Neuromyelitis optica spectrum disorders and systemic lupus erythematosus: A case series from a university center.

Neuromyelitis optica spectrum disorders (NMOSD) are immune-mediated inflammatory diseases of the central nervous system (CNS), which preferentially affect the optic nerves and the spinal cord. Anti-aquaporin 4 antibody is a specific serological marker. Systemic lupus erythematosus (SLE) is a rheumatologic disease that may affect the CNS. There are several reports about the coexistence of NMOSD and autoimmune diseases, mainly those of rheumatologic origin. We describe three different cases in which SLE and NMOSD subsequently occurred, drawing attention to the clinical heterogeneity, the challenge and the importance of recognizing this possible association.

Diagnostic value of serological biomarkers for detection of non-alcoholic fatty liver disease (NAFLD) and/or advanced liver fibrosis in people living with HIV.

OBJECTIVES: We aimed to evaluate the accuracy of serological biomarkers for non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis (METAVIR-F3F4) in HIV mono-infected individuals. METHODS: In all, 674 participants from the PROSPEC-HIV study (NCT02542020), who had blood sample tests and transient elastography (TE) performed on the same day, were eligible. Exclusion criteria were viral hepatitis co-infection (n = 90), abusive alcohol intake (n = 61), missing data (n = 47) or unreliable TE (n = 39). NAFLD was defined by controlled attenuation parameter ≥ 248 dB/m and advanced fibrosis by liver stiffness measurement ≥ 8.7 kPa with M probe or ≥ 7.2 kPa with XL probe. Biomarkers for NAFLD [Steato-ELSA, Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), NAFLD-Liver Fat Score (NAFLD-LFS)] and fibrosis [Fibrosis-4 score (FIB-4), Aspartate-to-Platelet Ratio Index (APRI) and NAFLD Fibrosis Score (NFS)] were calculated. RESULTS: A total of 437 patients [57% female, age = 44 (interquartile range: 35-52) years, body mass index (BMI) = 26.1 (23.4-29.3) kg/m2 , CD4 = 660 (427-901) cells/µL] were included. The prevalence [95% confidence interval (CI)] of NAFLD and advanced fibrosis were 38.2% (33.8-42.9) and 10.5% (8.0-13.8), respectively. The areas (95% CI) under the receiver operator curve (AUROCs) for diagnosis of NAFLD were 0.854 (0.818-0.889), 0.840 (0.804-0.877), 0.805 (0.762-0.847) and 0.793 (0.750-0.836) for Steato-ELSA, FLI, HSI and NAFLD-LFS (P < 0.001), respectively. All tests yielded satisfactory sensitivities, specificities and negative predictive values (NPVs). The AUROCs (95% CI) for diagnosis of advanced fibrosis were 0.736 (0.659-0.814), 0.700 (0.614-0.7851) and 0.795 (0.726-0.864) for FIB-4, APRI and NFS (P = 0.077), respectively. These tests yielded high specificities and negative predictive values (NPVs) > 90%. CONCLUSION: Biomarkers for NAFLD had a good accuracy and those for fibrosis had high specificities and NPVs. These tests should be integrated to HIV care to detect NAFLD and to exclude advanced liver fibrosis.

Correlation between plaque control and gingival health using short and extended oral hygiene intervals.

OBJECTIVES: To evaluate the correlation between dental plaque formation and gingival health in subjects performing high oral hygiene standards over short or extended intervals. MATERIALS AND METHODS: Fifty-two non-dental students volunteered for this study. The subjects, trained to perform high oral hygiene standards, were randomized to perform oral hygiene at 12-, 24-, 48-, or 72-h interval over 30 days. The plaque index (PlI) and the gingival index (GI) were evaluated at baseline, 15, and 30 days. For the statistical analysis, oral hygiene intervals were collapsed into daily (12 and 24 h; G12/24) and extended (48 and 72 h; G48/72) intervals. Summary statistics (mean ± SD) and Spearman correlations between the PlI and the GI at baseline, 15, and 30 days were estimated. RESULTS: At baseline, correlation coefficients between PlI and GI were positive for both groups (r = 0.29 and r = 0.25). At day 15 and 30, correlation was maintained with similar baseline values for the G48/72 group. GI levels did not increase despite an increase in PlI for the G12/24 group, and the correlation was lower than that observed at baseline (r = 0.13 vs. r = 0.29). CONCLUSIONS: In subjects with high oral hygiene standards, the oral hygiene frequency governs the correlation between dental plaque formation and gingival health. Subjects performing high oral hygiene standards at daily intervals will maintain gingival health in difference to subjects using extended hygiene intervals. CLINICAL RELEVANCE: Subjects performing high oral hygiene standards at daily intervals will maintain gingival health in difference to subjects using extended hygiene intervals.

