Spreading the word: pediatric pain education from treatment to prevention.

Pain affects everyone hence one can argue that it is in each individual's interest to understand pain in order to hold correct and adaptive beliefs and attitudes about pain. In addition, chronic pain is reaching pandemic proportions and it is now well known that people living with chronic pain have a reduced life expectancy. To address and to prevent the growth of this public health disaster, we must start looking beyond adulthood. How children view pain has an impact on their behavioral coping responses which in turn predict persistent pain early in the lifespan. In addition, children who suffer from chronic pain and who are not (properly) treated for it before adolescence have an increased risk of having chronic pain during their adult life. Explaining pain to children and youth may have a tremendous impact not only on the individual child suffering from chronic pain but also on society, since the key to stop the pain pandemic may well lie in the first two decades of life. In order to facilitate the acquisition of adaptive behavioral coping responses, pain education aims to shift people's view on pain from being an apparent threat towards being a compelling perceptual experience generated by the brain that will only arise whenever the conceivable proof of danger to the body is greater than the conceivable proof of safety to the body. Nowadays a lot of pain education material is available for adults, but it is not adapted to children's developmental stage and therefore little or not suitable for them. An overview of the state-of-the-art pain education material for children and youth is provided here, along with its current and future areas of application as well as challenges to its development and delivery. Research on pediatric pain education is still in its infancy and many questions remain to be answered within this emerging field of investigation.

Presumed cytomegalovirus retinitis late after kidney transplant / Retinite presumida por citomegalovírus tardiamente após um transplante renal

Abstract Cytomegalovirus (CMV) retinitis is a rare manifestation of CMV invasive disease and potentially threatening to vision in immunocompromised individuals. Clinical suspicion is fundamental since it is an unusual entity with a progressive and often asymptomatic installation over a long period. The authors report a 70-year-old man with diabetic nephropathy who underwent a kidney transplant (KT) in August 2014 with good clinical evolution. No previous CMV infection or episodes of acute rejection were reported. Five years after transplant, he was admitted due to a reduced visual acuity of the left eye with seven days of evolution with associated hyperemia, without exudate. The ophthalmologic evaluation was compatible with acute necrosis of the retina and presumed associated with CMV infection. He had a progressive improvement after ganciclovir initiation. CMV retinitis is one of the most serious ocular complications in immune-suppressed individuals and can lead to irreversible blindness, and because of that, early diagnosis and treatment remains crucial in obtaining the best visual prognosis in affected patients. Secondary prophylaxis with ganciclovir is not consensual, neither is the safety of reintroducing the antimetabolite in these cases.

Resumo A retinite por citomegalovírus (CMV) é uma manifestação rara de doença invasiva por CMV e potencialmente ameaçadora para a visão em indivíduos imunocomprometidos. A suspeita clínica é fundamental, uma vez que se trata de uma entidade incomum, com uma instalação progressiva e frequentemente assintomática durante um longo período. Os autores relatam um homem de 70 anos de idade com doença renal do diabetes que foi submetido a um transplante renal (KT) em Agosto de 2014 com boa evolução clínica. Nenhuma infecção anterior por CMV ou episódios de rejeição aguda foram relatados. Cinco anos após o transplante, ele foi internado devido a uma acuidade visual reduzida do olho esquerdo com sete dias de evolução com hiperemia associada, sem exsudato. A avaliação oftalmológica foi compatível com a necrose aguda da retina e presumivelmente associada à infecção por CMV. Ele teve uma melhora progressiva após o início do ganciclovir. A retinite por CMV é uma das complicações oculares mais graves em indivíduos imunossuprimidos e pode levar à cegueira irreversível e, por isso, o diagnóstico e o tratamento precoces continuam sendo cruciais para obter o melhor prognóstico visual em pacientes afetados. A profilaxia secundária com ganciclovir não é consensual, tampouco a segurança de reintroduzir o antimetabólito nestes casos.

Low biological phosphorus removal from effluents treated by slow sand filters.

