Inflammatory Mediators of Leprosy Reactional Episodes and Dental Infections: A Systematic Review.

Reactional episodes in leprosy are a result of complex interactions between the immune system, Mycobacterium leprae, and predisposing factors, including dental infections. To determine the main inflammatory mediators in the immunopathological process of dental infections and leprosy reactions, we conducted a systematic review of primary literature published between 1996 and 2013. A three-stage literature search was performed (Stage I, "leprosy reactions" and "inflammatory mediators"; Stage II, "dental infections" and "inflammatory mediators"; and Stage III, "leprosy reactions," "dental infections," and "inflammatory mediators"). Of the 911 eligible publications, 10 were selected in Stage I, 68 in Stage II, and 1 in Stage III. Of the 27 studied inflammatory mediators, the main proinflammatory mediators were IL-6, IFN-γ, TNF-α, IL-1ß, and IL-17; the main anti-inflammatory mediators were IL-10 and IL-4. Serum IL-6 and TNF-α concentrations were significant during periodontal and reactional lesion evolution; IFN-γ and IL-1ß were associated with types 1 and 2 reactions and chronic periodontal disease. The proinflammatory mediators in dental infections and leprosy reactions, especially IL-6 and TNF-α, were similar across studies, regardless of the laboratory technique and sample type. IFN-γ and IL-1ß were significant for leprosy reactions and periodontal diseases. This pattern was maintained in serum.

Chondroitin sulfate from fish waste exhibits strong intracellular antioxidant potential.

Chondroitin sulfate (CS) is a type of glycosaminoglycan described as an antioxidant molecule that has been found in animal species such as fish. Tilapia (Oreochromis niloticus) represents an eco-friendly source of this compound, since its economical processing generates usable waste, reducing the negative environmental impact. This waste was used for CS extraction, purification, characterization by enzymatic degradation, and evaluation of its antioxidant effect. CS obtained from tilapia presented sulfation mainly at carbon 4 of galactosamine, and it was not cytotoxic at concentrations up to 200 µg/mL. Furthermore, 100 µg/mL of CS from tilapia reduced the levels of reactive oxygen species to 47% of the total intracellular reactive oxygen species level. The ability of CS to chelate metal ions in vitro also suggested an ability to react with other pathways that generate oxidative radicals, such as the Haber-Weiss reaction, acting intracellularly in more than one way. Although the role of CS from tilapia remains unclear, the pharmacological effects described herein indicate that CS is a potential molecule for further study of the relationship between the structures and functions of chondroitin sulfates as antioxidants.

Molecular typing and antifungal susceptibility of clinical and environmental Cryptococcus neoformans species complex isolates in Goiania, Brazil.

A total of 124 Cryptococcus isolates, including 84 clinical strains obtained from cerebrospinal fluid from AIDS patients and 40 environmental isolates from pigeon excreta and from Eucalyptus trees, were studied. The varieties, serotypes, phospholipase activity and molecular profile of these isolates were determined. Cryptococcus neoformans var. grubii serotype A was identified in 120 isolates and Cryptococcus gattii serotype B in four isolates. The clinical isolates showed higher phospholipase activity than environmental isolates. Similar patterns of in vitro susceptibility to amphotericin B, fluconazole, itraconazole and voriconazole and no resistance were found for all isolates. Molecular type VNI (C. neoformans var. grubii) was recovered in 80 clinical and 40 environmental isolates while the type VGIII (C. gattii) was found in four clinical isolates. This study demonstrated for the first time the molecular types of clinical and environmental Cryptococcus isolates in the midwest Brazil region.

Chondroitin sulfate from fish waste exhibits strong intracellular antioxidant potential

Chondroitin sulfate (CS) is a type of glycosaminoglycan described as an antioxidant molecule that has been found in animal species such as fish. Tilapia (Oreochromis niloticus) represents an eco-friendly source of this compound, since its economical processing generates usable waste, reducing the negative environmental impact. This waste was used for CS extraction, purification, characterization by enzymatic degradation, and evaluation of its antioxidant effect. CS obtained from tilapia presented sulfation mainly at carbon 4 of galactosamine, and it was not cytotoxic at concentrations up to 200 µg/mL. Furthermore, 100 µg/mL of CS from tilapia reduced the levels of reactive oxygen species to 47% of the total intracellular reactive oxygen species level. The ability of CS to chelate metal ions in vitro also suggested an ability to react with other pathways that generate oxidative radicals, such as the Haber-Weiss reaction, acting intracellularly in more than one way. Although the role of CS from tilapia remains unclear, the pharmacological effects described herein indicate that CS is a potential molecule for further study of the relationship between the structures and functions of chondroitin sulfates as antioxidants.