Genetic Diversity in Nannotrigona testaceicornis (Hymenoptera: Apidae) Aggregations in Southeastern Brazil.

The Meliponini, also known as stingless bees, are distributed in tropical and subtropical areas of the world and plays an essential role in pollinating many wild plants and crops These bees can build nests in cavities of trees or walls, underground or in associations with ants or termites; interestingly, these nests are sometimes found in aggregations. In order to assess the genetic diversity and structure in aggregates of Nannotrigona testaceicornis (Lepeletier), samples of this species were collected from six aggregations and genetically analyzed for eight specific microsatellite loci. We observed in this analysis that the mean genetic diversity value among aggregations was 0.354, and the mean expected and observed heterozygosity values was 0.414 and 0.283, respectively. The statistically significant Fis value indicated an observed heterozygosity lower than the expected heterozygosity in all loci studied resulting in high homozygosis level in these populations. In addition, the low number of private alleles observed reinforces the absence of structuring that is seen in the aggregates. These results can provide relevant information about genetic diversity in aggregations of N. testaceicornis and contribute to the management and conservation of these bees' species that are critical for the pollination process.

The effect of intrauterine infusion of dextrose on clinical endometritis cure rate and reproductive performance of dairy cows.

The main objective of this study was to evaluate the intrauterine administration use of 200 mL of 50% dextrose solution as a treatment against clinical endometritis (CE); CE cure rate and reproductive performance were evaluated. Additionally, the association of several relevant risk factors, such as retained placenta (RP), metritis, CE, anovulation, hyperketonemia, and body condition score with reproductive performance, early embryonic mortality, and CE were evaluated. A total of 1,313 Holstein cows housed on 4 commercial dairy farms were enrolled in the study. At 7±3 DIM cows were examined for metritis and had blood collected to determine serum ß-hydroxybutyrate concentration. To determine if cows had ovulated at least once before 44±3 DIM, the presence of a corpus luteum was evaluated by ovarian ultrasonography at 30±3 DIM and at 44±3 DIM. At 30±3 DIM, CE was diagnosed using the Metricheck device (SimcroTech, Hamilton, New Zealand); cows with purulent or mucopurulent vaginal discharge were diagnosed as having CE. Cows diagnosed with CE (n=175) were randomly allocated into 2 treatment groups: treatment (intrauterine infusion of 200 mL of 50% dextrose) or control (no infusion). Clinical endometritis cows were re-evaluated as described above at 44±3 DIM, and cows that were free of purulent or mucopurulent vaginal discharge were considered cured. Intrauterine infusion of dextrose tended to have a detrimental effect on CE cure rate, and treatment did not have an effect on first-service conception rate and early embryonic mortality. A multivariable Cox's proportional hazard model was performed to evaluate the effect of several variables on reproductive performance; the variables RP, CE, parity, anovulation, and the interaction term between parity and anovulation were associated with hazard of pregnancy. Cows that did not have RP or CE were more likely to conceive than cows that were diagnosed with RP or CE. Cows that had RP were at 3.36 times higher odds of losing their pregnancy than cows that did not have RP. In addition, cows diagnosed with CE were at 2.16 higher odds of losing their pregnancy than cows without CE. In conclusion, intrauterine infusion of 200 mL of 50% dextrose solution as a treatment for CE had a strong statistical tendency to decrease CE cure rate, did not improve first-service conception rate and early embryonic mortality, and did not decrease calving-to-conception interval.

Analysis of the GSTM1-null polymorphism in patients with pterygium from Goiânia, Goiás Brazil.