The legislation for environment protection requires strict controls of the wastewater releasing in water bodies. The wastewater treatment plants (WWTP) have been used for organic matter degradation; however, the residual total phosphorus (TP) removal has not been efficient. TP and nitrogen present in wastewater are associated to eutrophication of water bodies and algae growth. Therefore, this study discusses the efficiency of phosphorus removal by a slow filter (SF), complementary to a WWTP and the microbial community involved. The results showed that the use of SF, with or without macrophytes, is not suitable to remove TP. Spatial variation in microbial communities distributed in three distinct zones was identified in the SF. Proteobacteria, Bacteroidetes, Chloroflexi and Firmicutes covered the hydrolytic and fermentative bacteria. The acetogenesis, nitrification, and denitrification, as well as the removal of phosphorus from the effluent, were performed by representatives affiliated to different groups. Alphaproteobacteria, Betaproteobacteria, and Gammaproteobacteria among these, Dokdonella sp., Frateuria sp., Comamonas sp., Diaphorobacter sp., Nitrosospira sp., Ferruginibacter sp., Flavobacterium sp., and the uncultured OD1 were the most abundant bacteria in the SF. The low efficiency for TP removing from SF effluents can be explained by the low abundance of phosphorus accumulating organisms (PAOs), with the association of the low concentration of biodegradable organic matter in the inlet effluent. Therefore, the alternative to using SF as a complement to WWTPs, as recommended by some Brazilian environmental agencies, did not prove to be viable and new approaches must be evaluated. KEY POINTS: • The phosphorus removal was performed by a slow filter system in a WWTP but obtained a low efficiency. • Microbial spatial variation was distributed into distinct zones from slow filter. • Low abundance of PAOs was observed due to the low availability of organic matter.

Presumed cytomegalovirus retinitis late after kidney transplant.

Cytomegalovirus (CMV) retinitis is a rare manifestation of CMV invasive disease and potentially threatening to vision in immunocompromised individuals. Clinical suspicion is fundamental since it is an unusual entity with a progressive and often asymptomatic installation over a long period. The authors report a 70-year-old man with diabetic nephropathy who underwent a kidney transplant (KT) in August 2014 with good clinical evolution. No previous CMV infection or episodes of acute rejection were reported. Five years after transplant, he was admitted due to a reduced visual acuity of the left eye with seven days of evolution with associated hyperemia, without exudate. The ophthalmologic evaluation was compatible with acute necrosis of the retina and presumed associated with CMV infection. He had a progressive improvement after ganciclovir initiation. CMV retinitis is one of the most serious ocular complications in immune-suppressed individuals and can lead to irreversible blindness, and because of that, early diagnosis and treatment remains crucial in obtaining the best visual prognosis in affected patients. Secondary prophylaxis with ganciclovir is not consensual, neither is the safety of reintroducing the antimetabolite in these cases.

Ultrasonographic Subclinical Signs of Inflammation of the Lacrimal, Parotid, and Submandibular Glands in Users of Cosmetic Fillers.

OBJECTIVES: To detect ultrasonographic inflammatory signs in the lacrimal, parotid, and submandibular glands in cosmetic fillers (CFs) users. METHODS: A prospective and cross-sectional ultrasound study of the glands in cases with CFs was performed. The sample included users of hyaluronic acid, silicone oil, polymethylmethacrylate, polycaprolactone, calcium hydroxyapatite, and polyacrylamide. Abnormalities of the parenchyma and hypervascularity signs of the glands were compared with a control group (n = 10), evaluated by 2 observers, and correlated with the type, number, and location of the facial CFs. Cohen's kappa test and logistic regression models with odds ratios (OR) adjusted by age with 95% CI were performed. RESULTS: Sixty-three patients with CFs met the criteria. Parotid and submandibular glands had the highest percentage of parenchymal involvement: 87.3 and 88.9%, respectively (p <.01). Abnormalities of the echostructure of the parenchyma and hypervascularity of the glands were detected with all kinds of fillers without significant differences per type. A significant substantial interrater kappa (0.61) with an agreement of 90% for all glands among observers was found. CONCLUSION: Users of common types of CFs frequently present subclinical ultrasonographic signs of inflammation of the lacrimal, parotid, and submandibular glands. Further research on the topic seems necessary.

Impact of Acupuncture Intervention on the Pain Intensity of Patients Treated at a Tertiary Hospital in Brazil.

BACKGROUND: Nowadays, in western societies, acupuncture is widely used over the control of pain and this analgesic approach is still the most studied aspect of acupuncture. Several studies have shown that most patients go through a significant pain decrease soon after the first sessions of acupuncture. OBJECTIVES: This research has as a goal the evaluation on the effect of acupuncture treatment regarding the relief of pain intensity of different etiologies, through the visual analog scale. METHODS: This research constitutes a retrospective, descriptive study, carried out with 449 patients attended in the Institute Hospital de Base of the Federal District, in Brasilia city- Brazil. Every data was gathered from our own form, with detailed clinical history which included age, marital status, work activity, reason for referral to acupuncture, main and secondary complaints, pain intensity evaluated by the Visual Analog Scale (VAS), number of sessions completed and drug therapy. All data was organized in the Microsoft Excel and processed in the Statistical Package for the Social Sciences (SPSS), version 20.0. RESULTS: Regarding the main complaint, the mean pain decreased from 7.3 (initial VAS) to 3.2 (final VAS), a reduction that meant more than 50% relief in pain intensity. This 50% reduction in initial pain was also observed in secondary complaints (initial VAS = 6.5 and final VAS = 3.1). CONCLUSIONS: The results of this research suggest that acupuncture treatment was effective in relieving pain intensity, providing a 50% reduction on the visual analogue scale, in relation to painful complaints of different etiologies.