Absence of the left pericardium diagnosed by computed tomography.

A case report of left pericardial absence in a 12-year-old boy is described. The suspected diagnosis was not shown either by cross-sectional echocardiography or angiography, but was correctly established by computed tomography (CT), showing the effectiveness of this diagnostic test for diagnosis of pericardial defects.

[Stoma therapy: an emerging specialty for Brazilian nursing]. / Estomaterapia: uma especialidade que emerge para a enfermagem brasileira.

The authors relate the experience in the organization and development of the I Enterostomal Therapy Specialization Course, the pioneer in Brazil. They report the concepts and history about enterostomal therapy as a specialty; discuss the objectives, contents, teaching strategies, and evaluation process of the course.

Efeito do flushing sobre o desempenho reprodutivo de ovelhas Morada Nova e Santa Inês submetidas à inseminação artificial em tempo fixo / The effect of flushing on the reproductive performance of Morada Nova and Santa Inês ewes submitted to fixed time artificial insemination

O objetivo do estudo foi analisar o efeito do flushing, do protocolo hormonal para sincronização de estro e da IATF sobre o desempenho reprodutivo de ovelhas Morada Nova (MN) e Santa Inês (SI). Foram utilizadas 27 ovelhas SI e 24 ovelhas MN suplementadas com concentrado (1% do peso vivo, em média) durante 75 dias de estação reprodutiva. Após 30 dias de suplementação, as ovelhas foram sincronizadas com protocolo hormonal (PH) à base de progestágeno, eCG e cloprostenol. A observação de estro foi realizada após 12, 24, 36 e 48 horas do término do PH, com o auxílio de dois rufiões, e a IATF foi realizada aproximadamente 55 horas após o final do PH. Do 20º ao 45º dia após o início do PH, realizou-se o repasse com um reproduto Dorper. O diagnóstico de prenhez foi realizado 70 dias após a IATF. Foi analisado o peso, escore da condição corporal (ECC), taxa de apresentação de estro, taxa de prenhez e prolificidade, testando-se os efeitos da raça, semana de suplementação (SS) e classe de ECC. O peso e ECC das ovelhas variaram em função da SS. Foi observada taxa de estro de 88,2%, sendo que 43,2% das ovelhas apresentaram estro até 24 horas do final do PH. A taxa de prenhez por IATF foi de 31,4% e a de prenhez após repasse foi de 50,0%, sendo que a classe de ECC interferiu nas taxas de prenhez. Obteve-se maior porcentagem de partos múltiplos de ovelhas prenhes por IATF do que por monta natural no repasse. Conclui-se que o flushing resultou em ganho de peso e aumento do ECC, o que garantiu a padronização do rebanho para a estação reprodutiva e, consequentemente, melhorou o desempenho reprodutivo. O PH utilizado aumentou a prolificidade e adiantou o início do estro; porém, não foi eficiente na sincronização de ovelhas deslanadas.(AU)