The first reports about pterygium date back to Hippocrates, and this disease still threatens vision health around the world. Pterygium is a formation of fibrous tissue consisting of highly vascularized epithelial and subepithelial tissue that grows excessively and with an abnormal shape on the cornea. Many physical and biological factors are associated with the pathogenesis of pterygium, including heat, dust, and other particles in the atmosphere, and immunological mechanisms, mechanisms involving extracellular matrix reorganization, growth factors, cytokines, apoptosis, and angiogenesis. The aim of this study was to further investigate the association between polymorphisms in GSTM1 and the formation of pterygium. We collected peripheral blood samples from 90 patients diagnosed with pterygium and from 23 subjects with-out the disease in order to perform molecular analysis of the GSTM1 gene. Subjects with one or two copies of the GSTM1 allele had a normal genotype while those without any copies of the allele had a null geno-type. The chi-square test or the Fisher exact test was performed in order to investigate possible associations between the molecular analysis and the risk of pterygium. A significant difference between the frequency of the GSTM1-null genotype in patient and control groups was identified. However, sub-group analysis found that the GSTM1-null genotype was statistically significant in men, but not in women, and in Caucasians, but not in Brown or Black groups. Furthermore, the GSTM1-null geno-type was not related to any of the risk factors analyzed: cases in family, occupational exposure, smoking, hypertension, and diabetes.

Pterygium in patients from Goiânia, Goiás, Brazil.

Pterygium is an inflammatory and degenerative ocular surface disease in which the conjunctiva on the cornea grows to form a fibrous tissue in the shape of a triangle. The disorder may be characterized by cell proliferation, inflammatory processes, fibrosis, angiogenesis, and destruction of the extracellular matrix. The anomaly is considered a degenerative eye disease and is erroneously confused with cataract. It displays similar features to those of tumors, such as local invasion, metaplasia of epithelial cells, presence of oncogenic viruses (human papilloma virus), inactivation of tumor suppressor genes (e.g., p53), and loss of heterozygosity. The treatment of pterygium is based on factors such as the evolution and progression of the disease, risk factors, symptoms, and patient age. Considerations about the best technique for the surgical removal of pterygium remain controversial, and complications and recurrence are very common. The development of new surgical techniques and adjuvant drugs is thus necessary. This study aims to analyze and compare the frequency of the GSTT1 genotypes in relation to pterygium through statistical analyzes in order to build a genotypic profile for the Replicon patients. The genotypic profile of the GSTT1-null polymorphism in Goiânia showed no significant difference when the frequency of the null genotype was compared between the control and experimental groups. The null genotype was more frequent in the population studied. Furthermore, the GSTT1 genotype was not related to the analyzed risk factors for pterygium, namely gender, ethnicity, family history, occupational exposure, smoking, hypertension, and diabetes.

Brazilian nursing history on the shoulders of giants.

BACKGROUND: This study describes the route followed by nursing in Brazil, through the foundation of nursing organizations and the emergence of nursing leaders and pioneers. AIM: To present the origins of modern nursing in Brazil, identifying the main nurse-leaders and analysing their performance for the creation and consolidation of the nursing organizations. METHODS: It is a historical and social study with descriptive approach, to describe the process of Brazilian nursing professionalization and leadership through a literature review. RESULTS: The oldest nursing organization is the Brazilian Nursing Association that holds scientific and cultural activities. There are also nurses' unions and nursing specialty associations, such as the Brazilian Academy for the History of Nursing, and the Federal Nursing Council. The latter has compulsory membership for controlling nursing services according to the qualifications of the personnel. The very first school for nurses in the Nightingale system was created in São Paulo, 1894, at the Samaritan Hospital, and by the government in 1923, in Rio de Janeiro, for which American nurses, led by Ethel Parsons, sponsored by the Rockefeller Foundation, were essential for the creation of the Anna Nery Nursing School, still in operation within a federal university. Some nurses pioneered these works such as Edith Fraenkel, Maria Rosa Pinheiro, Amalia Carvalho and others. CONCLUSION: The work done by nursing leaders has brought to the profession a better status and made it more recognized by the society.

Sedative and cardiorespiratory effects of dexmedetomidine alone or combined with acepromazine in healthy cats.

