Influence of the nutritional status in the clinical and therapeutical evolution in adults and elderly with American Tegumentary Leishmaniasis.

The objective of this study is to describe the nutritional status of adult and elderly patients with American Tegumentary Leishmaniasis (ATL). It was conducted a longitudinal study in 68 adult and elderly patients with ATL treating at the Surveillance Leishmaniasis Laboratory at the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation (Fiocruz), from 2009 to 2012. The nutritional assessment included the body mass index (BMI) and serum albumin levels. The clinical evolution (epithelialization and wound healing) was measured up to two years after ATL treatment. Most of the sample was composed of men (71%), adults (73%), with household income of 1-5 minimum wages (79%), and incomplete elementary school (48.5%). The predominant ATL form was cutaneous (72%), and 39% presented comorbidities, the most frequent was hypertension (30.8%). The most prevalent clinical and nutritional events were: recent decrease in food intake (23.9%); nasal obstruction (22.1%); oral ulcer (14.7%), anorexia and dysphagia (13.2% each) and odynophagia (10.3%). The total healing time was 115.00 (IR=80-230) days for skin lesions, and 120.00 (IR=104.50-223.50) days for mucous membrane lesions. Low body weight in 10%, and hypoalbuminemia in 12% of the patients have been observed. Low body weight was associated with age, mucosal leishmaniasis (ML), nasal obstruction, recent decrease in food intake and hypoalbuminemia. As for serum albumin depletion, association with the ML, dyspnea, dysphagia, odynophagia, recent decrease in food intake, absence of complete healing of the skin lesions, and increased healing time for mucous membrane lesions, was observed. The ML and their events that affect the alimentary intake have been related to the impairment of the nutritional status. Additionally, serum albumin depletion negatively affected the healing of the lesions, suggesting that a nutritional intervention can increase the effectiveness of the ATL treatment.

Signs of an in situ inflammatory reaction in scars of human American tegumentary leishmaniasis.

Skin inflammation plays an important role during the healing of American tegumentary leishmaniasis (ATL), the distribution of cells in active lesions may vary according to disease outcome and parasite antigens in ATL scars have already been shown. We evaluated by immunohistochemistry, 18 patients with 1- or 3-year-old scars and the corresponding active lesions and compared them with healthy skin. Small cell clusters in scars organized as in the active lesions spreaded over the fibrotic tissue were detected, as well as close to vessels and cutaneous glands, despite a reduction in the inflammatory process. Analysis of 1-year-old scar tissue showed reduction of NOS2, E-selectin, Ki67, Bcl-2 and Fas expression. However, similar percentages of lymphocytes and macrophages were detected when compared to active lesions. Only 3-year-old scars showed reduction of CD3(+), CD4(+) and CD8(+)T cells, in addition to reduced expression of NOS2, E-selectin, Ki67 and BCl-2. These results suggest that the pattern of cellularity of the inflammatory reaction observed in active lesions changes slowly even after clinical healing. Analysis of 3-year-old scars showed reduction of the inflammatory reaction as demonstrated by decrease in inflammatory cells and in the expression of cell-activity markers, suggesting that the host-parasite balance was only established after that period.

ChromaPipe: a pipeline for analysis, quality control and management for a DNA sequencing facility.

Optimizing and monitoring the data flow in high-throughput sequencing facilities is important for data input and output, for tracking the status of results for the users of the facility, and to guarantee a good, high-quality service. In a multi-user system environment with different throughputs, each user wants to access his/her data easily, track his/her sequencing history, analyze sequences and their quality, and apply some basic post-sequencing analysis, without the necessity of installing further software. Recently, Fiocruz established such a core facility as a "technological platform". Infrastructure includes a 48-capillary 3730 DNA Sequence Analyzer (Applied Biosystems) and supporting equipment. The service includes running samples for large-scale users, performing DNA sequencing reactions and runs for medium and small users, and participation in partial or full genome projects. We implemented a workflow that fulfills these requirements for small and high throughput users. Our implementation also includes the monitoring of data for continuous quality improvement (reports by plate, month and user) by the sequencing staff. For the user, different analyses of the chromatograms, such as visualization of good quality regions, as well as processing, such as comparisons or assemblies, are available. So far, 180 users have made use of the service, generating 155,000 sequences, 35% of which were produced for the BCG Moreau-RJ genome project. The pipeline (named ChromaPipe for Chromatogram Pipeline) is available for download by the scientific community at the url http://bioinfo.pdtis.fiocruz.br/ChromaPipe/. The support for assembly is also configured as a web service: http://bioinfo.pdtis.fiocruz.br/Assembly/.

