Study of the Epidemiological Profile of Tuberculosis and Coinfection of HIV-Seropositive Patients in a Reference Hospital in the State of Alagoas / Estudo do Perfil Epidemiológico da Tuberculose e Coinfecção de Pacientes Soropositivos para HIV em Hospital de Referência no Estado de Alagoas

Abstract Tuberculosis is a disease that has affected the population for more than centuries, it is caused by Mycobacterium tuberculosis with high incidence and prevalence in the population. In Brazil, active tuberculosis is the condition with the greatest impact on mortality in people living with the human immunodeficiency virus, since this part of the population is more likely to develop the disease. In this sense, in order to elucidate the epidemiological profile of patients coinfected with Tuberculosis/HIV, a retrospective study was carried out with a quantitative approach in a referral hospital in the care of these patients in the State of Alagoas. 956 cases of tuberculosis and HIV co-infection were reported, with a higher incidence in males (63.49%), in mixed race (82.42%) and in the age group corresponding to the economically active population, between 21 and 50 years (84,.08%). In addition, the pulmonary clinical form (73.95%) is predominant among the cases, with the peripheral lymph node (32.12%) being the most frequent among the extrapulmonary forms (19.87%). Regarding the clinical outcome of these patients, it was observed that there was a higher rate of treatment drop-out in patients reported with alcoholism, consequently reducing the cure rate of these patients. Therefore, it is evident that socioeconomic variables directly influence the incidence and outcome of patients co-infected with Tuberculosis/HIV and that despite the therapeutic advances and the existing support network, it is still a disease that generates negative impacts on the social development of the country. (AU)

Resumo A tuberculose é uma enfermidade que afeta a população há mais de séculos, é causada pelo Mycobacterium tuberculosis apresentando elevada incidência e prevalência na população. No Brasil, a tuberculose ativa é a condição de maior impacto na mortalidade em pessoas que vivem com o vírus da imunodeficiência humana, já que essa parcela da população apresenta uma maior probabilidade de desenvolver a doença. Nesse sentindo, a fim de elucidar o perfil epidemiológico dos pacientes coinfectados com Tuberculose/HIV, realizou-se um estudo retrospectivo com abordagem quantitativa em um hospital de referência no atendimento destes pacientes no Estado de Alagoas. Foram notificados 956 casos de coinfecção tuberculose e HIV, apresentando maior incidência no sexo masculino (63,49%), na cor parda (82,42%) e na faixa etária correspondente a população economicamente ativa, entre 21 e 50 anos (84,08%). Além disso, a forma clínica pulmonar (73,95%) é predominante dentre os casos, sendo a ganglionar periférica (32,12%) a mais incidente entre as formas extrapulmonares (19,87%). Em relação ao desfecho clínico desses pacientes, observou-se que houve uma maior taxa de abandono do tratamento em pacientes notificados com agravo por alcoolismo, reduzindo consequentemente a taxa de cura destes pacientes. Portanto, fica evidente que variáveis socioeconômicas influenciam diretamente na incidência e no desfecho de pacientes coinfectados com Tuberculose/HIV e que apesar dos avanços terapêuticos e da rede de suporte já existente, ainda é uma doença que gera impactos negativos para o desenvolvimento social do país. (AU)

Performance, meat quality, and lipidemia of meat-type quails fed with diets containing essential oils / Desempenho, qualidade da carne e lipidemia de codornas de corte alimentadas com rações contendo óleos essenciais

This study evaluated the effect of essential oil (ESOL) of Mentha piperita and Melaleuca alternifolia on meat-type quails. To examine performance, a completely randomized design was used, with four treatments and eight repetitions each, using seven birds per repetition. To assess lipidemia, a completely randomized design in a 4 × 2 factorial scheme was used, with four treatments and two collection conditions using eight repetitions and one bird per repetition. Weight gain, feed intake, feed conversion, carcass yield, cholesterol, high-density lipoporteins, triglycerides, pH, and brightness of quail breast meat were assessed. The data were analyzed for homoscedasticity and normality, and the means were subjected to analysis of variance. Adding M. piperita and M. alternifolia ESOL to the diets of meat-type quails can improve performance, carcass yield, and meat quality characteristics, comparable to the use of performance-enhancing antibiotics. The use of zinc bacitracin, M. piperita, and M. alternifolia under different collection conditions did not increase the serum levels of low-density and very low-density lipoproteins. The variation coefficients measured after 12 hours of fasting were 86% lower than without fasting.

