Parinaud syndrome due to cofirmed neurotuberculosis in a lupus eritematosis systemic patient.

INTRODUCTION: This article aims to describe a patient with Parinaud syndrome due to neurotuberculosis confirmed by cerebrospinal fluid analysis. CASE REPORT: Initially, patient sought medical care, performed a chest x-ray and later a chest CT scan, with a probable diagnosis of miliary tuberculosis. In addition, she presented binocular diplopia worse at right lateral gaze, paresis of vertical gaze, light near-dissociation and convergent retraction nystagmus and presence of mycobacterium tuberculosis on PCR Xpert MTB/RIF. The treatment of miliary tuberculosis was interrupted due to pharmacodermia, but after diagnosis of neurotuberculosis, it was restarted with isoniazid, pyrazinamide and ethambutol with partial visual symptoms improvement. DISCUSSION: This case demonstrates the importance of pursuing diagnosis through more accurate techniques, especially in a patient with previous treatment pharmacoderma, whose absence of proper diagnosis and treatment would be extremely deleterious.

Formal synthesis of non-fragile state-feedback digital controllers considering performance requirements for step response.

This work describes an approach for synthesizing state-feedback controllers for discrete-time systems, taking into account performance aspects. The proposed methodology is based on counterexample-guided inductive synthesis (CEGIS), producing safe controllers based on step response performance requirements, such as settling time and maximum-overshoot. Controller candidates are generated through constrained optimization based on genetic algorithms. Each iteration that does not satisfy the initial system requirements is learned as a failed result and then used in another attempt. During the verification phase, it is considered the controller fragility to ensure deployable implementations. Such an approach assists the discrete-time control system design since weaknesses occur during implementation on digital platforms, where systems that meet design requirements are employed. The proposed method is implemented in DSVerifier, a tool that uses bounded (and unbounded) model checking based on satisfiability modulo theories. Experimental results showed that our approach is practical and sound regarding the synthesis of discrete state-feedback control systems that present performance requirements. It considers finite word-length effects, unlike other methods that routinely ignore them.

Degree of Frugivory Predicts Rates of Food-Related Agonism and Intragroup Proximity in Wild Gray Woolly Monkeys (Lagothrix lagotricha cana).

The main factors influencing feeding competition among members of diurnal primate groups are the distribution, availability, and quality of food resources. Socioecological models predict that temporal availability of preferred resources, such as fruit, can influence intragroup feeding competition, which is expected to affect rates of agonism and intragroup spatial patterns. We evaluated the effects of temporal variation in fruit availability on the degree of frugivory (i.e., the proportion of time spent feeding on fruit in relation to total food consumption) and the effects of fruit availability and degree of frugivory on rates of agonistic interactions, and intragroup proximity in two wild groups of gray woolly monkeys (Lagothrix lagotricha cana) in southwestern Brazilian Amazonia. We recorded 227 agonistic interactions via the all occurrences method and 3549 records of spacing via scan sampling during an 8-mo field study from March to October 2017. We found that fruit availability showed a positive relationship with the woolly monkeys' degree of frugivory, which in turn showed a positive relationship with the rates of agonism. We also found that degree of frugivory positively affected intragroup proximity in periods of lower fruit availability, and that agonistic interactions and proximity covaried positively. Conversely, as the degree of frugivory increased, monkeys exhibited greater interindividual distances and, consequently, lower rates of agonism, consistent with lower levels of feeding competition in periods of higher fruit availability. Therefore, we suggest that intragroup contest competition for fruits is an important cost of group living even for generalized, opportunistic frugivorous primates, such as woolly monkeys.

Influência da ozonioterapia na cicatrização de úlceras do pé diabético / Influence of ozone therapy on the healing of diabetic foot ulcers

