Evaluation of the Amazonian fruit Ambelania acida: Chemical and nutritional studies.

Ambelania acida is native to the Amazon region, with few published studies of its fruits. We examined the proximate composition of its fruits, including minerals, fatty acids, volatile organic compounds (VOCs), as well as its antioxidant capacity. The protein contents (2.61%) of the pulp and seeds (13.6%) were higher than observed in other taxa of the family or in other tropical fruits. Peel and pulp showed high contents of potassium, calcium, and magnesium, and the potassium content in the pulp was 1125 mg/100 g. The peel had higher contents of total phenolics, tannins, and ortho-diphenols than the pulp, as well as better antioxidant activity as evidenced by 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), 1,1-diphenyl-2-picrylhydrazyl (DPPH), Ferric Reducing Antioxidant Power (FRAP), and Fe2+ chelating activity assays. GC-MS analyses identified 42 VOCs in the peel and pulp, with more than 90% being classified as terpenes. Eleven types of fatty acids were identified in the lipid fractions of the peel, pulp, and seeds. Linoleic acid, an essential fatty acid for humans, was the principal fatty acid in the edible portion of the fruit, therefore, evidencing its nutritionally significant profile for the fruits when considering the relationship among polyunsaturated, saturated, and monounsaturated fatty acids. The information gathered here indicates that this native fruit is a healthy food source and its cultivation and consumption should be stimulated.

Chemical and nutritional characterization of Ambelania duckei (Apocynaceae) an unexplored fruit from the Amazon region.

Ambelania duckei Markgr is a species of the Apocynaceae family, native to the Amazon region that is unexplored from a nutritional point of view and studied in relation to its chemical constituents. This work presents an unprecedented study of the proximate composition, lipid profile, a chromatographic analysis, and the antioxidant activity of extracts obtained from the pulp, peel and seeds of the fruit. The results showed that potassium, calcium, and magnesium stood out as the most abundant key minerals in the fruit peel and pulp, with an emphasis on the potassium present in the fruit pulp at 1750.0 mg/100 g. The peel had the highest content of total phenolics (374.86 mg/g), flavonoids (15.54 mg/g), tannins (27.45 mg/g) and O-diphenols (379.36 mg/g; 645.71 mg/g). The antioxidant activity (AA) was highest in the peel compared to the pulp in the DPPH, ABTS, and ORAC tests showing: IC50 of 29.82; 43.67; and 407.13 µg/mL, respectively but a lower activity for the Fe2+ chelator. The analysis of the lipid fractions from the peel, pulp, and seeds of the A. duckei fruit resulted in 14 types of fatty acids. The major fatty acids found in the three parts of the fruit were oleic acid (peel, 22.52 %), palmitic acid (pulp, 17.34 %), and linoleic acid (seeds, 47.99 %). The lipid profile and nutritional aspects had a PUFA/SFA ratio (0.4-1.8) in the different parts of the A. duckei fruit; the atherogenic and thrombogenic indexes were higher in the peel (1.23) and pulp (0.62), respectively. The ratio between the hypocholesterolemic and hypercholesterolemic fatty acids (0.5 - 3.8) calculated for the fruit are within the desirable range for a nutritious food. The chromatographic analysis of the volatile organic compounds (VOCs) from the peel and pulp of the fruit, identified 74 VOCs, of which 60.9 % are related to terpenes, and emit notes such as cucumber, green, fatty, floral, and mint, due to the presence of substances with OAVs > 10, especially α-ionone, 1,8-cineole, 2,4-decadienal, and dodecanal. The analysis of the MS and MS/MS spectra of the chromatograms obtained by LC- QTOF-HRMS led to the identification of 26 compounds in the peel, seeds and pulp of A. duckei, such as fatty acids, phenolic acid, flavonoids, proanthocyanidins, alkaloids, and terpenoids. The results show that the pulp of A. duckei has potential as nourishing food and the nutritional and chemical aspects of the peel can be applied to commercial applications.

