Nova ocorrência de lepidopterismo por Hylesia nigricans (Berg, 1875) (Lepidoptera: Saturniidae) no Rio Grande do Sul, Brasil / New occurrence of lepidopterism by Hylesia nigricans (Berg, 1875) (Lepidoptera: Saturniidae) in Rio Grande do Sul, Brazil

Adult forms of lepidopterans can cause health problems. This type of incident is known as Lepidopterism, which is caused by contact with urticating setae released by adults, such as those from the Hylesia Hübner (Saturniidae) genus. In this study, the objective is to document a new occurrence of lepidopterism caused by specimens of Hylesia nigricans(Berg, 1875) (Lepidoptera: Saturniidae). The outbreak took place in the summer of 2017 in the municipality of Três Coroas, Rio Grande do Sul, Brazil. During this period, approximately 300 people were affected by dermatitis in the municipality.The outbreak resulted from the release of two types of urticating setae by female moths in the area. We want to emphasize that in case of proliferation of this moth species, it is essential to instruct the population to avoid direct contact with these insects. Monitoring these groups of lepidopterans is fundamental in facilitating decision-making and ensuring public health. (AU)

Formas adultas de lepidópteros podem causar problemas de saúde. Esse tipo de acidente é conhecido como lepidopterismo, causado pelo contato com cerdas urticantes liberadas por adultos, como as do gênero Hylesia Hübner (Saturniidae). Neste estudo, o objetivo é registrar uma nova ocorrência de lepidopterismo causado por espécimes de Hylesia nigricans (Berg, 1875) (Lepidoptera: Saturniidae). O surto ocorreu no verão de 2017, no município de Três Coroas, Rio Grande do Sul, Brasil. No período, aproximadamente 300 pessoas foram acometidas por dermatite no município. O surto foi causado pela liberação de dois tipos de setas urticantes das mariposas fêmeas no ambiente. Ressaltamos que na ocorrência da proliferação dessa espécie de mariposa, é importante instruir a população a evitar o contato direto com esses insetos. O monitoramento desses grupos de lepidópteros é fundamental para facilitar a tomada de decisões e garantir a saúde pública. (AU)

Combined strategies on the treatment of cerebellar arteriovenous malformation.

Cerebellar arteriovenous malformations (AVMs) comprise 10%-15% of all intracranial AVMs and have a higher risk for morbidity and mortality than supratentorial AVMs. Patients with cerebellar AVMs present with hemorrhage more often than patients with cerebral AVMs, justifying an interventional treatment. Patient outcome can be predicted with specific grade systems, guiding vascular neurosurgeons in decision-making. The authors present the case of a 42-year-old man incidentally diagnosed with an unruptured cerebellar inferior vermian AVM, which was managed through a combined strategy of preoperative endovascular embolization of the main arterial feeders followed by microsurgical resection via midline suboccipital craniotomy, with a favorable outcome. The video can be found here: https://youtu.be/3WESejZbk90.

Hoplonannus australis sp. nov. (Hemiptera, Schizopteridae): amended diagnosis of the genus and first record from South America.

Hoplonannus McAtee Maloch, 1925 comprises three species described from Central America. Females of all these species are known only from brachypterous specimens. This paper describes the first South American species of the genus, Hoplonannus australis sp. nov. The new species differs from its congeners, in females, by the submacroptery, presence of ocelli and a basal bulge in the seventh sternite; in males, it differs by the presence of a process in the eighth tergite and the right paramere bifurcate apically, with branches subparallel. These traits entail a new diagnosis for the genus.

Pé diabético: onde podemos intervir? / Diabetic foot: where can we intervene?

Trata-se de estudo descritivo, em coorte transversal incluindo 59 indivíduos com DM, que apresentavam pé diabético como complicação, atendidos no ambulatório de Pé Diabético do Centro Hiperdia, no município de Juiz de Fora ­ MG, no período de julho de 2013 a julho de 2014. Resultados: As condições predisponentes mais prevalentes foram HAS (96,6%), neuropatia (85,4%) e dislipidemia (69,5%). Foi observada ainda presença de sobrepeso/obesidade (28,8%/50,8%), tabagismo (42,4%), sedentarismo (28,8%) e mau controle glicêmico (HbA1c: 8,8% ±2,24 ). Em relação ao cuidado com os pés, 86,4% dos participantes se diziam conscientes. É fundamental a instituição da educação em diabetes em todos os níveis de cuidado, para que a prevenção se dê de forma realmente eficaz, visto que a maioria dos fatores de risco são modificáveis. A orientação desses pacientes sobre cuidado com os pés é um importante instrumento na redução do risco de ulceração e amputação em membros inferiores.