Objetivou-se com este estudo avaliar o efeito do uso dos óleos essenciais (OLES) de Mentha piperita e Melaleuca alternifolia em codornas de corte. Para o estudo do desempenho foi utilizado o delineamento inteiramente ao acaso, com quatrotratamentos e oito repetições, sendo sete aves por repetição. Para o estudo da lipidemia utilizou-se o delineamento inteiramente casualizado em esquema fatorial: 4x2, consistindo em quatro tratamentos e duas condições de coleta, com oito repetições, sendo uma ave por repetição. As variáveis analisadas foram: ganho de peso, consumo ração, conversão alimentar, rendimento de carcaça, colesterol, HDL, triglicerídeos, pH, capacidade de retenção de água, perda de peso por cozimento, luminosidade na carne do peito de codornas. Os dados obtidos foram analisados quanto à homocedasticidade e normalidade, as médias foram submetidas à análise de variância. O uso de OLES de M. piperita e M. alternifolia na dieta de codornas de corte pode proporcionar desempenhos zootécnicos, rendimentos de carcaça e características de qualidade da carne comparáveis ao uso de antibióticos melhoradores de desempenho. A redução no nível de colesterol HDL foi notada nas aves tratadas com Bacitracina de zinco e com os OLES de M. piperita e M. alternifolia, em 8,12; 16,52 e 3,36% respectivamente. O uso da Bacitracina de zinco, da M. piperita e da M. alternifolia associado às diferentes condições de coleta não aumentaram os valores séricos de LDL, VLDL. Os coeficientes de variação aferidos na condição "após 12 horas de jejum" apresentaram-se 86% inferiores à condição "sem jejum".

Analysis of the Role of Female Hormones During Infection by COVID-19.

Women have metabolic, immunological, and genetic variables that ensure more protection from coronavirus infection. However, the indication of treatment for several pathologies and contraception is determined by hormones that have adverse effects and raise doubts about their use during the COVID-19 pandemic. Therefore, the present study searches women specificities and the relation between female sexual hormones and COVID-19, and reports the main recommendations in this background. To this end, a review of the literature was conducted in the main databases, auxiliary data sources, and official websites. Therefore, considering the hypercoagulability status of COVID-19, the debate about the use of contraceptives due to the relative risk of thromboembolic effects that they impose arises. However, the current available evidence, as well as the recommendations of main health organs around the world, demonstrate that the use of hormonal contraceptives must be maintained during the pandemic.

As mulheres possuem variáveis metabólicas, imunológicas e genéticas que conferem maior proteção à infecção pelo coronavírus. Todavia, a indicação de tratamento para certas patologias e para a contracepção é determinada por hormônios que possuem efeitos adversos e levantam dúvidas quanto ao seu uso durante a pandemia da COVID-19. Desta forma, o presente estudo busca investigar as especificidades da mulher e a relação dos hormônios sexuais femininos com a COVID-19, assim como relatar as principais recomendações neste contexto. Para isso, realizou-se uma revisão da literatura nas principais bases de dados, fontes auxiliares de dados e sites oficiais. Portanto, considerando o estado hipercoagulável da COVID-19, surge o debate quanto à utilização de contraceptivos pelo seu risco relativo de efeitos tromboembólicos. No entanto, as atuais evidências disponíveis, assim como as recomendações dos principais órgãos de saúde do mundo, demonstraram que o uso de contraceptivos hormonais deve ser mantido durante a pandemia.

Analysis of the Role of Female Hormones During Infection by COVID-19 / Análise do papel dos hormônios femininos durante a infecção por COVID-19

Abstract Women have metabolic, immunological, and genetic variables that ensure more protection from coronavirus infection. However, the indication of treatment for several pathologies and contraception is determined by hormones that have adverse effects and raise doubts about their use during the COVID-19 pandemic. Therefore, the present study searches women specificities and the relation between female sexual hormones and COVID-19, and reports the main recommendations in this background. To this end, a review of the literature was conducted in the main databases, auxiliary data sources, and official websites. Therefore, considering the hypercoagulability status of COVID-19, the debate about the use of contraceptives due to the relative risk of thromboembolic effects that they impose arises. However, the current available evidence, as well as the recommendations of main health organs around the world, demonstrate that the use of hormonal contraceptives must be maintained during the pandemic.

Resumo As mulheres possuem variáveis metabólicas, imunológicas e genéticas que conferem maior proteção à infecção pelo coronavírus. Todavia, a indicação de tratamento para certas patologias e para a contracepção é determinada por hormônios que possuem efeitos adversos e levantam dúvidas quanto ao seu uso durante a pandemia da COVID-19. Desta forma, o presente estudo busca investigar as especificidades da mulher e a relação dos hormônios sexuais femininos com a COVID-19, assim como relatar as principais recomendações neste contexto. Para isso, realizou-se uma revisão da literatura nas principais bases de dados, fontes auxiliares de dados e sites oficiais. Portanto, considerando o estado hipercoagulável da COVID-19, surge o debate quanto à utilização de contraceptivos pelo seu risco relativo de efeitos tromboembólicos. No entanto, as atuais evidências disponíveis, assim como as recomendações dos principais órgãos de saúde do mundo, demonstraram que o uso de contraceptivos hormonais deve ser mantido durante a pandemia.

