la evaluación presencial y 14 no formaron parte del estudio por la misma razón. Solo 36 personas empezaron las intervenciones (tasa de selección del 5,3%). Se observó una tasa de retención del 80,6%. Siete personas abandonaron el estudio, principalmente por falta de interés en las actividades. La tasa de asistencia fue del 80,9%, y el principal motivo de ausencia a las sesiones fue la incompatibilidad de horario con las citas médicas. La tasa de adherencia fue del 82,7%, con 180 interrupciones durante las sesiones, y la salida anticipada fue la razón más frecuente. Los resultados apuntan algunas dificultades en el proceso de realización del ECA con individuos en fase crónica del ACV con relación al entrenamiento específico de tarea. A pesar de esto, la intervención propuesta puede considerarse viable.

ABSTRACT Individuals who suffered stroke benefit from different therapeutic strategies whose efficacy has been proved by well-designed randomized controlled trials (RCTs). Understanding study steps may assist researchers in conducting future RCTs. Thus, the objective of this study was to describe the process of recruitment, retention, attendance, and adherence in conducting RCTs with individuals in the chronic phase of stroke in the municipality of Belo Horizonte/MG/Brazil, with the purpose of investigating the efficacy of specific task training for both lower and upper limbs in improving patients' physical activity and mobility. Results showed that, of the 674 potential participants, it was impossible to contact 240 individuals and 384 were excluded from our sample for failing to meet eligibility criteria. In total, 50 individuals participated in clinical evaluations and 14 were excluded from the study for the same reason. Overall, 36 individuals started the interventions, a 5.3% recruitment rate. An 80.6% retention rate was observed. In total, seven individuals left the study, mainly due to lack of interest in the activities. We found an 80.9% attendance rate, and the main reason for missing medical appointments was incompatibility with treatment schedule. We also observed an 82.7% adherence rate. Of these, 180 interrupted sessions were mainly due to patients leaving early. These results indicate some difficulties found in conducting RCTs with individuals in the chronic phase of stroke, especially regarding specific task training. Despite these difficulties, the proposed intervention can be considered feasible.

Temporal analysis of demographic and biometric parameters of the Mangalarga breed / Análise temporal de parâmetros demográficos e biométricos da raça Mangalarga

ABSTRACT: This study analyzed the demographic and biometric changes in registered animals of the Mangalarga breed over the decades. Information from 206,428 Mangalarga horses born between 1930 and 2018 extracted from the genealogic registry system of the Associação Brasileira de Criadores de Cavalos da Raça Mangalarga was employed. The data referred to sex, birth date, fur coat, breeding site location, score achieved at genealogic registration, and three body measurements. Height at withers and the thoracic and cannon bone circumferences were used to calculate five morphometric indices. Results were submitted to analysis of variance using a completely randomized split-plot design where the plots comprised the sexes and the split-plots comprised the decades of selection. Between 1930 and 1990, genealogic registrations progressively increased, particularly in the 1970s and 80s, when the herd experienced the highest growth rate. In 2018, Mangalarga breeding sites were reported in 23 Brazilian states and the states of São Paulo, Minas Gerais, and Bahia held the largest herds. Between 1970 and 2018, the height at withers of mares, stallions, and geldings increased by 5.1, 3.1, and 2.1 cm, respectively. The thoracic circumference of stallions increased by 3.3 cm and the cannon bone circumference of mares decreased by 0.34 cm. It is concluded that the Mangalarga breed is found across Brazil, especially in the Southeast region. Irrespective of sex, the selection of the breed has led to taller Mangalarga horses. In addition, the stallions became heavier and gained thoracic circumference, while mares became hypometric.