Úlcera do pé diabético é uma das complicações de diabetes mellitus que ocorre por causas multifatoriais. A abordagem multidisciplinar e multiprofissional do paciente com pé diabético é recomendada, uma vez que a afecção possui alta prevalência e que as ações de prevenção e controle das lesões são potencialmente eficazes. Há um crescente interesse da comunidade científica e boa aceitação do tratamento com ozônio pelas revistas acadêmicas, apesar de o número de pesquisas acerca do assunto não ser amplo. Desse modo, o objetivo da presente pesquisa foi avaliar a influência da ozonioterapia em pacientes com feridas do pé diabético. Metodologia: Tratou-se de revisão narrativa de literatura acerca da terapia com ozônio para tratamento de ferida do pé diabético. Foram utilizados os termos "ozônio", "ozônioterapia", "ozonização", "pé diabético", úlcera do pé diabético", bem como suas traduções para o inglês "ozone", "ozonetherapy", "diabetic foot", "diabetic foot ulcer". Foram consultadas as bases acadêmicas PubMed, Scielo, Lilacs e EBSCOhost. Resultados/Discussão: Muitas vezes o tratamento convencional para feridas é ineficiente devido à multiplicação de bactérias resistentes. Para feridas infectadas, primeiramente pode-se empregar o ozônio como desinfetante, pois o gás é tanto bactericida como fungicida, e para se obter uma ferida livre de patógenos; posteriormente, pode-se aplicar doses baixas da mistura gasosa oxigênio-ozônio para acelerar a cicatrização da lesão. Dentre as formas de tratamento com ozônio estão a utilização de óleo ozonizado sobre a ferida e a aplicação local de uma mistura de gases ozônio e oxigênio diretamente sobre a úlcera. Além disso, o ozônio funciona bem quando insuflado em microambiente controlado (saco plástico). a ozonização, quando comparada ao uso de antibióticos convencionais, pode reduzir o tamanho das lesões e abreviar o tempo de internação dos pacientes a curto prazo, mas aparentemente não promove a cura total da úlcera nem reduz o número de complicações. Conclusão: Há um crescente interesse pela comunidade científica e boa aceitação do tratamento com ozônio pelas revistas acadêmicas, apesar de o número de pesquisas acerca do assunto não ser grande. Diversos trabalhos demonstraram resultados positivos da utilização de ozônio como adjuvante da terapia convencional para úlceras do pé diabético, e concluíram que a ozonioterapia é uma ferramenta terapêutica complementar ao tratamento convencional. Apesar disso, ainda há muito a aprofundar acerca do tema e mais pesquisas devem ser conduzidas para validar a ozonioterapia na prática clínica.

Diabetic foot ulcer is one of the complications of diabetes mellitus that occurs due to multifactorial causes. The multidisciplinary and multidisciplinary approach of patients with diabetic feet is recommended, since the condition has a high prevalence and the actions for the prevention and control of injuries are potentially effective. There is growing interest from the scientific community and Good acceptance of ozone treatment by academic journals, although the number of studies on the subject is not large. Thus, the objective of the present research was to evaluate the influence of ozone therapy in patients with diabetic foot wounds. Methodology: It was a narrative literature review about ozone therapy for the treatment of diabetic foot wounds. The terms "ozone", "ozone therapy", "ozonization", "diabetic foot", diabetic foot ulcer were used, as well as their English translations "ozone", "ozonetherapy", "diabetic foot", "diabetic foot ulcer ". The academic bases PubMed, Scielo, Lilacs and EBSCOhost were consulted. Results / Discussion: The conventional treatment for wounds is often inefficient due to the multiplication of resistant bacteria. For infected wounds, ozone can first be used as a disinfectant, as the gas is both bactericidal and fungicidal, and to obtain a pathogen-free wound; subsequently, low doses of the oxygen-ozone gas mixture can be applied to accelerate the healing of the lesion. Among the forms of treatment with ozone are the use of ozonized oil on the wound and the local application of a mixture of ozone and oxygen gases directly on the ulcer. In addition, ozone works well when inflated in a controlled microenvironment (plastic bag). ozonation, when compared to the use of conventional antibiotics, can reduce the size of the lesions and shorten the patients' hospitalization time in the short term, but apparently does not promote a complete healing of the ulcer or reduce the number of complications. Conclusion: There is a growing interest in the scientific community and good acceptance of ozone treatment by academic journals, although the number of studies on the subject is not large. Several studies have shown positive results from the use of ozone as an adjunct to conventional therapy for diabetic foot ulcers, and concluded that ozone therapy is a therapeutic tool complementary to conventional treatment. Despite this, there is still much to be done about the topic and more research must be conducted to validate ozone therapy in clinical practice.