The purpose of this study was to assess sedation, emesis and cardiovascular effects of dexmedetomidine alone or combined with acepromazine in healthy cats. Fourteen male cats aged 0.9 ± 0.5 years and weighing 3.7 ± 0.7 kg were randomly assigned to one of two experimental groups: GD, dexmedetomidine 5 µg/kg; and GDA, dexmedetomidine 5 µg/kg with acepromazine 0.03 mg/kg, all intramuscularly. Measurements were recorded at baseline, at 20 minutes and then at 10-minute intervals following sedation and included heart rate (HR), respiratory rate (FR), systolic arterial pressure (SAP), rectal temperature (RT), number of episodes of emesis and sedation score (0-4). Data were compared using ANOVA for repeated measures followed by Sídák and Dunnet test. Sedation scores were compared between groups at T20 using Mann-Whitney test. Significance was considered when P <0.05. At T20, HR was significantly lower in GDA (99 ± 14 beats/min) compared with GD (133 ± 19 beats/min) and SAP was significantly lower in both groups compared with baseline (126 ± 14 vs. 148 ± 26 and 111 ± 13 vs. 144 ± 17 mmHg in GD and GDA, respectively). Duration of sedation was similar between groups, although sedation scores differed significantly at T20, with 1 (0-4) in GD and 4 (4-4) in GDA. More episodes of emesis were recorded in GD compared with GDA. The combination of dexmedetomidine and acepromazine produced more profound sedation with faster onset and lower incidence of emesis compared with dexmedetomidine alone in healthy cats.

Magnetic spheres as foreign body into the bladder.

INTRODUCTION: A great variety of foreign bodies in the lower urinary tract have been described; many of them are self-inflicted by the patient with masturbatory purposes. Depending on the nature of the foreign body the diagnostic and management might be challenging. AIMS: We report a case of an unusual magnetic self-inserted foreign body into the bladder for autoerotism and briefly discuss the diagnostic and therapeutic implications in this challenging situation. METHODS: We describe all the steps we have used to adequately diagnose the problem, describe the foreign body and treatments for the patient. Related articles were found by utilizing the PubMed database and are summarized in this study. RESULTS: The management approach must be planned according to the nature of the foreign body and should minimize bladder and urethral trauma. However, most of cases can be managed endoscopically. CONCLUSION: Removal of magnetic foreign body may be quite challenging, requiring high-level surgical skills and minimally invasive techniques resulting in fast recovery and low complication rate.

Antibody response and avidity of respiratory syncytial virus-specific total IgG, IgG1, and IgG3 in young children.

Respiratory syncytial virus (RSV) is a major cause of acute respiratory disease in infants and young children. Considering that several aspects of the humoral immune response to RSV infection remain unclear, this study aimed to investigate the occurrence, levels, and avidity of total IgG, IgG1, and IgG3 antibodies against RSV in serum samples from children ≤5 years old. In addition, a possible association between antibody avidity and severity of illness was examined. The occurrence and levels of RSV-specific IgG depended on age, with infants <3 months old displaying high levels of antibodies, which were probably acquired from the mother. Children ≥24 months old also showed frequent occurrence and high levels of IgG, which was produced actively during infection. In addition, the avidity assay showed that the avidity of RSV-specific total IgG and IgG1 was lower in infants <3 months old who had acute respiratory disease than in age-matched controls. The avidity of RSV-specific IgG detected in children ≥24 months old with lower respiratory infection was lower than that in children with upper respiratory infection. These results indicate that the presence of high avidity RSV-specific IgG antibodies may lead to better protection against RSV infection in children <3 months old, who may have a lower probability of developing disease of increased severity. In addition, children ≥24 months old with RSV-specific IgG antibodies of low avidity tended to develop more severe RSV illness. These findings may be helpful in establishing vaccination schedules when a vaccine becomes available.

Evolution of the magnetic properties in the antiferromagnet Ce2RhIn8 simultaneously doped with Cd and Ir.