O conceito de relevência pública na Constituição Federal / The concept of public relevance in the Federal Constitution

A finalidade do texto é indicar significado, o conteúdo e o alcance da expressão relevância pública, com um ponto de vista mais conceitual que operacional. À luz da proposta, os autores tratam da polissemia da expressão público e demonstram, utilizando passagens no texto constitucional, que existe distinção entre público e social. Justificam a antinomia entre expressões interesse do Estado e interesse da comunidade e apresentam a necessidade de se fazer uma interpretação sistemática, diante da possibilidade de não haver coincidência entre os interesses primários e secundários. Expõem a problemática recorrente da imprecisão do conceito de interesse público e destacam suas novas modalidades. Por fim, trabalham a questão da ampliação da atuação do Ministério Público e distinguem serviços públicos de serviços de relevância pública.

[A review of the pharmacologic treatment of migraine in children]. / Revisión del tratamiento farmacológico de la migraña en niños.

OBJECTIVE: To describe the efficacy and tolerability of the different medications used to treat migraine in children and adolescents. DEVELOPMENT: A literature review of the drug studies involving children and adolescents for the treatment of migraine was conducted. The treatment of migraine is divided into abortive and prophylactic. The different classes of drugs are described in respect to its efficacy and side effects. Few placebo-controlled, double-blind studies are available in children as compared to adults for the treatment of migraine headaches. Only ibuprofen and nasal sumatriptan have been studied and shown to be effective in more than one double blind placebo-controlled study for the abortive treatment of migraine in children. Unlike the adult studies, the oral triptans tested in children have not been effective when compared to placebo. Only flunarizine has shown efficacy in more than one placebo controlled trial for the prophylactic treatment. CONCLUSION: Most of the medications used to treat migraine in children and adolescents are well tolerated. The treatment response of migraine in children and adolescents may differ from that of adults. There seems to be a high placebo response rate in the pediatric population. Therefore, further prospective placebo-controlled studies are needed.

Revisión del tratamiento farmacológico de la migraña en niños / A review of the pharmacologic treatment of migraine in children

Objetivo. Describir la eficacia y tolerabilidad de los distintos fármacos empleados en el tratamiento de la migraña en la infancia y la adolescencia. Desarrollo. Se realizó una revisión de la bibliografía sobre estudios farmacológicos del tratamiento de la migraña llevados a cabo en la infancia y la adolescencia. Hay dos tipos de tratamiento para la migraña: el abortivo y el profiláctico. Se detallan las reacciones adversas y la eficacia de los diferentes tipos de fármaco. Se han publicado pocos estudios controlados por placebo y de doble ciego sobre el tratamiento de las cefaleas migrañosas en niños, comparados con los que se han publicado en adultos. El ibuprofeno y el sumatriptán por vía nasal son los únicos fármacos que se han investigado y que han demostrado ser eficaces en el tratamiento abortivo de la migraña en los niños en más de un estudio de doble ciego controlado por placebo. A diferencia de los estudios en los adultos, los triptanos orales probados en niños no han demostrado ser eficaces con respecto a los placebos. Sólo la flunarizina ha resultado ser eficaz como tratamiento profiláctico en más de una prueba controlada por placebo. Conclusión. La mayor parte de los fármacos que se emplean en el tratamiento de la migraña en los niños y los adolescentes se toleran bien. La respuesta al tratamiento de la migraña en los niños y los adolescentes puede ser distinta a la que se observa en los adultos. Entre la población pediátrica parece haber un alto índice de respuesta a los placebos. Es necesario, por tanto, la realización de más estudios prospectivos controlados por placebo (AU)