RESUMO: Objetivou-se analisar as alterações demográficas e biométricas dos animais registrados da raça Mangalarga, ao longo das décadas. Foram utilizadas informações de 206.428 equinos Mangalarga, extraídas do sistema de registro genealógico da Associação Brasileira de Criadores de Cavalos da Raça Mangalarga. Dos animais nascidos entre 1930 e 2018, foram consideradas informações referentes ao sexo, data de nascimento, pelagem, localização do criatório, pontuação obtida no ato do registro genealógico e três medidas corporais dos equinos. Utilizando a medida de altura à cernelha e os perímetros torácico e de canela foram calculados cinco índices morfométricos. Os resultados foram submetidos à análise de variância, utilizando delineamento inteiramente ao acaso em esquema de parcelas subdivididas, sendo as parcelas compostas pelos sexos e as subparcelas constituídas pelas décadas de seleção. Entre 1930 e 1990 houve aumento progressivo na emissão de registros genealógicos, com destaque para as décadas de 70 e 80, quando se registrou maior taxa de crescimento do rebanho. Em 2018 identificou-se criatórios da raça Mangalarga em 23 estados brasileiros, sendo o Estado de São Paulo detentor do maior rebanho, seguido de Minas Gerais e Bahia. Entre 1970 e 2018 registrou-se aumento na altura à cernelha das fêmeas, garanhões e machos castrados, que se tornaram 5,1 cm, 3,1 cm e 2,1 cm mais altos, respectivamente. Enquanto o perímetro torácico dos garanhões aumentou 3,3 cm, o perímetro de canela das fêmeas reduziu 0,34 cm. Concluiu-se que a raça Mangalarga está distribuída por todo o Brasil, com destaque para a região sudeste. Independente do sexo, a seleção aplicada à raça tornou os equinos Mangalarga mais altos. Além disso, os garanhões ficaram mais pesados e com maior perímetro torácico e as fêmeas tornaram-se hipométricas.

Analysis of the effects of low-level laser therapy on muscle fatigue of the biceps brachii muscle of healthy individuals and spastic individuals: Study protocol for a single-center, randomized, double-blind, and controlled clinical trial.

BACKGROUND: Muscular fatigue is caused by biochemical alterations that modify the mechanics of muscle contraction, resulting in negative changes in the performance of the contraction. Several resources are studied to mitigate this situation among which we can cite low-level laser therapy (LLLT). The effects of LLLT are being studied in healthy subjects with fibromyalgia and who are athletes, and currently the studies are being performed in spastic muscles with poststroke individuals. The aim will be to evaluate the effects of LLLT on the fatigue of the biceps brachii muscle of healthy individuals and individuals with spastic hemiparesis. METHODS: A cross-sectional, comparative, randomized, placebo, double-blind clinical trial will be divided into 2 phases: phase I shall consist of 30 healthy subjects and phase II of 30 poststroke individuals. The study will consist of 3 groups (control group, placebo group, and LLLT group), and all individuals will pass through all groups, following the randomization criteria. The protocol consists of the application of LLLT in the biceps brachii muscle on the dominant side in healthy individuals and in the hemiparetic side of poststroke individuals, and, subsequently, 3 maximal isometric voluntary contractions (MIVCs) will be performed for 50 seconds in the dynamometer, with an interval of 50 seconds between them. Pain intensity will be evaluated by means of the visual analog scale, and the myoelectric activity by means of surface electromyography associated with the evaluation of muscular strength by means of the dynamometer. The local temperature will be evaluated by infrared thermography and blood lactate concentration through the lactimeter, which will be measured at 4 different times, before the application of the laser (basal), and 3, 15, and 25 minutes after the MIVC.

Sensory-motor and cardiorespiratory sensory rehabilitation associated with transcranial photobiomodulation in patients with central nervous system injury: Trial protocol for a single-center, randomized, double-blind, and controlled clinical trial.