Predation of Boana boans (Anura, Hylidae) by an opportunistic frugivorous primate

Although relatively common among omnivorous primates, anurophagy is still poorly documented in frugivorous species. Here we report the predation of a giant gladiator treefrog (Boana boans) by a large arboreal frugivore, the gray woolly monkey (Lagothrix lagotricha cana). The predation event occurred in a stretch of riparian forest located in a fragmented region in Cacoal, Rondônia state, in southwestern Brazilian Amazonia. Anurans can be a profitable, non-contested, and relatively easily acquired alternative resource for gray woolly monkeys, helping to fulfill their demand for protein, especially in periods of fruit scarcity. This new record broadens the knowledge on the natural history and predators of the giant gladiator frog. (AU)

Insights into the development of a juvenile harpy eagle's hunting skills / Considerações sobre o desenvolvimento da habilidade de caça de um gavião-real juvenil

The post-fledging period is of paramount importance for raptors, since this is when a juvenile develops its hunting skills and gains the abilities required in adulthood and independence through dispersal. Little is known however, about this stage in the lives of raptors such as harpy eagles, Harpia harpyja. Between March 2016 and July 2017, we recorded three predation attempts on groups of primates by a wild juvenile harpy eagle in southwestern Brazilian Amazonia, including the first predation of an adult squirrel monkey, Saimiri ustus. These sequential records give insights into the gradual development of hunting skills during the post-fledging period, similar to what has been reported for other birds of prey. We hypothesize that a link between developing flight skills, decreasing parental food provisioning and increasingly successful captures triggers adulthood and independence in harpy eagles. (AU)

O período pós-emplumagem é de suma importância para os rapinantes, pois é quando um jovem desenvolve a habilidade de caça necessária na idade adulta e a independência por meio da dispersão. Entretanto, pouco se sabe sobre esse estágio na vida de rapinantes como o gavião-real, Harpia harpyja. Entre março 2016 e julho 2017, três tentativas de predação sobre grupos de primatas por um gavião-real juvenil foram registradas no sudoeste da Amazônia brasileira, incluindo a primeira predação de um macaco-de-cheiro adulto, Saimiri ustus. Estes registros sequenciais indicam um desenvolvimento gradual da habilidade de caça ao longo do período de pós-emplumagem, de forma similar ao relatado para outros rapinantes. Hipotetizamos que a associação entre o desenvolvimento da habilidade de voo, diminuição do provisionamento pelos pais e aumento da taxa de capturas bem-sucedidas promove a maturidade e independência no gavião-real.(AU)

Risk factors for low cardiac output syndrome after coronary artery bypass grafting surgery.

OBJECTIVES: Low cardiac output syndrome (LCOS) is a serious complication after cardiac surgery and is associated with significant morbidity and mortality. The aim of this study is to identify risk factors for LCOS in patients undergoing coronary artery bypass grafting (CABG) in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE (Recife, PE, Brazil). METHODS: A historical prospective study comprising 605 consecutive patients operated between May 2007 and December 2010. We evaluated 12 preoperative and 7 intraoperative variables. We applied univariate and multivariate logistic regression analysis. RESULTS: The incidence of LCOS was 14.7% (n = 89), with a lethality rate of 52.8% (n = 47). In multivariate analysis by logistic regression, four variables remained as independent risk factors: age > 60 years (OR 2.00, 95% CI 1.20 to 6.14, P = 0.009), on-pump CABG (OR 2.16, 95% CI 1.40 to 7.08, P = 0.006), emergency surgery (OR 4.71, 95% CI 1.34 to 26.55, P = 0.028), incomplete revascularization (OR 2.62, 95% CI 1.32 to 5.86, P = 0.003), and ejection fraction <50%. CONCLUSIONS: This study identified the following independent risk factors for LCOS after CABG: age> 60 years of off-pump CABG, emergency surgery, incomplete CABG and ejection fraction <50%.

Risk factors for low cardiac output syndrome after coronary artery bypass grafting surgery / Fatores de risco para síndrome de baixo débito cardíaco após cirurgia de revascularização miocárdica