The aim of this study was to analyze the effect of flushing on the reproductive performance of Morada Nova (MN) and Santa Inês (SI) ewes submitted to fixed time artificial insemination (TAI). Twenty seven SI and 24 MN supplemented with concentrate (1% of live weight, on average), for 75 days during the breeding season. After 30 days of supplementation, ewes were synchronized with the aid of a hormonal protocol (HP) based on progesterone, eCG and cloprostenol. The estrus observation was conducted at 12, 24, 36 and 48 h after the end of HP with the aid of two ruffians. TAI was done 55 h after the end of HP. From 20 to 45 days after the beginning of the HP ewes were exposed to rams (natural breeding). The pregnancy diagnosis was evaluated 70 days after TAI. We analyzed the weight, body condition score, estrus rate, pregnancy rate and prolificacy testing the effects of race, week of supplementation and body condition score class. The weight and body conditions of ewes varied according to the week of supplementation, with higher values in the first two weeks following TAI. The estrus rate was 88.2% and 43.2% of the ewes showed estrus up to 24 hours of the end of the HP. The pregnancy rate per TAI was 31.3% and the pregnancy rate after natural breeding was 50.0%. It was observed that body condition score classes interfered in pregnancy rates. There was a higher percentage of multiple births by pregnancy by TAI than by natural breeding. It was concluded that the flushing resulted in weight gain and better body conditions ensuring the standardization of the herd for breeding season, which therefore improved reproductive performance. The HP used advanced the onset of estrus and increased prolificacy, but was inefficient in the synchronization of woolless sheep.(AU)

Efeito do flushing sobre o desempenho reprodutivo de ovelhas Morada Nova e Santa Inês submetidas à inseminação artificial em tempo fixo / The effect of flushing on the reproductive performance of Morada Nova and Santa Inês ewes submitted to fixed time artificial insemination

O objetivo do estudo foi analisar o efeito do flushing, do protocolo hormonal para sincronização de estro e da IATF sobre o desempenho reprodutivo de ovelhas Morada Nova (MN) e Santa Inês (SI). Foram utilizadas 27 ovelhas SI e 24 ovelhas MN suplementadas com concentrado (1% do peso vivo, em média) durante 75 dias de estação reprodutiva. Após 30 dias de suplementação, as ovelhas foram sincronizadas com protocolo hormonal (PH) à base de progestágeno, eCG e cloprostenol. A observação de estro foi realizada após 12, 24, 36 e 48 horas do término do PH, com o auxílio de dois rufiões, e a IATF foi realizada aproximadamente 55 horas após o final do PH. Do 20º ao 45º dia após o início do PH, realizou-se o repasse com um reproduto Dorper. O diagnóstico de prenhez foi realizado 70 dias após a IATF. Foi analisado o peso, escore da condição corporal (ECC), taxa de apresentação de estro, taxa de prenhez e prolificidade, testando-se os efeitos da raça, semana de suplementação (SS) e classe de ECC. O peso e ECC das ovelhas variaram em função da SS. Foi observada taxa de estro de 88,2%, sendo que 43,2% das ovelhas apresentaram estro até 24 horas do final do PH. A taxa de prenhez por IATF foi de 31,4% e a de prenhez após repasse foi de 50,0%, sendo que a classe de ECC interferiu nas taxas de prenhez. Obteve-se maior porcentagem de partos múltiplos de ovelhas prenhes por IATF do que por monta natural no repasse. Conclui-se que o flushing resultou em ganho de peso e aumento do ECC, o que garantiu a padronização do rebanho para a estação reprodutiva e, consequentemente, melhorou o desempenho reprodutivo. O PH utilizado aumentou a prolificidade e adiantou o início do estro; porém, não foi eficiente na sincronização de ovelhas deslanadas...

The aim of this study was to analyze the effect of flushing on the reproductive performance of Morada Nova (MN) and Santa Inês (SI) ewes submitted to fixed time artificial insemination (TAI). Twenty seven SI and 24 MN supplemented with concentrate (1% of live weight, on average), for 75 days during the breeding season. After 30 days of supplementation, ewes were synchronized with the aid of a hormonal protocol (HP) based on progesterone, eCG and cloprostenol. The estrus observation was conducted at 12, 24, 36 and 48 h after the end of HP with the aid of two ruffians. TAI was done 55 h after the end of HP. From 20 to 45 days after the beginning of the HP ewes were exposed to rams (natural breeding). The pregnancy diagnosis was evaluated 70 days after TAI. We analyzed the weight, body condition score, estrus rate, pregnancy rate and prolificacy testing the effects of race, week of supplementation and body condition score class. The weight and body conditions of ewes varied according to the week of supplementation, with higher values in the first two weeks following TAI. The estrus rate was 88.2% and 43.2% of the ewes showed estrus up to 24 hours of the end of the HP. The pregnancy rate per TAI was 31.3% and the pregnancy rate after natural breeding was 50.0%. It was observed that body condition score classes interfered in pregnancy rates. There was a higher percentage of multiple births by pregnancy by TAI than by natural breeding. It was concluded that the flushing resulted in weight gain and better body conditions ensuring the standardization of the herd for breeding season, which therefore improved reproductive performance. The HP used advanced the onset of estrus and increased prolificacy, but was inefficient in the synchronization of woolless sheep...