The relevance of enzyme specificity for coenzymes and the presence of 6-phosphogluconate dehydrogenase for polyhydroxyalkanoates production in the metabolism of Pseudomonas sp. LFM046.

Reconstruction of genome-based metabolic model is a useful approach for the assessment of metabolic pathways, genes and proteins involved in the environmental fitness capabilities or pathogenic potential as well as for biotechnological processes development. Pseudomonas sp. LFM046 was selected as a good polyhydroxyalkanoates (PHA) producer from carbohydrates and plant oils. Its complete genome sequence and metabolic model were obtained. Analysis revealed that the gnd gene, encoding 6-phosphogluconate dehydrogenase, is absent in Pseudomonas sp. LFM046 genome. In order to improve the knowledge about LFM046 metabolism, the coenzyme specificities of different enzymes was evaluated. Furthermore, the heterologous expression of gnd genes from Pseudomonas putida KT2440 (NAD+ dependent) and Escherichia coli MG1655 (NADP+ dependent) in LFM046 was carried out and provoke a delay on cell growth and a reduction in PHA yield, respectively. The results indicate that the adjustment in cyclic Entner-Doudoroff pathway may be an interesting strategy for it and other bacteria to simultaneously meet divergent cell needs during cultivation phases of growth and PHA production.

Homeologous regulation of Frigida-like genes provides insights on reproductive development and somatic embryogenesis in the allotetraploid Coffea arabica.

Coffea arabica is an allotetraploid of high economic importance. C. arabica transcriptome is a combination of the transcripts of two parental genomes (C. eugenioides and C. canephora) that gave rise to the homeologous genes of the species. Previous studies have reported the transcriptional dynamics of C. arabica. In these reports, the ancestry of homeologous genes was identified and the overall regulation of homeologous differential expression (HDE) was explored. One of these genes is part of the FRIGIDA-like family (FRL), which includes the Arabidopsis thaliana flowering-time regulation protein, FRIGIDA (FRI). As nonfunctional FRI proteins give rise to rapid-cycling summer annual ecotypes instead of vernalization-responsive winter-annuals, allelic variation in FRI can modulate flowering time in A. thaliana. Using bioinformatics, genomic analysis, and the evaluation of gene expression of homeologs, we characterized the FRL gene family in C. arabica. Our findings indicate that C. arabica expresses 10 FRL homeologs, and that, throughout flower and fruit development, these genes are differentially transcribed. Strikingly, in addition to confirming the expression of FRL genes during zygotic embryogenesis, we detected FRL expression during direct somatic embryogenesis, a novel finding regarding the FRL gene family. The HDE profile of FRL genes suggests an intertwined homeologous gene regulation. Furthermore, we observed that FLC gene of C. arabica has an expression profile similar to that of CaFRL genes.

Uso de Fluorescência de Raios X (XRF) para fins de comparação entre a composição elementar da barba de timão Stryphnodendron adstringens (Mart) Coville com outras pomadas cicatrizantes / Use of X-ray Fluorescence (XRF) for purposes of comparison between the elemental composition of barba de timão Stryphnodendron adstringens (Mart) Coville and other healing ointments

Introdução: A Barba de timão é uma planta de origem do cerrado brasileiro, que vem sendo estudada por suas propriedades medicinais, tais como: antibacteriana, cicatrizante, coagulante sanguíneo, dentre outras. A cicatrização é um processo pelo qual o organismo tende a reparar uma lesão ou perda de tecido. Objetivo: Este trabalho compara a composição química da barba de timão com algumas pomadas cicatrizantes de origem farmacêuticas já presentes e disponíveis no mercado. Assim, pode-se relacionar a propriedade cicatrizante desta planta por meio de seus componentes químicos. Materiais e Métodos: Para realizar tal comparação, foi utilizada com amostra a planta barba de timão comercializada em mercados especializados e as pomadas, sulfato de neomicina e a sulfadiazina de prata. Para a análise multielementar, foi utilizada a espectroscopia por fluorescência de raios X (XRF). Com o espectro fornecido pela XRF foi possível comparar os elementos químicos das amostras. Conclusão: O espectro mostrou que a barba de timão tem propriedades químicas semelhantes, assemelhando-se com os componentes químicos encontrados na amostra de sulfato de neomicina, adicionada de três compostos químicos, K, Ca e Br, que também são importantes no processo de cicatrização. Ao comparar com a sulfadiazina de prata, o único elemento que se difere do fitoterápico, além do três já citados, é a Ag. (AU)