BACKGROUND: Central nervous system diseases such as stroke, spinal cord injury, traumatic brain injury, and multiple sclerosis can be fatal or cause sequelae, affecting sensorimotor and cardiorespiratory systems and quality of life. These subjects present a low response to aerobic and resistance exercise, due to decreased recruitment of muscle fibers and reduction of metabolic capacity. Aerobic exercises bring benefits in terms of fatigue retardation, gait improvement, regulation of the autonomic nervous system, neuroprotection of the brain, stimulation of the production of endogenous neutrotransmitters related to general well-being, and a favoring of neuroplasticity. Photobiomodulation (PBM Therapy) (previously known as low-level laser therapy), and especially transcranial PBM Therapy, has shown benefits in animals and humans such as cognitive improvement, memory, and behavioral improvement, including attenuation of depression and anxiety, and increased cortical oxygenation. The aims of this trial will be to evaluate the parameters related to the function of the musculoskeletal and cardiorespiratory system and the impact of PBM therapy on these parameters, as part of a rehabilitation and training program for people with reduced mobility. METHODS: This is a randomized, double-blind, placebo-controlled trial with 3 groups: Control, only cardiorespiratory rehabilitation (CCR), CCR with PBM Therapy (CR-PBM), CCR and placebo PBM Therapy (CR-PlaceboPBM). n = 90, 30 per group. PBM Therapy parameters: 810 nm laser, 0.028 cm, 100 mW, 3.5 W/cm, 30 seconds per point, 3 J per point, 107.1 J /cm to 3 electroencephalogram points F7 and F8 and AFz. The trial will be conducted at the University Clinics and the sessions will be 1 hour twice a week for 9 weeks. Baseline, intermediate (4th week), final (9th week), and 2-month follow-up will be performed. Muscular activation, heart rate variability, lung volumes and capacities, fatigability, exercise tolerance, cognition, and quality of life at baseline will be evaluated. Subsequent to baseline evaluations, the PBM Therapy groups will be offered laser therapy (active or inactive); all groups will then receive CCR. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID - NCT03751306 (approval date: November 22, 2018).

Principal components for the in vivo and carcass conformations of Anglo-Nubian crossbred goats / Componentes principais para conformações in vivo e das carcaças em caprinos mestiços da raça Anglo-Nubiana

ABSTRACT: This study aimed to identify the principal components (PC) that explain the highest percentages of total variance and best characterize the in vivo and carcass morphologies of Anglo-Nubian crossbred goats. Nineteen carcass morphometric traits and six in vivo morphometric traits were measured in 28 kids at eight months of age. Principal component analysis indicated that five PC were able to explain 83.57% of the total variance in the 19 original carcass traits. Those components were termed PC1-Carcass Size, PC2 - Body Condition, PC3-Carcass Width, PC4-Chest Depth, and PC5 - Hindquarter. For in vivo morphometric traits, the first two principal components explained 78.86% of the total variance. These components were called PC1-In vivo Size and PC2-In vivo Conformation.

RESUMO: Este estudo buscou identificar componentes principais (CP) que explicam os maiores percentuais de variância total e que melhor caracterizam cabritos mestiços da raça Anglo Nubiana, quanto à medidas morfológicas obtidas in vivo, e na carcaça de 28 animais com 8 meses de idade. Foram conduzidas duas análises de componentes principais, sendo uma para 19 características de carcaça e outra para seis características morfométricas in vivo. Os cinco primeiros CP explicaram 82,54% da variância total das 19 características incluídas nessa análise. Estes componentes foram chamados de: CP1 - Tamanho da Carcaça, CP2 - Condição Corporal, CP3 - Largura da Carcaça, CP4 - Profundidade do Tórax e, CP5 - Comprimento do Pernil. Os dois primeiros componentes principais das morfometrias obtidas in vivo explicaram 78,86% da variância total e foram chamados de CP1 - Tamanho in vivo e CP2 - Conformação in vivo.

Dermatomyositis-Part 2: Diagnosis, Association With Malignancy, and Treatment.

In this second part of the series on dermatomyositis, the diagnosis and its criteria with review of autoantibodies, capillaroscopy, imaging exams, histopathology, muscle biopsy, electroneuromyography, and muscular enzymes will be assessed. The association with malignancy, since it is described as paraneoplasic, will be discussed. The different therapeutic options for this disease will also be reported, including for dystrophic calcification, a rare and late complication of dermatomyositis.