Intoxicação cutânea grave por Paraquat / Serious skin poisoning by Paraquat

O Paraquat é um herbicida não seletivo altamente tóxico, sendo responsável por altas taxas de letalidade acidentais ou provocadas, devido, principalmente, à insuficiência respiratória. Apesar de a intoxicação por via oral ser a principal e mais grave, o contato prolongado com a substância em uma grande área corporal pode gerar uma toxicidade similar e levar ao óbito ­ fato pouco elucidado na literatura. Este é o relato de caso de um homem de 22 anos, que foi admitido em um hospital devido a queixas de mal-estar, náuseas, febre, cefaleia, dor abdominal, diarreia, queimaduras e dispneia. A suspeita diagnóstica inicial foi de hantavirose, leptospirose, dengue e tromboembolismo pulmonar e, posteriormente, foi comprovado intoxicação exógena com agrotóxico por via inalatória e cutânea. Exames de imagem revelaram fibrose pulmonar difusa e ele também apresentou alterações renais, hepáticas e coagulatórias. Como não há antídoto específico, foi empregado tratamento sintomático e suportivo, com uso de carvão ativado, antibióticos, corticoides, antioxidantes e hemodiálise. No entanto, o paciente teve uma piora progressiva do quadro, vindo a óbito devido à síndrome da angústia respiratória aguda e fibrose pulmonar. O Paraquat, embora proibido no Brasil em 2020, continua sendo utilizado de forma ilegal. Além disso, seu substituto, o Diquat, possui toxicidade semelhante. Assim, é fundamental que os profissionais da saúde reconheçam o diagnóstico da intoxicação por tais substâncias e suas diferentes vias de exposição. Também são necessárias novas medidas de fiscalização das substâncias e maior investimento em educação em saúde para evitar exposições acidentais, assim como relatado (AU).

Paraquat is a highly toxic non-selective herbicide and is responsible for high accidental or provoked lethality rates, mainly due to respiratory failure. Although oral poisoning is the primary and most severe, prolonged contact with the substance in a large body area can lead to similar toxicity and death ­ a fact that is little elucidated in the literature. This is the case report of a 22-year-old man admitted to a hospital due to complaints of malaise, nausea, fever, headache, abdominal pain, diarrhea, burns and dyspnea. The initial diagnostic suspicion was hantaviruses, leptospirosis, dengue and pulmonary thromboembolism, and there was subsequently proven exogenous intoxication with pesticides by inhalation and cutaneous route. Imaging tests revealed diffuse pulmonary fibrosis and he also had renal, hepatic and coagulation alterations. As there is no specific antidote, symptomatic and supportive treatment was performed using activated charcoal, antibiotics, corticosteroids, antioxidants and hemodialysis. However, the patient had a progressive worsening of the condition and died due to acute respiratory distress syndrome and pulmonary fibrosis. Paraquat, although banned in Brazil in 2020, continues to be used illegally. In addition, its substitute, the Diquat, has similar toxicity. Thus, it is essential that health professionals recognize the diagnosis of intoxication by such substances and their different exposure routes. New control measures for these substances and greater investment in health education are also needed to prevent accidental exposure, as reported (AU).

Allocation of sanitary landfill in consortium: strategy for the Brazilian municipalities in the State of Amazonas.

One of the current problems faced by the Brazilian municipalities is the adequate disposal of municipal solid waste in landfills while considering the environmental dimension. In addition to the design and technical requirements, the analysis of possible sites is a process requiring an evaluation of different criteria. With the proposal to minimize and rationalize efforts for site selection, this paper presents a methodology to evaluate its suitability based on certain criteria (legal, technical, environmental). The selection of the most preferable areas for the installation of a landfill is in context of a model for municipal consortium proposed in the State Plan of Solid Waste of Amazonas which applies to the municipalities of Atalaia do Norte, Benjamin Constant, and Tabatinga. The Analytic Hierarchy Process method was combined with geoprocessing tools in order to determine the relative importance of the evaluation criteria while considering the inherent limitations of data availability for the area of study. Thus, based on the participation of expert groups an aptitude map was produced where 47 potential areas were identified as suitable for the installation of a landfill in those municipalities. Among them, the most suitable is located near the highway that connects the municipalities of Benjamin Constant and Atalaia do Norte.

Pain Relief in CRPS-II after Spinal Cord and Motor Cortex Simultaneous Dual Stimulation.