O trabalho no campo da educação: o Fórum-Cosate como estratégia de resistência à máquina neoliberal / Labor in the field of education: fórum-cosate as a strategy of resistance against the neoliberal machine

O artigo introduz uma experiência de pesquisa-intervenção realizada na região metropolitana de Vitória, Espírito Santo, mais especificamente no município de Serra visando ao fortalecimento de práticas no contexto escolar que possam fazer frente à racionalidade neoliberal que toma a educação como bem privado de valor econômico. Apresenta a constituição de um fórum de trabalhadores da educação cujo objetivo é construir estratégias que possam desafiar o processo de adoecimento em curso nas escolas, decorrente da racionalidade econômica vigente no referido município. Aponta como direção ética a indissociabilidade entre clínica e política e aposta na criação de táticas coletivas de enfrentamento ao adoecimento nas unidades escolares da rede.

This article presents the experience of a research-intervention carried out in the municipality of Serra, metropolitan region of Vitória, Espírito Santo, aiming to strengthen practices in the school context that can face the neoliberal rationality that considers education as private goods of economic value. It describes the constitution of a forum for education workers to develop strategies that could challenge the sickness process underway in schools, due to the economics-guided thinking in that municipality. Its ethical direction, the inseparability between clinic and politics as well as the investment in the creation of collective tactics to fight sickness in the school units of the city are highlighted.

Anatomical study of the brachial plexus in human fetuses and its relation with neonatal upper limb paralysis.

OBJECTIVE: To study the anatomy of the brachial plexus in fetuses and to evaluate differences in morphology during evolution, or to find anatomical situations that can be identified as the cause of obstetric paralysis. METHODS: Nine fetuses (12 to 30 weeks of gestation) stored in formalin were used. The supraclavicular and infraclavicular parts of the brachial plexus were dissected. RESULTS: In its early course, the brachial plexus had a cord-like shape when it passed through the scalene hiatus. Origin of the phrenic nerve in the brachial plexus was observed in only one fetus. In the deep infraclavicular and retropectoralis minor spaces, the nerve fibers of the brachial plexus were distributed in the axilla and medial bicipital groove, where they formed the nerve endings. CONCLUSION: The brachial plexus of human fetuses presents variations and relations with anatomical structures that must be considered during clinical and surgical procedures for neonatal paralysis of the upper limbs.

Anatomical study of the brachial plexus in human fetuses and its relation with neonatal upper limb paralysis / Estudo anatômico do plexo braquial de fetos humanos e sua relação com paralisias neonatais do membro superior

ABSTRACT Objective To study the anatomy of the brachial plexus in fetuses and to evaluate differences in morphology during evolution, or to find anatomical situations that can be identified as the cause of obstetric paralysis. Methods Nine fetuses (12 to 30 weeks of gestation) stored in formalin were used. The supraclavicular and infraclavicular parts of the brachial plexus were dissected. Results In its early course, the brachial plexus had a cord-like shape when it passed through the scalene hiatus. Origin of the phrenic nerve in the brachial plexus was observed in only one fetus. In the deep infraclavicular and retropectoralis minor spaces, the nerve fibers of the brachial plexus were distributed in the axilla and medial bicipital groove, where they formed the nerve endings. Conclusion The brachial plexus of human fetuses presents variations and relations with anatomical structures that must be considered during clinical and surgical procedures for neonatal paralysis of the upper limbs.

RESUMO Objetivo Estudar a anatomia do plexo braquial em fetos e avaliar diferenças de morfologia durante a evolução, ou encontrar situações anatômicas que possam ser apontadas como causa de paralisias obstétricas. Métodos Foram utilizados nove fetos formolizados entre 12 a 30 semanas de gestação e submetidos à dissecação supra e infraclavicular do plexo braquial. Resultados O plexo braquial inicialmente tem formato de cordão durante sua passagem pelo hiato dos escalenos e em apenas um feto foi observada a origem do nervo frênico por meio do plexo braquial. Na região infraclavicular profunda e retropeitoral menor, os fascículos do plexo braquial se distribuíam na axila e sulco bicipital medial para a formação dos nervos terminais. Conclusão O plexo braquial de fetos humanos apresenta variações e relações com estruturas anatômicas que devem ser consideradas durante os procedimentos clínicos e cirúrgicos das paralisias neonatais do membro superior.