Impacto da sessão de hemodiálise na força de preensão manual / Impact of hemodialysis session on handgrip strength

Resumo Introdução: A força de preensão manual (FPM) é um método simples, confiável e com bom valor preditivo para avaliar a função muscular de pacientes submetidos à hemodiálise (HD). Porém, ainda não existe um consenso a respeito do momento mais apropriado para a aferição da medida, já que o desempenho da FPM pode ser influenciado pelas flutuações hidroeletrolíticas e de pressão arterial que acometem esses pacientes. Objetivo: Investigar o impacto da sessão de diálise sobre a FPM em pacientes submetidos à HD. Métodos: Trata-se de um estudo transversal com 156 pacientes [57,7% homens, idade mediana de 56,5 (42-67) anos, 28,8% diabéticos, IMC médio de 24,75 ± 4,5 kg/m2 e tempo em HD de 38 (19,25-72,75) meses]. Foram realizadas aferições da FPM com um dinamômetro nos minutos iniciais e ao término da sessão de HD. Os valores obtidos foram comparados com um padrão de referência nacional. Dados clínicos, demográficos e laboratoriais foram coletados do prontuário médico. Resultados: Foi observada uma redução significante da FPM após a sessão de HD (28,6 ± 11,4 kg para 27,7 ± 11,7 kg; p < 0,01). A prevalência de pacientes com FPM abaixo do percentil 30 aumentou de 44,9% para 55,1% (p < 0,01). A redução da pressão arterial durante a diálise foi o único fator que se associou com a redução da FPM. Conclusão: Os achados mostram que o processo de HD influencia negativamente a FPM.

Abstract Introduction: Handgrip strength (HGS) is a simple and reliable method with a good predictive clinical value for assessing muscle function of patients undergoing hemodialysis (HD). However, there is no consensus regarding the appropriate moment for performing the HGS measurement since the performance of the HGS can be influenced by fluid, electrolyte and blood pressure changes that affect patients on HD. Objective: To investigate the impact of the dialysis session on the HGS in patients undergoing HD. Methods: This is a cross-sectional study with 156 patients [57.7% male, median age of 56.5 (42-67) years old, 28.8% diabetes, mean BMI of 24.75 ± 4.5 kg/m2 and HD vintage of 38 (19.25 to 72.75) months]. Measures of HGS were performed with a dynamometer during the initial minutes of the HD session and at the end of the session. The values obtained were compared with a national standard reference. Clinical, demographic and laboratory data were collected from medical records. Results: A significant reduction of HGS was observed after the HD session (28.6 ± 11.4 kg to 27.7 ± 11.7 kg; p < 0.01). The prevalence of patients with HGS below the 30th percentile increased from 44.9% to 55.1% (p < 0.01). The decrease in blood pressure during dialysis was the only factor associated with the reduction of HGS. Conclusion: These findings show that the HD procedure affects negatively the HGS.

Martorell's Ulcer: Diagnostic and Therapeutic Challenge.

Martorell's ulcer is an uncommon ischemic and extremely painful lesion located in the distal portion of the lower limb, resulting from severe systemic and poorly controlled hypertension. It is common in women between 50 and 70 years of age. The diagnosis is clinical and mostly belated, following exclusion of other causes. The response to treatment takes time and is unsatisfactory. A combination of several drugs associated with surgery may be required for wound healing. The authors present a case of Martorell's hypertensive ulcer, with emphasis on the diagnostic and therapeutic difficulties.