P2Y12 receptor inhibition with prasugrel and ticagrelor in STEMI patients after fibrinolytic therapy: Analysis from the SAMPA randomized trial.

BACKGROUND: A pharmacodynamic comparison between ticagrelor and prasugrel after fibrinolytic therapy has not yet been performed. METHODS: In the single-center SAMPA trial, 50 consecutive STEMI patients previously treated with clopidogrel and undergoing a pharmacoinvasive strategy were randomized to either a ticagrelor (n=25) 180mg loading dose followed by 90mg bid, or a prasugrel (n=25) 60mg loading dose followed by 10mg/day, initiated after fibrinolytic therapy but before angiography. Platelet reactivity was assessed with the VerifyNow P2Y12 assay at 0, 2, 6, and 24h after randomization. RESULTS: Mean times from fibrinolysis to prasugrel or ticagrelor administration were 11.1±6.9 and 13.3±6.3h, respectively (p=0.24). The values of PRU decreased significantly from baseline to 2h (all p<0.001) and from 2h to 6h (all p<0.001) in both groups. There was no difference in PRU values between 6h and 24h. The mean PRU values at 0, 2, 6, and 24h were 234.9, 127.8, 45.4, and 48.0 in the prasugrel group and 233.1, 135.1, 67.7, and 56.9 in the ticagrelor group, respectively. PRU values did not significantly differ between groups at any time period of the study. CONCLUSIONS: In patients with STEMI treated with fibrinolytic therapy, platelet inhibition after clopidogrel is suboptimal and can be further increased with more potent agents. Ticagrelor and prasugrel demonstrated a similar extent of P2Y12 receptor inhibition within 24h, although maximal platelet inhibition after these potent agents was not achieved for 6h.

Prevalência de colelitíase em portadores de cirrose hepática. Disfunção hepática é um fator de risco? / Cholelithiasis's prevalence in patients with liver cirrhosis. Liver dysfunction is a risk factor?

Aproximadamente 10% da população ocidental adulta apresentam colelitíase. A frequência entre os portadores de cirrose hepática parece ser maior e os fatores associados são incertos. O presente estudo tem por objetivo determinar a prevalência de colelitíase e os possíveis fatores associados em portadores de cirrose hepática. Foram incluídos 101 portadores de cirrose hepática em seguimento no Ambulatório de Hepatologia do Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF) e o diagnóstico de colelitíase foi estabelecido pela Ultrassonografia. As seguintes variáveis foram analisadas: idade, sexo, Índice de Massa Corporal (IMC), grau de disfunção hepática (Meld/Child-Pugh), presença de varizes esofágicas e nível de aminotransferases. Entre os pacientes avaliados 58 (62%) foram classificados como Child-Pugh A e a média observada do escore Meld foi 11,5 ± 3,6. A presença de colelitíase foi observada em 21 (20,8%) pacientes. Não foi possível demonstrar associação entre a presença de colelitíase e as variáveis analisadas. Conclui-se que a prevalência de colelitíase entre portadores de cirrose hepática é elevada, porém não foi possível demonstrar associação entre disfunção hepática e presença de cálculos biliares.

Anatomic variation of thorax drainage: absence of accessory hemiazygos vein

Formed by the azygos, hemiazygos and accessory hemiazygos veins, this system is responsible for the venous drainage of the thorax and partially of the abdomen. Abnormalities of this system are not uncommon, and many are referred to in literature. The complete agenesis of the accessory hemyazigos vein is associated with complete regression of the left posterior cardinal vein or atrophy of the left subcardinal vein. The reported case consists of the complete absence of the accessory hemiazygos vein, culminating in the drainage of the 4th, 5th, 6th, 7th and 8th left posterior intercostal veins directly into the azygos vein of a male cadaver. The importance of the theme is due to the necessity of recognizing patterns and frequencies of these variations when facing procedures addressing the mediastinum or the major vessels.

Sternalis muscle: an anatomic variation of the anterior chest wall

The sternalis muscle’s presence is an uncommon anatomic variation of the anterior chest wall’s musculature. It is insufficiently mentioned by the most of anatomical textbooks, although it has been well described by the literature. The study of this anatomic variation is extremely relevant, principally for the interpretation of image’s exams that approach this region. For this study’s achievement, 102 cadavers were dissected (97 of the male sex and 5 of the female sex). The study of the sternalis muscle avoids the expenses with exams and the indication of aggressive treatments in a wrong way.

Risk factors for acute chest syndrome in patients from low socioeconomic background: a cohort study from Sergipe, Brazil.