Gestos clínicos na formação em psicologia: práticas de transformação coletiva no acompanhamento de processos educacionais / Gestos clínicos en la formación en psicología: prácticas de transformación colectiva en el seguimiento de los procesos educativos / Clinical gestures in psychology training: practices in the educational processes mentoring

A escrita deste artigo apresenta análises dos processos de produção de subjetividades e delineia gestos clínicos que orientam nossas práticas formativas em Psicologia no Programa de Formação em Investigação e Saúde no Trabalho (PFIST), vinculado ao Núcleo de Estudos em Subjetividade e Políticas (Nepesp) do Departamento de Psicologia da Universidade Federal do Espírito Santo, Brasil, tais como: postura de escrita e atenção acolhedora; produção de transversalidade; escuta sensível e ativação do corpo-si. A partir de cenas, rumores e indícios cultivados em um grupo de supervisão coletiva que reúne estudantes e professores, exercitam-se encontros regulares como oportunidade para a prática de gestos clínicos que desejamos sustentar nas intervenções vinculadas à construção de um fórum de discussão sobre a relação entre saúde e trabalho no ambiente escolar. Conclui-se que a ativação de gestos clínicos coincide com a prática de circulação da palavra, coletivização de análises e redistribuição de poder nas relações de trabalho no contexto educacional.

La redacción de este artículo presenta análisis de los procesos de producción de subjetividades y describe gestos clínicos que guían nuestras prácticas formativas en Psicología en el Programa de Formación en Investigación y Salud en el Trabajo (PFIST), vinculadas al Departamento de Psicología de la subjetividad y estudios de políticas (Nepesp), Departamento de Psicología, Universidad Federal de Espírito Santo, Brasil, tales como: escucha sensible y atención acogedora; producción de transversalidad; escucha sensible y activación del cuerpo-si. A partir de escenas y rumores cultivados en un grupo de supervisión colectiva que reúne a estudiantes y maestros, las reuniones regulares se ejercen como un oportunidad para practicar gestos clínicos que deseamos sostener en intervenciones vinculadas a la construcción de un foro de discusión sobre la relación entre salud y trabajo em el entorno escolar. Se concluye que la activación de los gestos clínicos coincide com la práctica de la circulación de palabras, la colectivación del análisis y la redistribución del poder en las relaciones laborales en el contexto educativo.

This article presents analyzes of the subjectivities processes productions and outlines clinical gestures that guide our formative practices in Psychology in the Training Program in Research and Health at Work, which is linked to the Department of Psychology of Subjectivity and Policy Studies (Nepesp), Department of Psychology, Federal University of Espírito Santo, Brazil, such as: writing posture and welcoming attention; transversality production; sensitive listening and body-self activation. From scenes, rumors and evidence cultivated in a collective supervision group that brings together students and teachers, regular meetings are exercised as an opportunity to practice clinical gestures that we wish to sustain in interventions bound by the construction of a discussion forum on the relationship between health and work in the school environment. It was concluded that the activation of clinical gestures coincides with the practice of word circulation, analysis collectivization not to mention the redistribution of power in work relationships in the educational context.

Inhibitors of the 5-lipoxygenase arachidonic acid pathway induce ATP release and ATP-dependent organic cation transport in macrophages.

We have previously described that arachidonic acid (AA)-5-lipoxygenase (5-LO) metabolism inhibitors such as NDGA and MK886, inhibit cell death by apoptosis, but not by necrosis, induced by extracellular ATP (ATPe) binding to P2X7 receptors in macrophages. ATPe binding to P2X7 also induces large cationic and anionic organic molecules uptake in these cells, a process that involves at least two distinct transport mechanisms: one for cations and another for anions. Here we show that inhibitors of the AA-5-LO pathway do not inhibit P2X7 receptors, as judged by the maintenance of the ATPe-induced uptake of fluorescent anionic dyes. In addition, we describe two new transport phenomena induced by these inhibitors in macrophages: a cation-selective uptake of fluorescent dyes and the release of ATP. The cation uptake requires secreted ATPe, but, differently from the P2X7/ATPe-induced phenomena, it is also present in macrophages derived from mice deficient in the P2X7 gene. Inhibitors of phospholipase A2 and of the AA-cyclooxygenase pathway did not induce the cation uptake. The uptake of non-organic cations was investigated by measuring the free intracellular Ca(2+) concentration ([Ca(2+)]i) by Fura-2 fluorescence. NDGA, but not MK886, induced an increase in [Ca(2+)]i. Chelating Ca(2+) ions in the extracellular medium suppressed the intracellular Ca(2+) signal without interfering in the uptake of cationic dyes. We conclude that inhibitors of the AA-5-LO pathway do not block P2X7 receptors, trigger the release of ATP, and induce an ATP-dependent uptake of organic cations by a Ca(2+)- and P2X7-independent transport mechanism in macrophages.

Performance and characteristics of carcass and non-carcass components of lambs fed peach-palm by-product.