[Traumatic injuries of the pancreas: report of 65 cases]. / Lesões traumáticas do pâncreas: análise de 65 casos.

With the aim of aiding the accurate diagnosis and treatment of patients with pancreatic injuries, we reviewed the medical records of sixty-five patients, treated for traumatic pancreatic lesions at the Department of Surgery of the University of São Paulo in the 5-year period from 1989 through 1993. Records, including operative and pathology reports, were reviewed and the location of the pancreatic injury, associated intra-abdominal injuries, type of injury, trauma scores, treatment, complications and mortality rates recorded. There were 58 male and seven female patients with a mean age of 28.3 years (range, 2-77 years). Of the 65 pancreatic injuries, 45 (69.2%) were caused by penetrating wounds and twenty by blunt trauma. The most frequent site of lesion was the head of the pancreas (38.5%). Associated injuries were found in all but five of the patients. In the 65 patients, 170 intra-abdominal injuries were found (2.6 per patient). Twenty-eight of the 65 patients (43.1%) had liver lacerations. Lacerations of major abdominal vessels (27 patients), gastric lacerations (25 patients) and colorectal lacerations (17 patients) were the next most frequent injuries. Fifteen out of twenty patients died within two days after the accident from severe concomitant injuries. Simple drainage was performed in 33 patients, distal pancreatectomy in 17 and duodenopancreatectomy in six patients. Pancreas-related complications occurred in 20 (30.7%) out of 57 patients who survived the initial operation. We concluded that the type of repair employed in our series was related to the class of injury and clinical conditions (based on trauma scores). Therefore, whenever possible, conservative management (no pancreatic resection) was employed in patients that sustained class I and II injuries and pancreatic resection in class III and IV injuries.

[Muscle-aponeurotic transposition for treatment of anal incontinence]. / Transposições músculo-aponevróticas utilizadas para o tratamento da incontinência anal grave.

The management of anal incontinence varies. It can be treated either clinically or surgically depending on its etiology and the intensity of the signs and symptoms. The variety of procedures and techniques employed in its treatment is proof of the incomprehension of the pathophysiological mechanisms involved as well as their diversity. Sphincteroplasties are indicated for those patients with well-defined muscle injury, usually resulting from obstetrical trauma, iatrogenic surgery or vehicular accidents. In cases of persistent anal incontinence after previous sphincteroplasty or those in which extensive destruction of the sphincteric musculature is confirmed, muscle-aponeurotic transpositions are an attractive option. A detailed survey of the literature of the chief techniques utilized and their results is presented.

[Risk factors in emergency surgery relaparotomy]. / Fatores de risco em relaparotomia na cirurgia de urgência.

Reintervention in abdominal surgery involves the difficulty of precise indication and the limitations of surgical technics during the operation. It may bring to evidence professional errors. It presents a very high morbimortality index. In order to establish risk factors and death rate, we comparatively analysed the initial diagnoses, the number, the cause and the time of relaparotomy, the existence of associated diseases, the age and the illness severity, using APACHE-II after the first surgical intervention. During a two years period starting 1990 we retrospectively analysed charts of 40 patients submitted to relaparotomy in the Emergency Service of Hospital das Clínicas of Medicine University of São Paulo.

Bowel preparation for colonoscopy: comparison of mannitol and sodium phosphate. Results of a prospective randomized study.