A prospective cohort study to assess the risk factors for acute chest syndrome (ACS) in individuals with sickle cell disease was carried out in a referral center from Sergipe, Brazil. A total of 168 SS homozygotic individuals (ages between 12 wk and 26 y) were followed for 12 months. There were 134 admissions of 81 patients. There were 50 events of ACS, which was the second most frequent cause of hospital admission (after pain crisis). One patient died of ischemic stroke during follow up. In bivariate analysis, the following variables showed statistically significant associations with the occurrence of ACS: age less than 5 years, living in rural area, history of previous hospital admission; white blood cell count greater than 10,000/dL; hemoglobin concentration less than 7 g/dL and oxygen saturation ≤95% on admission. After controlling for confounding in multivariate logistic regression, only a history of previous admission remained as an independent predictor of ACS (relative risk=4.20; 95% confidence interval: 1.79-9.87; P=0.001). Patients with a positive history of hospital admission are under increased risk and should be monitored closely for prevention and early detection of ACS.

Risk factors for acute chest syndrome in patients from low socioeconomic background: a cohort study from Sergipe, Brazil.

A prospective cohort study to assess the risk factors for acute chest syndrome (ACS) in individuals with sickle cell disease was carried out in a referral center from Sergipe, Brazil. A total of 168 SS homozygotic individuals (ages between 12 wk and 26 y) were followed for 12 months. There were 134 admissions of 81 patients. There were 50 events of ACS, which was the second most frequent cause of hospital admission (after pain crisis). One patient died of ischemic stroke during follow up. In bivariate analysis, the following variables showed statistically significant associations with the occurrence of ACS: age less than 5 years, living in rural area, history of previous hospital admission; white blood cell count greater than 10,000/dL; hemoglobin concentration less than 7 g/dL and oxygen saturation ≤ 95% on admission. After controlling for confounding in multivariate logistic regression, only a history of previous admission remained as an independent predictor of ACS (relative risk=4.20; 95% confidence interval: 1.79-9.87; P=0.001). Patients with a positive history of hospital admission are under increased risk and should be monitored closely for prevention and early detection of ACS.

Evaluation of the cytokines IL-10 and IL-13 as mediators in the progression of Symmers fibrosis in patients with hepatosplenic schistosomiasis mansoni.

OBJECTIVE: To investigate the serum levels of IL-10 and IL-13 in patients with hepatosplenic schistosomiasis mansoni (HSM), evaluating the role of these cytokines in the development of hepatic fibrosis. METHODS: The study was prospective and analytical, developed at the Department of Surgery, Federal University of Pernambuco, Keizo Asami Laboratory of Immunology. We studied three groups: Group I - 25 patients with hepatosplenic schistosomiasis mansoni who were not submitted to surgery; Group II - 30 individuals who underwent splenectomy and ligature of left gastric vein; Group III - 33 subjects without hepatosplenic schistosomiasis mansoni or any other disease or condition that could compromise the hepatic functional reserve. Serum concentrations of IL-10 and IL-13 were obtained through ELISA. Considering their non-parametric nature, all concentrations were analyzed by Kruskal-Wallis test, with p<0.05 used to reject the null hypothesis. RESULTS: The mean concentrations of IL-10 in ng/mL in serum were GI: 50.0 ± 59.0; GII: 38.0 ± 270; GIII: 38.0 ± 20.0. Concentrations of IL-13 in ng/mL in the serum of patients were respectively: 41.0 ± 93.0 in GI, 16.0 ± 17.0 in GII and 18.0 ± 34.0 in GIII. There was no significant difference between the mean concentrations of IL-10 and IL-13 between the study groups (p> 0.05). CONCLUSION: The mean serum concentrations of IL-10 and IL-13 were similar in all three groups, indicating that possibly the presence of these cytokines in serum is not associated with different degrees of Symmers fibrosis in patients with hepatosplenic schistosomiasis mansoni.

Avaliação das citocinas IL-10 e IL-13 como mediadores na progressão da fibrose de Symmers em portadores de esquistossomose mansônica na forma hepatoesplênica / Evaluation of the cytokines IL-10 and IL-13 as mediators in the progression of symmers fibrosis in patients with hepatosplenic schistosomiasis mansoni