OBJECTIVES: Low cardiac output syndrome (LCOS) is a serious complication after cardiac surgery and is associated with significant morbidity and mortality. The aim of this study is to identify risk factors for LCOS in patients undergoing coronary artery bypass grafting (CABG) in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE (Recife, PE, Brazil). METHODS: A historical prospective study comprising 605 consecutive patients operated between May 2007 and December 2010. We evaluated 12 preoperative and 7 intraoperative variables. We applied univariate and multivariate logistic regression analysis. RESULTS: The incidence of LCOS was 14.7% (n = 89), with a lethality rate of 52.8% (n = 47). In multivariate analysis by logistic regression, four variables remained as independent risk factors: age > 60 years (OR 2.00, 95% CI 1.20 to 6.14, P = 0.009), on-pump CABG (OR 2.16, 95% CI 1.40 to 7.08, P = 0.006), emergency surgery (OR 4.71, 95% CI 1.34 to 26.55, P = 0.028), incomplete revascularization (OR 2.62, 95% CI 1.32 to 5.86, P = 0.003), and ejection fraction <50%. CONCLUSIONS: This study identified the following independent risk factors for LCOS after CABG: age> 60 years of off-pump CABG, emergency surgery, incomplete CABG and ejection fraction <50%.

OBJETIVOS: A síndrome de baixo débito cardíaco (SBDC) é uma complicação grave após cirurgias cardíacas, estando associada à significativa morbidade e mortalidade. O objetivo deste estudo é identificar fatores de risco para SBDC em pacientes submetidos à cirurgia de revascularização miocárdica (CRM), na Divisão de Cirurgia Cardiovascular do Pronto Socorro Cardiológico de Pernambuco - PROCAPE (Recife, PE, Brasil). MÉTODOS: Estudo prospectivo histórico compreendendo 605 pacientes consecutivos operados entre maio de 2007 e dezembro de 2010. Avaliaram-se 12 variáveis pré-operatórias e sete variáveis intraoperatórias. Aplicaram-se análises univariada e multivariada por regressão logística. RESULTADOS: A incidência de SBDC foi de 14,7% (n = 89), com taxa de letalidade de 52,8% (n = 47). Na análise multivariada por regressão logística, quatro variáveis permaneceram como fatores de risco independentes: idade > 60 anos (OR 2.00, IC 95% 1,20 a 6,14, P = 0,009), CRM com circulação extracorpórea (OR 2,16, IC 95% 1,40 a 7,08, P = 0,006), cirurgia de emergência (OR 4,71, IC 95% 1,34 a 26,55, P = 0,028), CRM incompleta (OR 2,62, IC 95% 1,32 a 5,86, P = 0,003) e fração de ejeção < 50% (OR 1,87, IC 95% 1,17 a 3,98, P = 0,007). CONCLUSÕES: Este estudo identificou os seguintes fatores de risco independentes para SBDC após CRM: idade > 60 anos, CRM com CEC, cirurgia de emergência, CRM incompleta e fração de ejeção < 50%.

O desenvolvimento da pós-graduação stricto sensu em enfermagem no Brasil: estudo exploratório / The development of post-graduate programs in nursing in Brazil: an exploratory study / El desarrollo de programas de posgrado en enfermería en Brasil: un estudio exploratorio

Objetivo: analisar o desenvolvimento da pós-graduação stricto sensu em Enfermagem no Brasil. Método: pesquisa documental, exploratória, tendo como fonte primária a base de dados virtual da CAPES, referente às avaliações trienais dos cursos de mestrado e doutorado no Brasil. Para análise e discussão dos dados foram utilizadas como fontes secundárias artigos da Base de Dados em Enfermagem - BDENF tendo como descritores: Educação em Enfermagem; Educação de Pós-Graduação em Enfermagem. Resultados: percebe-se uma concentração dos programas de pós-graduação stricto sensu em enfermagem nas regiões sul e sudeste do país. Entretanto, com a interiorização dos cursos de graduação, inicia-se um processo similar com cursos de mestrado e doutorado, porém o ritmo de qualificação docente não tem acompanhado as demandas do mercado, gerando concentrações regionais de doutores enfermeiros. Conclusões: há dificuldades para o atendimento das demandas quanto à titulação docente para o atendimento do crescimento das instituições de ensino superior em enfermagem no Brasil. Necessita-se de um incremento quanto à titulação docente em enfermagem e criação de cursos de mestrado e doutorado, principalmente, em regiões como norte, nordeste e centro-oeste para atendimento das demandas locais.(AU)