Introduction: Barba de timão is a plant of the Brazilian Cerrado origin, which is already studied for its medicinal properties, such as: antibacterial, healing, blood coagulant, etc. Healing is a process by which the body tends to repair an injury or loss of tissue. Objective: This work compares the chemical composition of barba timão with some pharmaceutical healing scouring ointments already present and used in the market. Thus, we can relate the healing properties of this plant. Material and Methods: In order to make such a comparison, it was used the barba timão plant marketed in specialized markets, and the ointments neomycin sulfate and silver sulfadiazine. For multielement analysis, X-ray fluorescence spectroscopy (XRF) was used. With the spectrum provided by the XRF it was possible to compare the chemical elements of the samples. Conclusion: The spectrum shows that the barba timão has similar chemical properties, it resembles the chemical components found in the sample of neomycin sulfate, but with three more chemical compounds that is K, Ca and Br, that are also important in the healing process. When comparing with silver sulfadiazine, the only element that differs beyond the K and Ca of the phytotherapic, is the Ag of the ointment sample. (AU)

Proteolytic bacterial dominance in a full-scale municipal solid waste anaerobic reactor assessed by 454 pyrosequencing technology.

Biomethanization entails a good means to reduce the organic fraction (OF) derived from municipal solid wastes (MSW). The bacterial diversity of a full scale MSW anaerobic reactor located in Madrid (Spain) was investigated using high-throughput 454 pyrosequencing. Even though the proteolytic bacteria prevailed throughout all of the process, community shifts were observed from the start-up to the steady-state conditions, with an increasing biodiversity displayed over time. The Bacteroidetes and the Firmicutes were the majority phyla: 55.1 and 40.2% (start-up) and 18.7 and 78.7 (steady-state) of the total reads. The system's lack of evenness remains noteworthy as the sequences affiliated to the proteolytic non-saccharolytic Proteiniphylum, Gallicola and Fastidiosipila genera, together with the saccharolytic Saccharofermentans, were predominant on the system and this predominance appears to correlate with the presence of a high ammonium concentration. The 454 pyrosequencing revealed a great diversity of rare organisms which seemingly do not sustain any metabolic roles in the course of the OF-MSW degradation. However, this scarce and unique microbiota can confer great resilience to the system as a buffer against nutritional and environmental changing conditions, thus opening the door to increase the current knowledge about the bacterial community dynamics taking place during MSW treatment processes.

Draft Genome Sequence of Halomonas sp. HG01, a Polyhydroxyalkanoate-Accumulating Strain Isolated from Peru.

Halomonas sp. strain HG01, isolated from a salt mine in Peru, is a halophilic aerobic heterotrophic bacterium accumulating poly-3-hydroxybutyrate and poly(3-hydroxybutyrate-co-3-hydroxyvalerate) from different carbon sources. Here, we report the draft genome sequence of this isolate, which was found to be 3,665,487 bp long, with a G+C content of 68%.

A telemedicine network for remote paediatric cardiology services in north-east Brazil.

PROBLEM: Providing health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries. APPROACH: In October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart defects. Echocardiograms were performed by physicians under direct online supervision of a cardiologist; alternatively, a video recording of the examination was subsequently reviewed by a cardiologist. Cardiovascular surgeons came to a paediatric hospital in the state capital once a week to perform heart surgeries. LOCAL SETTING: Until 2011, the State of Paraíba had no structured programme to care for children with heart disease. This often resulted in missed or late diagnosis, with adverse health consequences for the children. RELEVANT CHANGES: From 2012 to 2014, 73,751 babies were screened for heart defects and 857 abnormalities were identified. Detection of congenital heart diseases increased from 4.09 to 11.62 per 1000 live births (P < 0.001). Over 6000 consultations and echocardiograms were supervised via the Internet. Time to diagnosis, transfers and hospital stays were greatly reduced. A total of 330 operations were carried out with 6.7% (22/330) mortality. LESSONS LEARNT: Access to an echocardiography machine with remote supervision by a cardiologist improves the detection of congenital heart disease by neonatologists; virtual outpatient clinics facilitate clinical management; the use of Internet technology with simple screening techniques allows resources to be allocated more efficiently.