OBJETIVO: Investigar os níveis de IL-10 e IL-13 no soro de portadores da esquistossomose mansônica na forma hepatoesplênica (EHE), avaliando o papel destas citocinas no desenvolvimento da fibrose hepática. MÉTODOS: O estudo foi prospectivo e analítico, desenvolvido no Departamento de Cirurgia da Universidade Federal de Pernambuco, Laboratório de Imunologia Keizo Asami. Foram estudados três grupos: Grupo I - 25 portadores de esquistossomose mansônica na forma hepatoesplênica e não submetidos a tratamento cirúrgico; Grupo II - 30 submetidos à esplenectomia e ligadura da veia gástrica esquerda; Grupo III - 33 indivíduos sem esquistossomose mansônica na forma hepatoesplênica ou qualquer outra doença ou agravo que comprometesse a reserva funcional hepática. As concentrações séricas de IL-10 e IL-13 foram obtidas pelo método ELISA. Considerando-se a natureza não paramétrica, todas as concentrações foram analisadas pelo teste de Kruskal-Wallis. p<0,05 foi usado para rejeição da hipótese de nulidade. RESULTADOS: As médias das concentrações de IL-10, em ng/mL, no soro foram: GI 50,0 ± 59,0; GII 38,0 ± 270; GIII 38,0 ± 20,0. As concentrações de IL-13, em ng/mL, no soro dos pacientes foram respectivamente: GI 41,0 ± 93,0; GII 16,0 ± 17,0; GIII 18,0 ± 34,0. Não se observou diferença significante entre as médias das concentrações de IL-10 e IL-13 entre os grupos de estudo (p>0,05). CONCLUSÃO: As médias das concentrações séricas de IL-10 e IL-13 foram similares nos três grupos estudados, indicando que, possivelmente, estas citocinas no soro não estejam associadas aos diferentes graus de fibrose de Symmers nos pacientes.

OBJECTIVE: To investigate the serum levels of IL-10 and IL-13 in patients with hepatosplenic schistosomiasis mansoni (HSM), evaluating the role of these cytokines in the development of hepatic fibrosis. METHODS: The study was prospective and analytical, developed at the Department of Surgery, Federal University of Pernambuco, Keizo Asami Laboratory of Immunology. We studied three groups: Group I - 25 patients with hepatosplenic schistosomiasis mansoni who were not submitted to surgery; Group II - 30 individuals who underwent splenectomy and ligature of left gastric vein; Group III - 33 subjects without hepatosplenic schistosomiasis mansoni or any other disease or condition that could compromise the hepatic functional reserve. Serum concentrations of IL-10 and IL-13 were obtained through ELISA. Considering their non-parametric nature, all concentrations were analyzed by Kruskal-Wallis test, with p<0.05 used to reject the null hypothesis. RESULTS: The mean concentrations of IL-10 in ng/mL in serum were GI: 50.0 ± 59.0; GII: 38.0 ± 270; GIII: 38.0 ± 20.0. Concentrations of IL-13 in ng/mL in the serum of patients were respectively: 41.0 ± 93.0 in GI, 16.0 ± 17.0 in GII and 18.0 ± 34.0 in GIII. There was no significant difference between the mean concentrations of IL-10 and IL-13 between the study groups (p> 0.05). CONCLUSION: The mean serum concentrations of IL-10 and IL-13 were similar in all three groups, indicating that possibly the presence of these cytokines in serum is not associated with different degrees of Symmers fibrosis in patients with hepatosplenic schistosomiasis mansoni.

Repercussões histólogicas da esquistossomose mansônica em fêmur de camundongos / Repercussions histology of schistosomiasis mansoni in the femur of mices

RESUMO: A esquistossomose mansônica é um problema médico-social no Nordeste do Brasil. É preocupante o número de portadores da forma hepatoesplênica, que apresenta como fator de morbidade a hipertensão porta, ocasionando episódios de sangramento digestivo alto. A densitometria óssea tem sido usada para a avaliação da osteoporose de humanos. Foram avaliadas histomorfometricamente as repercussões da esquistossomose no fêmur de camundongos infectados com Schistosoma mansoni. O estudo foi feito em cortes transversais dos fêmures. Foi realizada análise microscópica, discriminando-se o as alterações histopatológicas e histomorfométricas levando-se em consideração as alterações das áreas de osso e das áreas de trabéculas, antes e após 100 dias da infestação. As áreas foram medidas por planimetria. Utilizou-se o teste “t” de Student para avaliação de diferenças entre médias. As médias das áreas trabecular e óssea foram mais elevadas no grupo infectado, todavia, a diferença foi significante apenas para a área óssea (p<0,05). A explicação para este achado é a evidente reorganização na arquitetura óssea dos fêmures dos camundongos infectados; caracterizada pela presença de atividade osteoblástica com redirecionamento celular ao redor das trabéculas ósseas, visualizada em todas as lâminas destes animais. Isto sugere reparação óssea na área medular. A ausência de atividade anormal dos osteoclastos nas lâminas dos animais infectados demonstra que o mecanismo de desmineralização óssea não é induzido pela osteoporose clássica, ficando indefinido o mecanismo de remodelação óssea, uma vez que o mecanismo conhecido está diretamente relacionado à presença de osteoclastos na área afetada