Evaluation of the extract of Zeyheria tuberculosa with a view to products for wound healing / Avaliação do extrato da Zeyheria tuberculosa na perspectiva de um produto para cicatrização de feridas / Evaluación del extracto de la Zeyheria tuberculosa en la perspectiva de un producto para cicatrización de heridas

OBJECTIVES: to evaluate the antimicrobial, cytotoxic and healing activities of the ethanolic extract of the stems of Z. tuberculosa via topical use and/or oral ingestion. METHOD: antimicrobial assays in vitro using the disk diffusion method, the Artemia salina toxicity test, and in vivo assays with Wistar rats. From these was collected clinical, histological and biochemical data for evaluating the healing process. RESULTS: in vitro antimicrobial testing showed activity in relation to Streptococcus pyogenes, Staphylococcus aureus and Staphylococcus epidermidis, with zones of inhibition of 18, 14 and 10 mm, respectively. The best minimum inhibitory concentration was 62.5 µg/ml for S. aureus, this bacteria being chosen for the in vitro assays. Animals treated with the ointments with the extract of Z. tuberculosa showed the best results in the reduction of the wound diameter, data confirmed by the presence of re-epithelialization in the histological samples. CONCLUSION: the extract was shown to be promising for the continuation of studies which may identify the active ingredients responsible for the pharmacological activity and its mechanism of action in the process of wound healing, so as to develop a product which may be used as an alternate means in the repair of infected cutaneous wounds. .

OBJETIVOS: avaliar as atividades antimicrobiana, citotóxica e cicatrizante do extrato etanólico do caule da Z. tuberculosa por via tópica e/ou ingestão oral. MÉTODO: ensaios antimicrobianos in vitro pelo método de difusão em disco, teste de toxicidade da Artemia salina e ensaios in vivo com ratos Wistar. Nesses foram coletados dados clínicos, histológicos e bioquímicos para avaliação do processo de cicatrização. RESULTADOS: ensaios antimicrobianos in vitro mostraram atividade frente à Streptococcus pyogenes, Staphylococcus aureus e Staphylococcus epidermidis, com halos de inibição de 18, 14 e 10mm, respectivamente. A melhor concentração inibitória mínima foi 62,5µg/mL para S. aureus, sendo essa bactéria escolhida para os ensaios in vivo. Animais tratados com as pomadas do extrato da Z. tuberculosa apresentaram melhores resultados na redução do diâmetro da ferida, dado confirmado pela presença de reepitelização nos cortes histológicos. CONCLUSÃO: o extrato mostrou-se promissor para a continuação de estudos que identifiquem os princípios ativos responsáveis pela atividade farmacológica e seu mecanismo de ação no processo de cicatrização de feridas, a fim de desenvolver um produto que possa ser utilizado de forma alternativa no reparo de feridas cutâneas infectadas. .

OBJETIVOS: evaluar las actividades antimicrobianas, citotóxicas y cicatrizantes del extracto etanólico del tallo de la Z. tuberculosa por vía tópica y/o ingestión oral. MÉTODO: ensayos antimicrobianos in vitro por el método de difusión en disco, prueba de toxicidad de la Artemia salina y ensayos in vivo con ratones Wistar. En estos fueron recolectados datos clínicos, histológicos y bioquímicos para evaluación del proceso de cicatrización. RESULTADOS: los ensayos antimicrobianos in vitro mostraron actividad frente a la Streptococcus pyogenes, Staphylococcus aureus y Staphylococcus epidermidis, con halos de inhibición de 18, 14 y 10 mm, respectivamente. La mejor concentración inhibitoria mínima fue 62,5 µg/mL para S. aureus, siendo esta bacteria escogida para los ensayos in vivo. Animales tratados con las pomadas del extracto de la Z. tuberculosa presentaron mejores resultados en la reducción del diámetro de la herida, dato confirmado por la presencia de reepitelización en los cortes histológicos. CONCLUSIÓN: el extracto se mostró promisor para la continuación de estudios que identifiquen los principios activos responsables por la actividad farmacológica y su mecanismo de acción en el proceso de cicatrización de heridas, con la finalidad de desarrollar un producto que pueda ser utilizado de forma alternativa en la reparación de heridas cutáneas infectadas. .