The objective of this study was to evaluate the effects of supplying the by-product of peach-palm (Bactris gasipaes) on performance and characteristics of carcass and non-carcass components of feedlot lambs. Twenty Santa Ines lambs of 150 days average age and 22.4 ± 3.4 kg body weight were confined in individual pens. A completely randomized design was utilized with four experimental diets composed of: fresh peach-palm by-product enriched with urea, fresh peach-palm by-product + concentrate, silage of peach-palm by-product + concentrate, and silage of peach-palm by-product enriched with 15 % corn meal + concentrate. Intake was evaluated daily, and at the end of 42 days of experiments, lambs were slaughtered and the characteristics of carcass and non-carcass parts were evaluated. Performance and carcass characteristics showed differences between the animals' intake of total mixed rations (TMR) and only the diet with roughage. For the lambs that intaked TMR, the form of utilization of roughage (fresh or as silage) affected animal performance but did not change the carcass characteristics. Dry matter intake and feed conversion were influenced by the form of utilization of the silage (with and without additive). Providing fresh by-product plus concentrate improves lamb performance but does not interfere in the carcass characteristics, compared with the use of by-product in the form of silage.

Prevalence of Chlamydia trachomatis endocervical infection in systemic lupus erythematosus patients and evaluation of the risk for HPV-induced lesions.

Chlamydia trachomatis (CT) is the most common bacterial cause of sexually transmitted disease. It has been associated with arthritis and it is a risk factor for human papillomavirus (HPV)-induced lesions. There are few studies on the frequency of CT infection among systemic lupus erythematosus (SLE) patients. The aim of this study was to determine the prevalence of endocervical CT infection among SLE patients and evaluate whether or not CT infection is a risk factor for HPV-induced lesions. A cross-sectional study included a group of patients who fulfilled the American College Rheumatology criteria for a definite diagnosis of SLE and a control group of non-SLE female individuals from Bahia, Brazil. Polymerase chain reaction was used on endocervical swab specimens to test for CT; a gynecological examination including a cervical cytology and biopsy was done for the identification of HPV lesions. A total of 105 SLE patients were studied, and the control group was composed of 104 age-matched apparently normal women. The prevalence of CT endocervical infection was 3.0 % [confidence interval (CI) 95 % = 0.6-8.0 %] in the SLE group and 5.0 % (95 % CI = 2.0-11.0 %) in the control group; the prevalence ratio was 0.60 (95 % CI = 0.1-2.5). The prevalence of vulvar condyloma was higher among SLE patients (11.0 vs. 1.0 %, p < 0.001), as were the prevalences of low-grade lesion (12.0 vs. 1.0 %, p < 0.001) and cervical intraepithelial neoplasia 1 (9.0 vs. 1.0 %, p = 0.02). There was no association between the presence of HPV lesions and CT infections. However, the small number of patients with CT prevents a definite conclusion from being drawn. The prevalence of endocervical CT infection in women with SLE is low and similar to that of the normal population. This suggests that this infection has no role in the pathogenesis of SLE or the development of HPV-induced lesions.

ATP-induced apoptosis involves a Ca2+-independent phospholipase A2 and 5-lipoxygenase in macrophages.

Macrophages express P2X(7) and other nucleotide (P2) receptors, and display the phenomena of extracellular ATP (ATP(e))-induced P2X(7)-dependent membrane permeabilization and cell death by apoptosis and necrosis. P2X(7) receptors also cooperate with toll-like receptors (TLRs) to induce inflammasome activation and IL-1beta secretion. We investigated signaling pathways involved in the induction of cell death by ATP(e) in intraperitoneal murine macrophages. Apoptosis (hypodiploid nuclei) and necrosis (LDH release) were detected 6h after an induction period of 20 min in the presence of ATP. Apoptosis was blocked by caspase 3 and caspase 9 inhibitors and by cyclosporin A. The MAPK inhibitors PD-98059, SB-203580 and SB-202190 provoked no significant effect on apoptosis, but SB-203580 blocked LDH release. Neither apoptosis nor necrosis was inhibited when both intra- and extracellular Ca(2+) were chelated during the induction period. Mepacrine, a generic PLA(2) inhibitor and BEL, an inhibitor of Ca(2+)-independent PLA(2) (iPLA(2)) blocked apoptosis, while pBPB and AACOOPF(3), inhibitors of secretory and Ca(2+)-dependent PLA(2) respectively, had no significant effect. Cycloxygenase inhibitors had no effect on apoptosis, while the inhibitors of lipoxygenase (LOX) and leukotriene biosynthesis nordihydroguaiaretic acid (NDGA), zileuton, AA-861, and MK-886 significantly decreased apoptosis. Neither NDGA nor MK-886 blocked apoptosis of 5-LOX(-/-) macrophages. CP-105696 and MK-571, antagonists of leukotriene receptors, had no significant effect on apoptosis. None of the inhibitors of PLA(2) and LOX/leukotriene pathway had a significant inhibitory effect on LDH release. Our results indicate that a Ca(2+)-independent step involving an iPLA(2) and 5-LOX are involved in the triggering of apoptosis but not necrosis by P2X(7) in macrophages.