UNLABELLED: We describe a case of a 30-year-old woman who suffered a traumatic injury of the right brachial plexus, developing severe complex regional pain syndrome type II (CRPS-II). After clinical treatment failure, spinal cord stimulation (SCS) was indicated with initial positive pain control. However, after 2 years her pain progressively returned to almost baseline intensity before SCS. Additional motor cortex electrode implant was then proposed as a rescue therapy and connected to the same pulse generator. This method allowed simultaneous stimulation of the motor cortex and SCS in cycling mode with independent stimulation parameters in each site. At 2 years follow-up, the patient reported sustained improvement in pain with dual stimulation, reduction of painful crises, and improvement in quality of life. The encouraging results in this case suggests that this can be an option as add-on therapy over SCS as a possible rescue therapy in the management of CRPS-II. However, comparative studies must be performed in order to determine the effectiveness of this therapy. KEY WORDS: Chronic neuropathic pain, Complex regional pain syndrome Type II, brachial plexus injury, motor cortex stimulation, spinal cord stimulation.

Atypical Presentation of Temporal Dermoid Cyst: Case Report / Apresentação atípica de cisto dermoide temporal: caso clínico

Dermoid account for 0.04­0.06% of intracranial tumors. The rupture of these slowgrowing lesions are a rare event, generally taking place spontaneously. Their presentation are clinically variable according to cyst topography and integrity. Surgery remains the first-line therapy and gross total resection should be attempted if feasible. We report on a case of a 22-year-old male with a 2-year history of seizures and cognitive impairment and a temporal mesial dermoid cyst successfully treated with gross total resection microsurgery.

Os Cistos dermoides compreendem 0,04­0,06% dos tumores intracranianos. É uma lesão de crescimento lento, e sua ruptura é um evento raro e espontâneo. A variabilidade clínica vai de acordo com a topografia do cisto e sua integridade. A cirurgia continua a ser a terapia de primeira linha, e a ressecção total é a opção sempre que for possível. Os autores relatam um caso de paciente com 22 anos de idade com histórico de 2 anos de convulsões e comprometimento cognitivo e diagnosticado com um cisto dermoide mesial temporal, tratado com sucesso com ressecção microcirúrgica.

Características morfogênicas e estruturais do capim-braquiária em locais do mesmo pasto com distintos graus de pastejo / Morphogenetical and structural characteristics of signal grass in the locations of same pasture with different grazing degrees

Em locais de um mesmo pasto, existem plantas submetidas aos distintos graus de pastejo, o que desencadeia mudanças nas suas características morfogênicas e estruturais, como forma de otimizar o seu crescimento e persistência. Desse modo, objetivou-se avaliar a morfogênese de perfilhos em locais do mesmo pasto de Brachiaria decumbens cv. Basilisk (capim-braquiária) com níveis de pastejo variáveis, quais sejam: local com subpastejo, com pastejo adequado e com sobrepastejo. O capim-braquiária foi manejado em lotação contínua com bovinos e com altura média de 25 cm. Adotou-se o delineamento em blocos casualizados com três repetições. A taxa de aparecimento foliar foi inferior no local subpastejado em relação aos demais locais avaliados. Contudo, o filocrono, a duração de vida da folha, o número de folha morta e as taxas de alongamento de colmo e de senescência foliar foram maiores no local subpastejado, quando cotejado aos locais com pastejo adequado e com sobrepastejo. Os números de folhas expandidas, em expansão e vivas não diferiram entre os locais avaliados. A taxa de alongamento foliar e os comprimentos da lâmina foliar e do pseudocolmo foram menores no local com sobrepastejo em comparação aos outros locais avaliados. O pastejo desuniforme dos bovinos faz com que as características morfogênicas e estruturais dos perfilhos de B. decumbens sejam variáveis no plano horizontal da pastagem, o que resulta na estrutura horizontal do pasto.

In areas the same pasture, there are plants of different grazing degrees, which triggers changes in their morphogenetic and structural characteristics as a way to optimize their growth and persistence. Thus, this study was conducted to evaluate the morphogenesis of tillers in areas of same Brachiaria decumbens cv. Basilisk pasture (signalgrass) with variable grazing levels, namely: undergrazed site, site with proper grazing and overgrazed site. The signalgrass was managed with grazing cattle and with an average height of 25 cm. The randomized block design with three replications was adopted. The leaf appearance rate was lower in undergrazed site compared to other sites evaluated. However, the phyllochron, the leaf lifespan, the dead leaf number and stem elongation and leaf senescence rates were greater in undergrazed site when comparing the sites with proper and over grazing. The numbers of expanded, expanding and live leaves did not differ between the sites evaluated. The leaf elongation rate and the leaf and stem lengths were lower in overgrazed site compared to other sites evaluated. The uneven grazing of cattle causes variability in morphogenetic and structural characteristics of B. decumbens tillers in horizontal plane of pasture, resulting in the horizontal structure of pasture.