Sheep abortion associated with Neospora caninum in Mato Grosso do Sul, Brazil / Abortos por Neospora caninum em ovinos em Mato Grosso do Sul

Canids are the main hosts of Neospora caninum, but cattle, (sheep, goats and horses may serve as intermediary hosts. N. caninum infection of pregnant intermediary hosts may provoke abortion and neonatal infections. This study is the first to report lamb abortion associated with N. caninum in Mato Grosso do Sul. Epidemiological data were obtained from interviews with sheep producers. For microscopic examination, fragments of different organs removed from 4 sheep fetuses, aborted and necropsied, were fixed in 10% formaldehyde, embedded in paraffin and subjected to the hematoxylin-eosin staining protocol and immunohistochemistry (IHC) to test for N. caninum and Toxoplasma gondii. The abortion outbreak studied was reported from a herd of 268 Santa Inês sheep (including 186 pregnant ewes), with 10 abortion cases in the last third of gestation. Four fetuses were examined, 3 from a same ewe. At necropsy, one fetus exhibited crackling in the lung and all its organs were reddish. Histological findings detected mononuclear cell infiltrates among myocardium fibers and around blood vessels, in addition to circular structures with basophilic points resembling protozoans. IHC tests revealed strongly positive staining for N. caninum and weakly positive for T. gondii, characterizing N. caninum infection.

Neospora caninum é um protozoário que tem o cão como hospedeiro defiinitivo e, bovinos, ovinos, caprinos e equinos como hospedeiros intermediários. Nestas últimas espécies pode provocar abortos e infecções neonatais. Este trabalho é o primeiro relato de aborto em ovinos associado com N. caninum no Mato Grosso do Sul. Os dados epidemiológicos foram obtidos através de entrevistas com o proprietário dos animais. Quatro fetos foram necropsiados, dos quais foram colhidos fragmentos de diversos órgãos fiixados em formol a 10%, incluídos em parafiina, processados pela técnica usual de hematoxilina e eosina e também foi realizada imuno-histoquímica para N. caninum e Toxoplasma gondii. O surto ocorreu em um rebanho constituído por 268 ovinos da raça Santa Inês, destes 186 eram fêmeas prenhes, no terço fiinal de gestação e 10 abortaram. Dos quatro fetos analisados, três eram da mesma fêmea, sendo um de menor tamanho. À necropsia o pulmão de um dos fetos estava crepitante e todos os órgãos estavam avermelhados. Os achados histológicos foi infiiltrado mononuclear entre as fiibras do miocárdio e ao redor dos vasos, além de estruturas circulares compostas por pontilhados basofiílicos semelhantes a protozoários. A IHQ revelou marcação fortemente positiva para N. caninum e fracamente positiva para T. gondii, caracterizando infecção por N. caninum.

Atypical glandular cells and cervical cancer: systematic review.

Atypical glandular cells are a common finding in cervical cytology in cervical cancer screening and its occurrence has increased in the last decades. The identification of these cells is clinically very important due to its association with cervical and endometrial dysplasic lesions and cancer. Using a systematic approach, this article reviewed studies investigating cervical lesions that are characteristic in patients previously diagnosed as having atypical glandular cells. Studies in which diagnostic investigation did not include histopathological diagnosis were excluded. A comprehensive search for available material in LILACS, SciELO, PubMed/ Medline and Old Medline databases, dated between 1966 and 2009 was performed. Articles omitted by the electronic database search were also included. Nineteen articles met the inclusion criteria and were selected. This report aims at evaluating whether atypical glandular cells, initially found in cervical cytology and subsequently identified at the histological analysis, are related to the presence of benign, pre-malignant and malignant lesions. Eleven out of 19 selected articles showed the highest correlation between atypical glandular cells with benign diseases and six with squamous pre-malignant lesions.