Effect of the purinergic receptor P2X7 on Chlamydia infection in cervical epithelial cells and vaginally infected mice.

Ligation of the purinergic receptor, P2X7R, with its agonist ATP has been previously shown to inhibit intracellular infection by chlamydiae and mycobacteria in macrophages. The effect of P2X7R on chlamydial infection had never been investigated in the preferred target cells of chlamydiae, cervical epithelial cells, nor in vaginally infected mice. In this study, we show that treatment of epithelial cells with P2X7R agonists inhibits partially Chlamydia infection in epithelial cells. Chelation of ATP with magnesium or pretreatment with a P2X7R antagonist blocks the inhibitory effects of ATP. Similarly to previous results obtained with macrophages, ATP-mediated inhibition of infection in epithelial cells requires activation of host-cell phospholipase D. Vaginal infection was also more efficient in P2X7R-deficient mice, which also displayed a higher level of acute inflammation in the endocervix, oviduct, and mesosalpingeal tissues than in infected wild-type mice. However, secretion of IL-1beta, which requires P2X7R ligation during infection by other pathogens, was decreased mildly and only at short times of infection. Taken together, these results suggest that P2X7R affects Chlamydia infection by directly inhibiting infection in epithelial cells, rather than through the ability of P2X7R to modulate IL-1beta secretion.

[Möbius sequence: long-term strabismus surgical outcome]. / Seqüência de Möbius: resultados a longo prazo, da correção cirúrgica do estrabismo.

PURPOSE: To analyze the long-term results in a consecutive series of Möbius sequence patients, who underwent surgical correction of strabismus. METHODS: Ten patients with Möbius sequence fulfilled the inclusion criteria of this study. All patients presented esotropia at the preoperative examination, above or equal to 15 prismatic diopters (DP) varying from 15 to 85. All patients presented lateral rectus muscles severe underaction, six presented hipertropia above or equal 10 DP associated with esodeviation, and five presented anisotropia in A or in V. The patients were operated upon protocol, in a consecutive way, in July 2002. Patients were reexamined periodically, and at 2nd postoperative year as for: the visual acuity; deviation measurements; ocular rotations; cosmetic aspect and socialization. RESULTS: The patients presented satisfactory surgical results in eight cases, considering an eso or exodeviation up to 15 DP and a hipertropia lower than 10 DP. Four (40%) patients presented correction of the preoperative anisotropia. Variation of ocular deviation in the primary position (from the 90th day to the 2nd postoperative year was observed) in 9 patients (90%), demonstrating that strabismus surgical stabilization needs time. CONCLUSIONS: The surgical results were considered satisfactory, improving patient self-esteem and the parent satisfaction, making the social inclusion easier.

Seqüência de Möbius: resultados a longo prazo, da correção cirúrgica do estrabismo / Mõbius sequence: long-term strabismus surgical outcome

OBJETIVOS: Analisar os resultados cirúrgicos, a longo prazo, em uma série consecutiva de pacientes com a seqüência de Mõbius, submetidos à correção cirúrgica do estrabismo. MÉTODOS: Dez portadores da seqüência de Mõbius atenderam aos critérios de inclusão. Todos apresentaram esotropia no exame pré-operatório maior ou igual a 15 dioptrias prismáticas (DP), variando de 15 a 85. Todos os pacientes demonstraram hipofunção dos músculos retos laterais, seis, apresentaram hipertropia associada maior ou igual que 10 DP e, cinco, anisotropia em A ou em V. Os pacientes foram submetidos de forma consecutiva à cirurgia para a correção do estrabismo em julho de 2002, de acordo com protocolo previamente elaborado. Todos os casos foram reavaliados periodicamente, analisando-se o resultado visual final no segundo ano pós-operatório, quanto a: acuidade visual, desvio ocular, rotações oculares, estética e socialização. RESULTADOS: Os pacientes apresentaram resultado cirúrgico satisfatório final em oito casos, considerando-se um eso ou exo desvio de até 15 DP e uma hipertropia menor que 10 DP. Quatro (40 por cento) pacientes apresentaram correção da anisotropia pré-operatória. Observou-se variação do desvio ocular em posição primária do olhar (entre o 90° dia e o 2° ano pós-operatório) em 9 pacientes (90 por cento), demonstrando que a estabilização da correção cirúrgica do estrabismo requer tempo. CONCLUSÕES: O resultado cirúrgico final mostrou-se bastante satisfatório, elevando a auto-estima dos pacientes e a de seus genitores, facilitando a sua inclusão social.