Tomografia computadorizada das células etmoidais intra e extramurais: ensaio iconográfico / Computed tomography of intra- and extramural ethmoid cells: iconographic essay

O desenvolvimento dos seios paranasais é um processo intricado que se inicia na vida intrauterina e termina na idade adulta. Dos seios da face, as células etmoidais são provavelmente as estruturas mais complexas e as que estão associadas com o maior número de variantes da normalidade. Variações no padrão de pneumatização das células etmoidais podem ser divididas em intra ou extramurais. Intramurais são aquelas que ao se desenvolverem mantêm contato com o labirinto etmoidal, e extramurais as que se desenvolvem isoladamente. A tomografia computadorizada é a ferramenta mais útil na avaliação de processos inflamatórios dos seios paranasais. De igual modo, ela é importante para o planejamento pré-operatório e controle pós-operatório, pois possibilita grande detalhe anatômico das estruturas normais e detecção precisa de suas variantes. Neste ensaio iconográfico os autores descrevem as principais variantes da normalidade do labirinto etmoidal e suas relações com estruturas adjacentes. Cirurgias endoscópicas para o tratamento de afecções dos seios paranasais têm-se tornado cada vez menos invasivas, o que certamente aumentará a demanda por relatórios de imagem cada vez mais ricos em detalhes desta região.

The development of the paranasal sinuses is an intricate process that begins in the intrauterine life and terminates in early adulthood. Among the paranasal sinuses, the ethmoid cells or labyrinth are probably the most complex structures, being associated with the highest number of normal variants. Variations in the pattern of pneumatization of the ethmoid cells can be divided into intra- and extramural cells. Intramural cells are those which develop within the ethmoid labyrinth. Extramural cells are those that develop isolatedly. Computed tomography is the most useful tool in the evaluation of inflammatory processes of the paranasal sinuses. Computed tomography also plays a relevant role in the preoperative planning as well as in the postoperative follow-up, since it demonstrates exact anatomical details of normal structures with accuracy in the detection of variants. In the present pictorial essay, the authors describe the most common anatomical variants of the ethmoid labyrinth and their relationship with adjacent structures. Endoscopic sinonasal surgery has become increasingly less invasive, requiring more detailed anatomical imaging of this region.

Mixoma atrial gigante simulando estenose mitral grave em paciente jovem / Giant atrial myxoma mimicking severe mitral stenosis in young patient / Mixoma atrial gigante simulando estenosis mitral grave en paciente joven

Homem de 20 anos, previamente hígido, com quadro clínico de dispneia paroxística noturna e cansaço aos médios esforços com evolução em torno de dez dias, apresentou, ao exame ecocardiográfico, mixoma em átrio esquerdo funcionando como estenose mitral grave.

The echocardiogram of a twenty-year-old man, previously healthy, suffering from paroxysmal nocturnal dyspnea and fatigue after moderate exertion that intensified over a period of about ten days, showed the left atrium myxoma working as severe mitral stenosis.

Hombre de 20 años, previamente sano, con cuadro clínico de disnea paroxística nocturna y cansancio a los esfuerzos medios con evolución alrededor de diez días, presentó, al examen ecocardiográfico, mixoma en atrio izquierdo funcionando como estenosis mitral grave.

Giant atrial myxoma mimicking severe mitral stenosis in young patient.

The echocardiogram of a twenty-year-old man, previously healthy, suffering from paroxysmal nocturnal dyspnea and fatigue after moderate exertion that intensified over a period of about ten days, showed the left atrium myxoma working as severe mitral stenosis.

Reconstrução cirúrgica de fratura fronto-naso-órbito-etmoidal / Surgical reconstruction of a frontonasal orbital-etmoidal fracture

As fraturas do seio frontal são originadas a partir de acidentes de grande intensidade, que incluem acidentes automobilísticos, agressões físicas, acidentes esportivos e quedas. Normalmente, estão associadas com fraturas do terço médio da face, incluindo fraturas maxilares, naso-órbito-etmoidais e zigomáticas. Várias modalidades de tratamento têm sido propostas para reconstrução das fraturas fronto-naso-órbito-etmoidais, incluindo fixação dos fragmentos ósseos com placas e parafusos, reconstrução com enxertos ósseos e implante de malhas de titânio. No caso ora apresentado, utilizou-se do acesso bicoronal para reconstrução da parede anterior do seio frontal e restabelecimento do contorno fronto-naso-órbito-etmoidal, sendo utilizado enxerto ósseo de calota craniana para esse fim. Verificou-se a integridade do ducto fronto-nasal, não havendo necessidade de canulização deste. Esse procedimento é importante diretriz no plano de tratamento, uma vez que determina a obliteração ou canulização do ducto. Nenhuma complicação ou sequela foi observada na proservação de aproximadamente um ano. A proservação por longos períodos pós-operatórios é importante para avaliação de possíveis complicações.