Células glandulares atípicas e câncer de colo uterino: revisão sistemática / Atypical glandular cells and cervical cancer: systematic review

Atipias de células glandulares em esfregaços cervicovaginais é um achado citológico na rotina de rastreamento do câncer cervical, que aumentou nas últimas décadas. Sua constatação é importante clinicamente, pois é alta a percentagem de casos associados com doença cervical e endometrial de alto grau e câncer. Este trabalho avaliou, por meio de uma revisão sistemática, estudos que investigaram o perfil das lesões de colo uterino em avaliações histológicas de seguimento de pacientes já diagnosticadas com células glandulares atípicas. Foram excluídos os estudos cuja investigação diagnóstica não incluísse o diagnóstico histopatológico. Realizou-se uma busca abrangente de publicações no período de 1966 a 2009, nas bases do LILACS, SciELO, PubMed/Medline e Old Medline. Os artigos omitidos na busca eletrônica também foram incluídos. Estavam de acordo com os critérios de inclusão 19 artigos, que foram selecionados. Este estudo tem como objetivo avaliar se a atipia celular glandular observada inicialmente na citologia relacionava-se histologicamente com a presença de lesões benignas, pré-neoplásicas ou neoplásicas. Dos 19 estudos selecionados, 11 mostraram maior correlação entre atipia glandular com patologias benignas e seis com lesões escamosas pré-malignas.

Atypical glandular cells are a common finding in cervical cytology in cervical cancer screening and its occurrence has increased in the last decades. The identification of these cells is clinically very important due to its association with cervical and endometrial dysplasic lesions and cancer. Using a systematic approach, this article reviewed studies investigating cervical lesions that are characteristic in patients previously diagnosed as having atypical glandular cells. Studies in which diagnostic investigation did not include histopathological diagnosis were excluded. A comprehensive search for available material in LILACS, SciELO, PubMed/ Medline and Old Medline databases, dated between 1966 and 2009 was performed. Articles omitted by the electronic database search were also included. Nineteen articles met the inclusion criteria and were selected. This report aims at evaluating whether atypical glandular cells, initially found in cervical cytology and subsequently identified at the histological analysis, are related to the presence of benign, pre-malignant and malignant lesions. Eleven out of 19 selected articles showed the highest correlation between atypical glandular cells with benign diseases and six with squamous pre-malignant lesions.

Polioencefalomalacia experimental induzida por amprólio em bovinos / Experimentally amprolium-induced polio-encephalomalacia in cattle

Para estabelecer um modelo experimental para o estudo da etiologia, patologia e patogênese da polioencefalomalacia (PEM) em bovinos, a condição foi induzida em quatro novilhos pela administração oral de amprólio nas doses diárias de 500 e 350mg/kg de peso vivo, respectivamente por 22 e 26-28 dias. Todos os bovinos morreram espontaneamente ou foram eutanasiados in extremis após um curso clínico de 4-7 dias. Três bovinos que receberam 1.000mg/kg de amprólio e dois que receberam 500mg/kg morreram espontaneamente com quadro clínico agudo a subagudo sem desenvolverem sinais e lesões de PEM. Nos novilhos que PEM foi reproduzida, os sinais neurológicos incluíram marcada apatia, incoordenação, posição de cavalete, quedas ocasionais, hiperexcitabilidade, tremores musculares, cegueira, bruxismo, estrabismo, nistagmo, midríase, opistótono, decúbito lateral e movimentos de pedalagem. Os principais achados de necropsia eram restritos ao encéfalo e consistiam de tumefação, achatamento, amolecimento e amarelamento das circunvoluções cerebrais. Histologicamente, havia necrose neuronal segmentar e laminar (neurônios vermelhos) associada a edema, tumefação endotelial, separação das lâminas de neurônios do córtex telencefálico ou entre as substâncias cinzenta e branca e infiltração moderada a acentuada de macrófagos espumosos. Essas alterações eram mais acentuadas nos lobos telencefálicos frontal, parietal e occipital. Adicionalmente, lesões similares e moderadas foram detectadas no mesencéfalo e hipocampo. A necrose neuronal e o edema afetaram uniformemente as camadas de neurônios da substância cinzenta dos lobos telencefálicos frontal, parietal e occipital. Esse modelo experimental de PEM com administração oral de amprólio parece ser útil para o estudo da doença em bovinos, conforme observado anteriormente em ovinos.