PURPOSE: To analyze the long-term results in a consecutive series of Mõbius sequence patients, who underwent surgical correction of strabismus. METHODS: Ten patients with Mõbius sequence fulfilled the inclusion criteria of this study. All patients presented esotropia at the preoperative examination, above or equal to 15 prismatic diopters (DP) varying from 15 to 85. All patients presented lateral rectus muscles severe underaction, six presented hipertropia above or equal 10 DP associated with esodeviation, and five presented anisotropia in A or in V. The patients were operated upon protocol, in a consecutive way, in July 2002. Patients were reexamined periodically, and at 2nd postoperative year as for: the visual acuity; deviation measurements; ocular rotations; cosmetic aspect and socialization. RESULTS: The patients presented satisfactory surgical results in eight cases, considering an eso or exodeviation up to 15 DP and a hipertropia lower than 10 DP. Four (40 percent) patients presented correction of the preoperative anisotropia. Variation of ocular deviation in the primary position (from the 90th day to the 2nd postoperative year was observed) in 9 patients (90 percent), demonstrating that strabismus surgical stabilization needs time. CONCLUSIONS: The surgical results were considered satisfactory, improving patient self-esteem and the parent satisfaction, making the social inclusion easier.

The role of P2 receptors in controlling infections by intracellular pathogens.

A growing number of studies have demonstrated the importance of ATP(e)-signalling via P2 receptors as an important component of the inflammatory response to infection. More recent studies have shown that ATP(e) can also have a direct effect on infection by intracellular pathogens, by modulating membrane trafficking in cells that contain vacuoles that harbour intracellular pathogens, such as mycobacteria and chlamydiae. A conserved mechanism appears to be involved in controlling infection by both of these pathogens, as a role for phospholipase D in inducing fusion between lysosomes and the vacuoles has been demonstrated. Other P2-dependent mechanisms are most likely operative in the cases of pathogens, such as Leishmania, which survive in an acidic phagolysosomal-like compartment. ATP(e) may function as a "danger signal" that alerts the immune system to the presence of intracellular pathogens that damage the host cell, while different intracellular pathogens have evolved enzymes or other mechanisms to inhibit ATP(e)-mediated signalling, which should, thus, be viewed as virulence factors for these pathogens.

ATP activates a reactive oxygen species-dependent oxidative stress response and secretion of proinflammatory cytokines in macrophages.

Secretion of the proinflammatory cytokines, interleukin (IL)-1beta and IL-18, usually requires two signals. The first, due to microbial products such as lipopolysaccharide, initiates transcription of the cytokine genes and accumulation of the precursor proteins. Cleavage and secretion of the cytokines is mediated by caspase-1, in association with an inflammasome containing Nalp3, which can be activated by binding of extracellular ATP to purinergic receptors. We show that treatment of macrophages with ATP results in production of reactive oxygen species (ROS), which stimulate the phosphatidylinositol 3-kinase (PI3K) pathway and subsequent Akt and ERK1/2 activation. ROS exerts its effect through glutathionylation of PTEN (phosphatase and tensin homologue deleted from chromosome 10), whose inactivation would shift the equilibrium in favor of PI3K. ATP-dependent ROS production and PI3K activation also stimulate transcription of genes required for an oxidative stress response. In parallel, ATP-mediated ROS-dependent PI3K is required for activation of caspase-1 and secretion of IL-1beta and IL-18. Thus, an increase in ROS levels in ATP-treated macrophages results in activation of a single pathway that promotes both adaptation to subsequent exposure to oxidants or inflammation, and processing and secretion of proinflammatory cytokines.

Activation of ERK1/2 by extracellular nucleotides in macrophages is mediated by multiple P2 receptors independently of P2X7-associated pore or channel formation.

Macrophages express several P2X and P2Y nucleotide receptors and display the phenomenon of ATP-induced P2X7-dependent membrane permeabilization, which occurs through a poorly understood mechanism. Several P2 receptors are known to be coupled to the activation of mitogen-activated protein kinases (MAPKs) and Ca2+ signaling. Here, we use macrophages to investigate the phosphorylation of extracellular signal-regulated kinases 1 and 2 (ERK1/2) by nucleotides and the involvement of MAPKs and intracellular Ca2+ concentration in ATP-induced membrane permeabilization. Short-term (5 min) pre-exposure to oxidized ATP (oATP), a P2X7 antagonist that does not inhibit P2X7-associated inward currents or membrane permeabilization, inhibits the activation of ERK1/2 by ATP, ADP, the P2X7 agonist 2'-3'-O-(4-benzoylbenzoyl)-ATP (BzATP), but not by UTP and UDP. We conclude that macrophages display several P2Y receptors coupled to the ERK1/2 pathway and that oATP antagonizes the action of purine nucleotides, possibly binding to P2X7 and/or other purine-binding P2Y receptors. We also show that BzATP and ATP activate ERK1/2 by two different pathways since ERK1/2 activation by BzATP, but not by ATP, is blocked by the tryrosine kinase inhibitor, genistein, and the Src protein kinase inhibitor, tyrphostin. However, the activation of ERK1/2 by ATP is blocked by the protein kinase C (PKC) inhibitor, chelerythrine chloride. Under the same conditions, membrane permeabilization is not blocked by genistein, tyrphostin, or chelerythrine chloride, indicating that tyrosine kinase, Src protein kinase, and PKC are not required for pore opening. Membrane permeabilization is independent of ERK1/2 activation since chelerythrine, or short-term exposure to oATP or PD98059, efficiently block ERK1/2 activation without inhibiting membrane permeabilization. In addition, membrane permeabilization is not inhibited by SB203580 and SB202190, two inhibitors of p38 MAPK, nor by intracellular BAPTA, which blocks ATP-induced Ca2+ signals. These results suggest that multiple P2 receptors lead to ERK1/2 activation, that ligation of the same receptors by agonists with different affinities can lead to differential stimulation of separate pathways, and that MAPKs and intracellular Ca2+ fluxes are independent of P2X7-associated pore formation.