Objective. To describe the efficacy and tolerability of the different medications used to treat migraine in children and adolescents. Development. A literature review of the drug studies involving children and adolescents for the treatment of migraine was conducted. The treatment of migraine is divided in abortive and prophylactic. The different classes of drugs are described in respect to its efficacy and side effects. Few placebo-controlled, double-blind studies are available in children as compared to adults for the treatment of migraine headaches. Only ibuprofen and nasal sumatriptan have been studied and shown to be effective in more than one double blind placebo-controlled study for the abortive treatment of migraine in children. Unlike the adult studies, the oral triptans tested in children have not been effective when compared to placebo. Only flunarizine has shown efficacy in more than one placebo-controlled trial for the prophylactic treatment. Conclusion. Most of the medications used to treat migraine in children and adolescents are well tolerated. The treatment response of migraine in children and adolescent may differ from that of adults. There seems to be a high placebo response rate in the pediatric population. Therefore, further prospective placebo-controlled studies are needed (AU)

Continuous-display four-channel electroencephalographic monitoring in the evaluation of neonates with paroxysmal motor events.

The objective of this study was to determine the value of continuous-display four-channel electroencephalographic (EEG) monitoring to distinguish epileptic front nonepileptic paroxysmal motor events. Five full-term neonates with paroxysmal motor events were included in the study. Nurses were instructed to print contiguous pages of the continuous-display four-channel EEG monitoring and to activate the event marker on the simultaneously conducted continuous video-EEG telemetry unit during each paroxysmal motor event. The printouts from the continuous-display four-channel EEG monitoring were interpreted and compared with the corresponding segments of continuous video-EEG telemetry. Thirty paroxysmal motor events were captured. Sixteen paroxysmal motor events were epileptic, and 14 were nonepileptic. The interpretation of the printouts of the continuous four-channel EEG monitoring concurred with an independent interpretation of the corresponding video-EEG telemetry segments in all of the events. Continuous-display four-channel EEG monitoring is a valuable tool in the evaluation of neonates with paroxysmal motor events since it reliably distinguishes epileptic and nonepileptic events.

Internal carotid artery thrombus: an underdiagnosed source of brain emboli in neonates?

We report a full-term neonate with a left middle cerebral artery infarct, narrowing of the internal carotid artery detected by magnetic resonance angiography and B-mode ultrasonography, and a large thrombus at the origin of the internal carotid artery detected by B-mode ultrasonography. Internal carotid arterial thrombus is seldom considered the source of middle cerebral arterial embolus in neonates. We suggest that B-mode ultrasonography of the carotid artery be included in the diagnostic evaluation of middle cerebral artery infarcts in neonates.

Mental retardation in pediatric candidates for epilepsy surgery: the role of early seizure onset.

PURPOSE: We sought to determine whether early age at seizure onset is a risk factor for mental retardation, independent of etiology. Assessment of risk for mental retardation with continued uncontrolled seizures plays a role in considerations of timing for epilepsy surgery. Previous studies have indicated that onset of seizures in the first years of life may be a risk factor for mental retardation, but the etiologies of the epilepsies were not included in the analyses. METHODS: Intellectual function was assessed at ages 2-20 years during presurgical evaluation in 100 patients with intractable epilepsy due to focal lesions limited to part of one lobe of the brain. Mental retardation (MR) was defined as Full-Scale Intelligence Quotient (FSIQ) < or =70. The age at seizure onset and the seizure frequency were obtained retrospectively. RESULTS: Younger ages at seizure onset were associated with lower FSIQ scores, and mean FSIQ was also significantly lower for patients with onset of epilepsy at < or =24 months of age (74.0 +/- 21.5) versus that in patients with onset of epilepsy later in life (87.8 +/- 18.8; p = 0.005). The frequency of patients with MR was significantly higher for patients with seizure onset at < or =24 months of age (15 of 33, 46%) than for patients with seizure onset later in life (eight of 67, 12%; p < 0.001). This difference persisted within etiologic subgroups. For patients with focal malformation of cortical development, MR was seen in eight (50%) of 16 patients with seizure onset at < or =24 months versus two (10%) of 20 patients with seizure onset at >24 months (p < 0.001); for patients with tumor, MR was seen in four (50%) of eight patients with seizure onset at < or =24 months versus four (13%) of 30 patients with seizure onset at >24 months (p = 0.003); and for patients with hippocampal sclerosis, MR was seen in two (28%) of seven patients with seizure onset at < or =24 months versus none of 30 patients with seizure onset at >24 months (NS). Within the subgroup with daily seizures, MR was present in 13 (65%) of 20 patients with seizure onset at < or =24 months versus five (17%) of 29 patients with seizure onset later in life (p = 0.001). CONCLUSIONS: These results indicate that onset of intractable epilepsy within the first 24 months of life is a significant risk factor for MR, especially if seizures occur daily. The risk based on early age at seizure onset appeared independent of etiology and persisted within subgroups of patients with focal malformation of cortical development, tumor, or hippocampal sclerosis. Prospective studies will be important to clarify whether early surgical intervention may reduce the risk for subsequent MR in carefully selected infants.