In order to establish an experimental model for the study of the etiology, pathology, and pathogenesis of polioencephalomalacia (PEM) in cattle, the condition was induced into four steers by oral administration of amprolium at daily doses of 500 and 350mg per kg of body weight respectively for 22 and 26-28 days. All steers died spontaneously or were euthanized in extremis after being sick for 4-7 days. Three steers that received the drug at 1,000mg/kg and two that received 500mg/kg died spontaneously with acute or subacute clinical signs and without lesions and signs of PEM. In those steers in which PEM was reproduced, the neurological signs included marked apathy, incoordination, sawhorse stance, occasional falls, hyperexcitability, muscle tremors, blindness, grinding of teeth, strabismus, nystagmus, mydriasis, opisthotonus, and lateral recumbency with paddling movements. Main gross lesions were restricted to the brain and included swelling, flattening, softening and yellow discoloration of the cerebral circumvolutions. Histologically, there was segmental laminar neuronal necrosis (red neurons) associated with edema, swelling of endothelial cells, cleavage of laminar neuronal layers or between gray and white matter and moderate to severe infiltration by foamy macrophages (gitter cells). These changes were more marked in the frontal, parietal and occipital telencephalic lobes. Additionally, similar and moderate lesions were detected in the midbrain and hippocampus. Neuronal necrosis and edema affected uniformly the neurons layers of the grey matter of the frontal, parietal and occipital lobes. This experimental model of PEM with oral administration of amprolium may be useful for the study in cattle, as previously observed in sheep.

Análise citogenética em material de abortamento espontâneo / Cytogenetic analysis of material from spontaneous abortion

OBJETIVO: Descrever as anormalidades cromossômicas em material de abortamento espontâneo. MÉTODOS: Realizou-se compilação retrospectiva da análise de cariótipo em lâmina corada com Banda G por microscopia óptica e em material de 428 produtos de abortamento encaminhados para estudo. RESULTADOS: Foram observados 145 resultados normais (33,9 por cento) e 237 resultados anormais (55,4 por cento). Em 46 amostras não houve crescimento celular (10,7 por cento). As anormalidades numéricas foram as mais frequentes, destacando-se a trissomia do 16 (41 casos), a triplodia (27 casos), a monossomia do X (26 casos), a tetraploidia (13 casos) e a trissomia do 15 (13 casos). CONCLUSÃO: As alterações citogenéticas representam importante causa de perdas gestacionais e sua detecção auxilia o aconselhamento genético do casal. A trissomia do cromossomo 16 é a alteração mais frequentemente encontrada.

OBJECTIVE: To describe chromosomal abnormalities in spontaneous abortion material. METHODS: A retrospective compilation of karyotype analysis of slides stained with Band G was carried out by optical microscopy with materials of 428 abortion products referred for study. RESULTS: There were 145 normal results (33.9 percent) and 237 abnormal results (55.4 percent). In 46 samples there was no cell growth (10.7 percent). Numerical abnormalities were the most frequent, especially trisomy 16 (41 cases), triplodia (27 cases), monosomy X (26 cases), tetraploidy (13 cases) and trisomy 15 (13 cases). CONCLUSION: Cytogenetic alterations are an important cause of pregnancy loss and their detection helps the genetic counseling to the couple. Trisomy 16 is the most often found change.

Terapia biológica na doença inflamatória intestinal: nova abordagem terapeutica / Biological therapy in inflammatory bowel disease: new therapeutic approach

Estudo de revisão baseado nos dados recentes publicados sobre a maior eficácia dos agentes biológicos, anti-TNF, frente à terapia convencional no tratamento da Doença Inflamatória Intestinal [DII], podendo mudar o curso da doença. Estudos compararam pacientes tratados com a terapia convencional (“stp-up”), em relação aos submetidos a uma abordagem precoce dos biológicos, a “top-down”. Revisado eficácia e segurança desta terapia, assim como a percepção do paciente de seu custo/ benefício.