Frontal sinus fractures are originated from high intensity accidents, including automobile accidents, altercations, sports accidents and falls. Normally, they are associated with fractures of the middle third of the face, including maxillary, nasal-orbital-etmoidal and zygomatic fractures. Several treatment modalities have been proposed to reconstruct fronto-nasal-orbital-etmoidal fractures, including fixation of bone fragments with plates and screws, reconstruction with bone grafts and titanium mesh implants. In the case here presented, bicoronal access was used to reconstruct the anterior wall of the frontal sinus and to reestablish the fronto-nasal-orbital-etmoidal contour, using a bone graft from the cranial cap for this purpose. The integrity of fronto-nasal duct was verified, and there was no need to canalize it. This procedure is an important guideline in the treatment plan, since it determines obliteration or canalization of the duct. After one year of follow-up, no complication or sequela was observed. Long periods of post-operative follow up are very important to evaluate possible complications.

[Brucellosis spondylodiscitis: case report]. / Espondilodiscite por brucelose: relato de caso.

A case of spondylodiscitis due to Brucella with systematic manifestation of the disease, in a 56-year-old male patient who was a farmer, is reported. The diagnosis was made from serological tests, with a titer of 1/160. The blood culture was positive and the blood sedimentation rate was high. Radiological abnormalities showed spondylodiscitis at the T8/T9 level that were compatible with this disease. The patient was treated with streptomycin at 1g IM/day for 15 days, and doxycycline plus rifampicin for six weeks, with a clinical improvement in the condition. Vertebral involvement in brucellosis is a complication of variable occurrence in the literature. However, it is considered to be infrequent and difficult to diagnose, particularly in regions with high prevalence of tuberculosis, given that this may mimic conditions of brucellosis. Attention is drawn to this rare case of spondylodiscitis due to brucellosis, given the need for early diagnosis and treatment in order to avoid possible sequelae.

Espondilodiscite por brucelose: relato de caso / Brucellosis spondylodiscitis: case report

Relata-se um caso de espondilodiscite por Brucella em um paciente do sexo masculino, 56 anos, fazendeiro, com manifestações sistêmicas da doença. O diagnóstico foi realizado por sorologia com título de 1/160, hemocultura positiva, o VHS foi elevado, bem como alterações radiológicas mostraram espondilodiscite ao nível de T8/T9 compatíveis com a patologia. O paciente foi tratado com estreptomicina 1gIM/dia por 15 dias, doxaciclina e rifampicina por seis semanas, com melhora clínica do quadro. O envolvimento vertebral na brucelose é uma complicação de ocorrência variável na literatura, mas considerado pouco freqüente, de difícil diagnóstico principalmente em regiões com alta prevalência de tuberculose, visto que esta pode mimetizar o quadro de brucelose. Chama-se atenção a um caso raro de espondilodiscite por brucelose, dada a necessidade de diagnóstico precoce e tratamento a fim de se evitar possíveis seqüelas.

A case of spondylodiscitis due to Brucella with systematic manifestation of the disease, in a 56-year-old male patient who was a farmer, is reported. The diagnosis was made from serological tests, with a titer of 1/160. The blood culture was positive and the blood sedimentation rate was high. Radiological abnormalities showed spondylodiscitis at the T8/T9 level that were compatible with this disease. The patient was treated with streptomycin at 1g IM/day for 15 days, and doxycycline plus rifampicin for six weeks, with a clinical improvement in the condition. Vertebral involvement in brucellosis is a complication of variable occurrence in the literature. However, it is considered to be infrequent and difficult to diagnose, particularly in regions with high prevalence of tuberculosis, given that this may mimic conditions of brucellosis. Attention is drawn to this rare case of spondylodiscitis due to brucellosis, given the need for early diagnosis and treatment in order to avoid possible sequelae.