Epidemiologia dos acidentes no surfe no Brasil / Epidemiology of surfing accidents in Brazil

Apesar do grande número de praticantes do surfe no Brasil, nenhum trabalho científico nacional foi dedicado à caracterizaçäo e análise epidemiológica das lesões esportivas desse grupo.Pretendeu-se com este estudo identificar os tipos e lesões mais frequentes relacionadas à prática do surfe recreacional e competitivo no Brasil...

Pediatric manifestations of Hashimoto's encephalopathy.

Hashimoto's encephalopathy is a steroid-responsive encephalopathy associated with elevated blood concentrations of antithyroid antibodies. The patients are usually euthyroid or mildly hypothyroid. The authors report two pediatric patients with Hashimoto's encephalopathy and review the literature. The clinical picture in adolescents, as with adults, is pleomorphic but frequently associated with seizures, confusion, and hallucinations. Alternatively, progressive cognitive decline manifested by a drop in school performance can be observed. The diagnosis of Hashimoto's thyroiditis is often overlooked at presentation and a high degree of suspicion is necessary for proper diagnosis.

Urban development and traffic accidents in Brazil.

Brazil started to experience high traffic accident rates since the 1960s, when road transportation began to be dominant and the number of motorized vehicles increased sharply. The severity of the problem was also related to the fast and uncontrolled urban growth, which allowed for the organization of an inherently dangerous circulation space, characterized by a complex pattern of traffic conflicts. With respect to traffic accidents, the results have been highly negative: national statistics report about 28,000 fatalities a year, with more than 340,000 injured people. The paper analyses current patterns of traffic accidents in urban areas, using the data from two of the three largest cities in the country. Hospital data is analyzed to understand the true social impacts of such accidents. Several causal factors are identified, at the political, cultural and technical sides. Challenges to change current conditions are also identified. Practical measures are suggested, especially the change of the dangerous environment and the need to improve the technical approach to the problem, education programs and enforcement logistics.

Analgesic rebound headache in children and adolescents.

For more than a decade, the frequent use of analgesics has been recognized to lead to daily headaches in adults. To date, no studies on the occurrence of analgesic rebound headache have been done on the pediatric population. We retrospectively reviewed all charts of patients with the diagnosis of headache seen in our pediatric headache clinic between January 1996 and May 1997. Among the 98 patients seen, 46 (47%) suffered from daily or near daily headaches; 30 of them were consuming daily analgesics. Twenty-four patients (mean age 12.1 years, and mean follow-up 6.2 months) successfully discontinued their analgesics. Twenty-two patients were also placed on amitriptyline. A significant reduction in the frequency (80%), severity (47%), and number of school days missed (74%) were seen. In conclusion, this data is comparable to previous observations reported in adults, and suggests that the daily use of analgesics might result in daily or near daily headaches in the pediatric population. Discontinuing daily analgesics, with the concomitant use of amitriptyline, is an effective treatment for analgesic rebound headache in this population.

MRI nerve root enhancement in Krabbe disease.

Krabbe disease is characterized by abnormal breakdown and turnover of myelin, leading to extensive demyelination in both the peripheral and central nervous systems. A 7-month-old infant with early-onset Krabbe disease had deceptively normal head images, but spinal MRI demonstrated abnormal gadolinium enhancement of the lumbosacral sacral nerve roots and cauda equina such as that seen in Guillain-Barré syndrome. Abnormal enhancement in spinal MRI has not been previously described in patients with leukodystrophies.

Short-wavelength far-infrared laser cavity yielding new lines in methanol.

We report 16 new laser lines generated in a short-wavelength far-infrared Fabry-Perot laser cavity. The CO(2) pump laser is coupled into the far-infrared laser outside the far-infrared laser mode, and the cavity uses a 45 degrees adjustable output coupling mirror; this combination results in a low-loss Fabry-Perot cavity for wavelengths below 150 microm. The new lines are of medium and strong intensity and have wavelengths in the region 26.2-125.7 microm.