Draft Genome Sequence of Pseudomonas sp. Strain LFM046, a Producer of Medium-Chain-Length Polyhydroxyalkanoate.

Pseudomonas sp. LFM046 is a medium-chain-length polyhydroxyalkanoate (PHAMCL) producer capable of using various carbon sources (carbohydrates, organic acids, and vegetable oils) and was first isolated from sugarcane cultivation soil in Brazil. The genome sequence was found to be 5.97 Mb long with a G+C content of 66%.

Agronomic traits of coffee tree progenies from Timor Hybrid x Catuaí crossing / Características agronômicas de progênies de cafeeiro oriundas do cruzamento de Híbrido de Timor x Catuaí

The objective of this work was to evaluate the agronomic traits of coffee tree progenies. The experiment was set in Ouro Verde Farm, located at Campos Altos County, MG. Twenty three coffee progenies and seven control cultivars were used. These progenies are from the fourth generation of crossing between Timor Hybrid and Catuaí. The experiment was set in a randomized block design with four replicates, a total of 120 plots with 8 plants per plot. The yield of processed coffee sacks ha-1 was evaluated in eight crop years from the 2003 to the 2011 harvests. The percentage of fruits at the cherry stage, floating fruits, coffee classification (sieve above 17), income and plant vigor were evaluated in the 2010 and in the 2011 harvests. It was concluded that the progenies showed a great variability for the agronomic traits. Progenies 514-7-4-C130, 493-1-2-C134 and 518-2-10-C408 had the highest yield in the four two-year periods. The progenies 436-1-4-C26, 516-8-2-C109, 493-1-2-C134, 518-2-10-C408, 514-7-16-C211 and 514-7-16-C208 presented the highest values for plant vigor. Progeny 493-1-2-C134 stood out in all analyzed traits, showing to be promising for the advance of the generations.

Objetivou-se com este trabalho avaliar o comportamento agronômico de progênies de cafeeiro. O experimento foi instalado na Fazenda Ouro Verde, situada no Município de Campos Altos-MG, compreendendo vinte e três progênies e sete cultivares utilizadas como testemunhas. Essas progênies referem-se à quarta geração do cruzamento entre Híbrido de Timor e Catuaí. Foi utilizado o delineamento de blocos ao acaso, com quatro repetições, totalizando 120 parcelas, sendo cada parcela constituída por oito plantas. A produtividade em sacas de café beneficiado ha-1 foi avaliada em oito colheitas, de 2003 a 2011. Nas colheitas de 2010 e 2011 foram avaliadas a porcentagem de frutos no estádio cereja e de frutos chochos, a classificação do café (peneira 17 acima), renda e vigor vegetativo. Conclui-se que as progênies apresentaram grande variabilidade para as características agronômicas estudadas. As progênies 514-7-4-C130, 493-1-2-C134 e 518-2-10-C408 apresentaram os maiores valores de produtividade na média dos quatro biênios avaliados. As progênies 436-1-4-C26, 516-8-2-C109, 493-1-2-C134, 518-2-10-C408, 514-7-16-C211 e 514-7-16-C208 apresentaram as maiores notas de vigor vegetativo. A progênie 493-1-2-C134 se destacou em todas as características analisadas, mostrando-se promissora para o avanço de gerações.

Manobra de recrutamento alveolar e suporte ventilatorio perioperatorio em pacientes obesos submetidos a cirurgia abdominal / Alveolar recruitment maneuver and perioperative ventilatory support in obese patients undergoing abdominal surgery

O desenvolvimento da cirurgia abdominal proporcionou uma alternativa terapêutica para obesos mórbidos; entretanto, os pacientes submetidos a esse procedimento frequentemente apresentam complicações pulmonares pós-operatórias. Uma possível alternativa para a redução dessas complicações é a utilização da manobra de recrutamento alveolar e/ou estratégias ventilatórias perioperatórias, com foco na redução das complicações pulmonares pós-operatórias. Nesta revisão, são descritos os benefícios de estratégias ventilatórias perioperatórias, assim como a realização de manobra de recrutamento alveolar em pacientes obesos submetidos a cirurgia abdominal.

The development of abdominal surgery represents an alternative therapy for the morbidly obese; however, patients undergoing this surgical procedure often experience postoperative pulmonary complications. The use of alveolar recruitment maneuvers and/or perioperative ventilatory strategies is a possible alternative to reduce these complications, focusing on the reduction of postoperative pulmonary complications. In this review, the benefits of perioperative ventilatory strategies and the implementation of alveolar recruitment maneuvers in obese patients undergoing abdominal surgery are described.