Objective: to analyze the development of post-graduate programs in nursing in Brazil. Method: documentary research, exploratory, with the primary source of online database of CAPES, the ratings on the three-year master's and doctorate in Brazil. For analysis and discussion of data were used as secondary sources of articles Base in Nursing - indexed for with descriptors such as: Education, Nursing, and Education Graduate Nursing. Results: there is a perceived concentration of post-graduate programs in nursing in the south and southeast. However, with the internalization of undergraduate courses, begins a similar process with masters and doctorates, but the pace of teacher qualification has not kept pace the market demands, creating regional concentrations of doctors nurses. Conclusions: There are difficulties to meet the demands on the titration teachers to meet the growth of institutions of higher education in nursing in Brazil. There needs to be increased as the titration nursing staff and the creation of master's and doctorate, especially in regions such as north, northeast and Midwest to meet local demand.(AU)

Objetivo: analizar el desarrollo de programas de postgrado en enfermería en Brasil. Método: la investigación documental, experimental, con la fuente primaria de base de datos en línea de la CAPES, las puntuaciones de los tres maestros años y doctorado en Brasil. Para el análisis y discusión de los datos se utilizaron como fuentes secundarias de artículos de la base en Enfermería - NLM con descripciones tales como: Educación, Enfermería y Educación de Postgrado en Enfermería. Resultados: se percibe una concentración de los programas de postgrado en enfermería en el sur y sureste. Sin embargo, con la internalización de los cursos de pregrado, se inicia un proceso similar con másters y doctorados, pero el ritmo de calificación del personal docente no ha seguido el ritmo de las demandas del mercado, la creación de concentraciones regionales de las enfermeras médicos. Conclusiones: Existen dificultades para satisfacer las demandas de la titulación de los profesores para satisfacer el crecimiento de las instituciones de educación superior en enfermería en Brasil. Es necesario que haya aumentado el personal de enfermería la valoración y la creación de maestría y doctorado, especialmente en regiones como el Norte, Nordeste y Centro-Oeste para satisfacer la demanda local.(AU)

Quantitative analysis of the variation in angles of the carpal arch after open and endoscopic carpal tunnel release. Clinical article.

OBJECT: Previous studies have demonstrated that the volume of the carpal canal increases after open and endoscopic surgery in patients with carpal tunnel syndrome. There is some controversy regarding the contribution of the post operative widening of the carpal arch to the increment in carpal canal volume. The objectives of this study were to: 1) evaluate the degree of variation in the angles formed by the borders of the carpal arch following the surgical division of the transverse carpal ligament; and 2) determine if there are differences in the variation of these angles after the classical open surgery versus endoscopic carpal tunnel release.Methods. The authors prospectively studied 20 patients undergoing carpal tunnel syndrome surgery: 10 patients were treated via the standard open technique, and 10 underwent endoscopic carpal tunnel release. The angles of the carpal arch were measured on CT scans of the affected hand obtained before and immediately after the surgical procedures.Measurements were performed at the level of the pisiform-scaphoid hiatus and at the level of the hook of the hamate-trapezium hiatus. RESULTS: There was widening of the postoperative angles of the carpal arch after open and endoscopic division of the flexor retinaculum; however, the difference between pre- and postoperative angulations reached statistical significance only in those patients treated by means of the open procedure. The mean (+/- SD) values for the postoperative increase in the angles at the level of the pisiform-scaphoid hiatus were 5.1 +/- 0.4 degrees after open surgery and 2.5 +/- 0.3 degrees after the endoscopically assisted procedure (p < 0.05). At the level of the hook of the hamate-trapezium hiatus, the mean values for the widening of the angles were 6.2 +/- 0.6 degrees for the open surgery group and 1.2 +/- 0.4 degrees for those patients treated by means of the endoscopic technique (p < 0.05). CONCLUSIONS: The widening of the postoperative angles of the carpal arch is a phenomenon observed at the proximal and distal levels of the carpal canal, and it can be noted after both open and endoscopically assisted carpal tunnel release. The endoscopic procedure yielded less increase in these angles than the open surgery.

Doença de Behçet cursando com trombose de veia cava superior / Behçet's disease presenting with superior vena cava thrombosis

A trombose venosa é o principal acometimento do sistema vascular na doença de Behçet, sendo uma complicação freqüente na evolução clínica dessa patologia, e está mais associada ao sexo masculino. Os autores relatam o caso de uma paciente do sexo feminino que apresentou início da doença há 3 anos com úlceras orais, além de úlceras genitais, e que vem cursando com episódios recorrentes de trombose venosa, sendo a primeira uma trombose venosa profunda no membro inferior direito; a segunda, de jugular interna esquerda; e, por último, uma trombose da veia cava superior.