[Cataract in childhood: socioeconomic and gestational profiles and neuropsychomotor development]. / Catarata na infância: perfil socioeconômico, gestacional e desenvolvimento neuropsicomotor.

PURPOSE: To analyze the socioeconomic and gestational profiles, and the neuropsychomotor development of patients with infantile cataract cared for at a medical ophthalmologic center in Pernambuco state, Brazil. METHODS: A standardized questionnaire was applied, in October and November 2003, to the parents of children who underwent child cataract surgery at the Altino Ventura Foundation. RESULTS: Of the 40 patients, 23 were females (57.0%) and 17 males (43.0%). Most of the mothers (65.0%) and fathers (55.0%) of the children informed that they had not finished elementary school. The family income was between 1 and 3 minimum wages in 70.0% of the cases. As for the parental marital status, 40.0% of them were married. Thirty-nine mothers (97.5%) underwent prenatal exams, 37 reported that they had not received rubella immunization (92.5%), and 13 reported rubella during their pregnancy (32.5%). Three mothers reported consanguinity with their husbands and 5 were exposed to medications during pregnancy. Most of the patients had a neuropsychomotor development within limits considered normal by other studies. Fourteen patients (35.0%) were 6 years or older when the interview was performed. Eleven (78.6%) of these children attended school and 45.4% of them had to repeat the school grade. CONCLUSION: It was observed in the studied sample that the patients were characterized by being part of a low-income population. Less than half of the interviewed parents were married and the patients presented low school performance. Insufficiencies in the health system as regards immunization against rubella was identified.

Catarata na infância: perfil socioeconômico, gestacional e desenvolvimento neuropsicomotor / Cataract in childhood: socioeconomic and gestational profiles and neuropsychomotor development

OBJETIVO: Analisar o perfil socioeconômico e gestacional e o desenvolvimento neuropsicomotor de pacientes com catarata infantil atendidos em centro de referência oftalmológica no estado de Pernambuco, Brasil. MÉTODOS: Aplicou-se um questionário estruturado, em outubro e novembro de 2003, aos genitores das crianças submetidas à cirurgia de catarata infantil na Fundação Altino Ventura. RESULTADOS: Dos 40 pacientes, 23 eram do gênero feminino (57,0 por cento) e 17 do masculino (43,0 por cento). A maioria das mães (65,0 por cento) e dos pais (55,0 por cento) das crianças informou ter como grau de instrução o primeiro grau incompleto. A renda familiar variou de 1 a 3 salários mínimos, em 70,0 por cento dos casos. Quanto ao estado civil 40,0 por cento dos genitores eram casados. Trinta e nove mães (97,5 por cento) fizeram pré-natal, 37 (92,5 por cento) referiram não terem sido imunizadas contra a rubéola, e 13 (32,5 por cento) referiram rubéola na gravidez. Três mães (7,5 por cento) referiram consangüinidade com seus cônjuges e cinco (12,5 por cento) relataram exposição a medicamentos durante a gestação. O desenvolvimento neuropsicomotor da maioria dos pacientes analisados estava dentro dos limites tidos como normais em outros estudos. Quatorze pacientes (35,0 por cento) tinham idade maior ou igual que 6 anos no momento da entrevista e, onze desses (78,5 por cento) estavam na escola. O índice de repetência escolar dessas crianças foi de 45,4 por cento. CONCLUSAO: Na amostra estudada, observou-se que os pacientes caracterizavam-se por pertencerem a uma população de baixa renda. Menos da metade dos pais entrevistados eram casados e, os pacientes tinham baixo rendimento escolar. Identificaram-se falhas no sistema de saúde quanto à imunização para rubéola.