We report the evolution of the magnetic properties of Ce2Rh1-xIrxIn8-yCdy single crystals. In particular, for Ce2Rh0.5Ir0.5In8 (TN=2.0K) and Ce2Rh0.5Ir0.5In7.79Cd0.21 (TN=4.2K), we have solved the magnetic structure of these compounds using single-crystal neutron magnetic diffraction experiments. Taking the magnetic structure of the Ce2RhIn8 heavy-fermion antiferromagnet as a reference, we have identified no changes in the q=12,12,0 magnetic wave vector; however, the direction of the ordered Ce3+ moments rotates toward the ab plane, under the influence of both dopants. By constraining the analysis of the crystalline electric field (CEF) with the experimental ordered moment's direction and high-temperature magnetic-susceptibility data, we have used a mean-field model with tetragonal CEF and exchange interactions to gain insight into the CEF scheme and anisotropy of the CEF ground-state wave function when Cd and Ir are introduced into Ce2RhIn8. Consistent with previous work, we find that Cd doping in Ce2RhIn8 tends to rotate the magnetic moment toward the ab plane and lower the energy of the CEF excited states' levels. Interestingly, the presence of Ir also rotates the magnetic moment towards the ab plane although its connection to the CEF overall splitting evolution for the y = 0 samples may not be straightforward. These findings may shed light on the origin of the disordered spin-glass phase on the Ir-rich side of the phase diagram and also indicate that the Ce2MIn8 compounds may not follow exactly the same Rh-Ir CEF effects trend established for the Ce2MIn5 compounds.

Tuning the crystalline electric field and magnetic anisotropy along the CeCuBi2-xSbx series.

We have performed X-ray powder diffraction, magnetization, electrical resistivity, heat capacity and inelastic neutron scattering (INS) to investigate the physical properties of the intermetallic series of compounds CeCuBi2-xSbx. These compounds crystallize in a tetragonal structure with space group P4∕nmm and present antiferromagnetic transition temperatures ranging from 3.6 K to 16 K. Remarkably, the magnetization easy axis changed along the series, which is closely related to the variations of the tetragonal crystalline electric field (CEF) parameters. This evolution was analyzed using a mean field model, which included an anisotropic nearest-neighbor interactions and the tetragonal CEF Hamiltonian. We obtained the CEF parameters by fitting the magnetic susceptibility data with the constraints given by the INS measurements. More broadly, we discuss how this CEF evolution can affect the Kondo physics and the search for a superconducting state in this family.

Electronic and magnetic properties of stoichiometric CeAuBi2.

We report the electronic and magnetic properties of stoichiometric CeAuBi2 single crystals. At ambient pressure, CeAuBi2 orders antiferromagnetically below a Néel temperature (TN ) of 19 K. Neutron diffraction experiments revealed an antiferromagnetic propagation vector τ ^ = [ 0 , 0 , 1 ∕ 2 ] , which doubles the paramagnetic unit cell along the c axis. At low temperatures several metamagnetic transitions are induced by the application of fields parallel to the c axis, suggesting that the magnetic structure of CeAuBi2 changes as a function of field. At low temperatures, a linear positive magnetoresistance may indicate the presence of band crossings near the Fermi level. Finally, the application of external pressure favors the antiferromagnetic state, indicating that the 4f electrons become more localized.

Effect of different feed restriction programs on the performance and reproductive traits of broiler breeders.

The current experiment evaluated the effect of different feed restriction programs applied during rearing on the performance and reproductive traits of broiler breeder pullets reared on floor pens, isolating the birds' weight effect from the analysis. At 4 wk of age, 1,400 breeder pullets were distributed in a completely randomized design with 4 treatments: daily restriction (DAILY-every day feeding), skip-a-day restriction (SKIP-every other day feeding), 4/3 restriction (4/3-4 days feeding and 3 nonconsecutive fasting days) and 5/2 restriction (5/2-5 days feeding and 2 nonconsecutive fasting days), and 8 replicates. At 11, 18, 25, 32, and 39 wk of age, body weight, feed intake, feed conversion ratio, carcass composition, organs relative weight (liver, fat, oviduct, and ovary stroma), egg production, and egg weight were accessed. At 32 and 39 wk, 12 eggs by experimental unit were collected and incubated to determine hatchability and fertility parameters. Body weight, carcass EE, and FCR were higher for SKIP birds when compared to other feed restriction programs. SKIP birds also showed the lowest number of eggs per bird (NEB) and % of egg production when compared to 4/3 feeding schedule, which provided higher values. Feed conversion ratio per egg mass (FCEM) was also higher in 4/3 schedule in relation to SKIP birds. In regard to incubation parameters, 5/2 treatment showed higher values for hatchability (HAT) and fertility (FERT), similar to results of 4/3 and DAILY treatments, while SKIP birds showed the lowest. In conclusion, 4/3 and 5/2 feeding programs showed best results and should be used by broiler breeder producers to control pullets' body weight. Therefore, the higher number of eggs produced with less feed and statistically not different fertility and hatchability between programs obtained in this study suggest the 4/3 program could be more efficient than 5/2 program. Body weight'|'s effect isolation was important to analyze the effect of feed restriction program per se, and should be applied in future approaches.