METHOD: Eighty patients were prospectively randomized for precolonoscopic cleansing either with 750ml of 10% mannitol (Group M) or 180ml of a sodium phosphate preparation (Group NaP). Laboratory examinations before and after preparation on all patients included hemoglobin, hematocrit, sodium, potassium, phosphorous, calcium and serum osmolarity. A questionnaire was used to assess undesirable side effects and patient tolerance to the solution. The quality of preparation was assessed by the endoscopist who was unaware of the solution employed. RESULTS: Statistically significant changes were verified in serum sodium, phosphorous, potassium and calcium between the two groups, but no clinical symptoms were observed. There were no significant differences in the frequency of side effects studied. Six of the eight patients in Group NaP who had taken mannitol for a previous colonoscopy claimed better acceptance of the sodium phosphate solution. The endoscopic-blinded trial reported excellent or good bowel preparation in 85% prepared with sodium phosphate versus 82.5% for mannitol (p=0.37). CONCLUSIONS: Quality of preparation and frequency of side effects was similar in the two solutions. The smaller volume of sodium phosphate necessary for preparation seems to be related to its favorable acceptance. Nevertheless, the retention of sodium and phosphate ions contraindicates the use of sodium phosphate in patients with renal failure, cirrhosis, ascites, and heart failure.

[Traumatic rupture of duodenal diverticulum. Report of a case and literature review]. / Ruptura traumática de divertículo duodenal. Relato de um caso e revisão da literatura.

Duodenal diverticulum is a common anatomic abnormality. Its inflammatory perforation is a rare complication, with less than 100 cases reported in the available literature. Traumatic perforation is exceedingly rare (only 3 cases reported). In this report one more case of traumatic perforation is presented, and the literature is reviewed focusing on the pathogenic, diagnostic and therapeutic aspects of this severe disease.

[Colonoscopy as a diagnostic and therapeutic method in large intestine diseases. Results of 1715 exams]. / Emprego da colonoscopia como método diagnóstico e terapêutico das doenças do intestino grosso. Resultados observados em 1.715 exames.

Widespread use of colonoscopy in clinical practice results from the continuous progress of the techniques developed for exam completion and from the therapeutic perspective for several colorectal conditions. This paper analyses in a retrospective basis the results associated to the employment of fibrocolonoscopy between 1984 and 1995 at Discipline of Coloproctology from the University of São Paulo School of Medicine. For this period, 1,715 exams were realized. More than 50% of the patients were between the 50th and 70th decade. Habit change of hemorrhage were indications for the exam in more than 35%. Inflammatory bowel disease and cancer follow-up were indications, respectively, in 18% and 16%. "Express mannitol" bowel prep resulted satisfactory in more than 97% but precluded complete exam for seven (0.4%) patients. In 42.5%, colonoscopic examination was normal. Polyps were found in 248 (14.5%) patients for whom 376 polypectomy procedures were done successfully. Endoscopists could not reach the cecum in 68 (3.9%) patients. Incidence of hemorrhage and perforation was nill for this series. Authors conclude that fibrocolonoscopy remains as a safe and efficient method for the diagnosis and treatment (polypectomy) of common colorectal conditions.

Inflammatory mediators of leprosy reactional episodes and dental infections: a systematic review

Reactional episodes in leprosy are a result of complex interactions between the immune system, Mycobacterium leprae, and predisposing factors, including dental infections. To determine the main inflammatory mediators in the immunopathological process of dental infections and leprosy reactions, we conducted a systematic review of primary literature published between 1996 and 2013. A three-stage literature search was performed (Stage I, "leprosy reactions" and "inflammatory mediators"; Stage II, "dental infections" and "inflammatory mediators"; and Stage III, "leprosy reactions," "dental infections," and "inflammatory mediators"). Of the 911 eligible publications, 10 were selected in Stage I, 68 in Stage II, and 1 in Stage III. Of the 27 studied inflammatory mediators, the main proinflammatory mediators were IL-6, IFN-γ, TNF-α, IL-1ß, and IL-17; the main anti-inflammatory mediators were IL-10 and IL-4. Serum IL-6 and TNF-α concentrations were significant during periodontal and reactional lesion evolution; IFN-γ and IL-1ß were associated with types 1 and 2 reactions and chronic periodontal disease. The proinflammatory mediators in dental infections and leprosy reactions, especially IL-6 and TNF-α, were similar across studies, regardless of the laboratory technique and sample type. IFN-γ and IL-1ß were significant for leprosy reactions and periodontal diseases. This pattern was maintained in serum.