Prevalence and clinical aspects of respiratory syncytial virus A and B groups in children seen at Hospital de Clínicas of Uberlândia, MG, Brazil.

Respiratory syncytial virus (RSV) is well recognized as the most important pathogen causing acute respiratory disease in infants and young children, mainly in the form of bronchiolitis and pneumonia. Two major antigenic groups, A and B, have been identified; however, there is disagreement about the severity of the diseases caused by these two types. This study investigated a possible association between RSV groups and severity of disease. Reverse transcription-polymerase chain reaction was used to characterize 128 RSV nasopharyngeal specimens from children less than five years old experiencing acute respiratory disease. A total of 82 of 128 samples (64.1%) could be typed, and, of these, 78% were group A, and 22% were group B. Severity was measured by clinical evaluation associated with demographic factors: for RSV A-infected patients, 53.1% were hospitalized, whereas for RSV B patients, 27.8% were hospitalized (p = 0.07). Around 35.0% of the patients presented risk factors for severity (e.g., prematurity). For those without risk factors, the hospitalization occurred in 47.6% of patients infected with RSV A and in 18.2% infected with RSV B. There was a trend for RSV B infections to be milder than those of RSV A. Even though RSV A-infected patients, including cases without underlying condition and prematurity, were more likely to require hospitalization than those infected by RSV B, the disease severity could not to be attributed to the RSV groups.

Forestier syndrome and obstructive sleep apnea: Surgical treatment.

INTRODUCTION: We report a case of obstructive sleep apnea that occurred as a result of Forestier disease and describe the surgical treatment that was performed. SUMMARY: The patient is a 56-year-old man who presented dysphagia for solids and liquids, snoring (score 10) and excessive daytime sleepiness for 5 years. On fiber optic laryngoscopy examination, there was interarytenoid edema and protrusion of the posterior wall of the larynx. The cervical X-Ray showed protrusion of intervertebral disc between C3-C5 (skeletal hyperostosis) and the polysomnography revealed apnea-hypopnea index (AHI) of 56 events/h. Surgery was performed by the otorhinolaryngology and orthopedic teams. The patient evolved with complete symptom resolution and an AHI of 3,9 events/h on the control polysomnography. DISCUSSIONS: This is the first reported case of Forestier Syndrome (FS) associated with Obstructive Sleep Apnea (OSA) that was proposed surgical treatment and the patient evolved with complete symptom improvement.

Prevention of deep venous thrombosis and pulmonary embolism following stroke: a systematic review of published articles.

We performed a systematic review of the literature on venous thromboembolism (VTE) prophylaxis following cerebral infarct (CI) and haemorrhagic stroke. MEDLINE, Cochrane, LILACS and SciELO databases were scanned, and the Abstracts from Brazilian, American and European Neurology and Stroke Congresses were scrutinized for clinical trials. Moreover, the reference lists of articles and reviews were searched. A pooled analysis of two large studies with aspirin was made. Both unfractionated heparin and low molecular weight heparins/heparinoids (LMWH) are partially effective for VTE prophylaxis after CI, and should be routinely used in patients with motor deficit and reduced mobility and no contraindications. Reduction of deep venous thrombosis is better established than the effect over pulmonary embolism or mortality. Some evidence points to a greater efficacy of LMWH. The available evidence does not support the use of mechanical methods or dextran. Aspirin may have a mild protective effect. Low-dose Warfarin might be useful in the rehabilitation setting. Strict recommendations cannot be made in patients with haemorrhagic stroke but intermittent pneumatic compression merits further study. There are important limitations of current VTE preventive strategies following stroke. Additional studies on the combination of methods after CI and of low doses of anticoagulants following cerebral haemorrhage are urgently needed.