Spawning induction and embryonic development of Salminus hilarii (Characiformes: Characidae).

The present study aimed to evaluate two different methods of artificial reproduction induction, and characterize the embryonic development of Salminus hilarii. Different than observed for other tropical fish species, artificial reproduction induction followed by hand-stripping of gametes was considered unfeasible for S. hilarii, as no gamete fertilization was observed. However, females that were induced and spawned naturally presented a fertilization rate of 65.64 ± 0.54%. With a mean temperature of 26.20 ± 0.90ºC it was possible to clearly distinguish a large perivitelline space at 14 min after fertilization (AF) and at 49 min AF more than 50% of the embryos presented two blastomeres, and these cleavages occurred until 1 h 54 min AF. The gastrula phase was characterized at 3 h 56 min AF, and blastopore closure was observed at 8 h 31 min AF. At 9 h 1 min, organogenesis started, with a clear distinction of the yolk mass, embryonic axis, cephalic and caudal regions; at 11 h 51 min AF the embryos already had advanced segmentation and a free tail. Total hatching occurred at 21 h 17 min and after opening the mouth, which occurred at 33 h 9 min, the larvae of S. hilarii presented a strong and characteristic cannibalism. This information can be considered fundamental to improving S. hilarii production in captivity and for collaboration with a conservation programme in the upper Tietê river basin.

Orbital Bone Decompression for Non-Thyroid Eye Disease Proptosis.

PURPOSE: To report a multicenter large case series of orbital decompression for non-thyroid eye disease proptosis. METHODS: Retrospective chart review of cases of orbital decompression performed by 9 experienced orbital surgeons from different countries from 2014 to 2017 for non-thyroid eye disease proptosis. Patients were divided into 3 groups: 1) negative vector (high axial length or shallow orbit), 2) inflammatory, and 3) tumor. Types of orbital decompression and Hertel exophthalmometry (preoperative and minimum 6 months postoperative) were recorded. Charts were also assessed for serious complications. The amount of exophthalmometry improvement was recorded according to the above groups. RESULTS: The analysis included 41 orbits of 29 patients (14 women and 15 men) with a mean age of 38.9 years (ranging from 9 to 74; standard deviation (SD) 15.66). There were 17 orbits of 11 patients in the negative vector group, 16 orbits of 10 patients in the inflammatory group, and 8 orbits of 8 patients in the tumor group. The mean reduction of proptosis was 2.95 mm in the negative vector group, 2.54 mm in the inflammatory group, and 5.75 mm in the tumor group. There were no serious complications. CONCLUSIONS: Orbital decompression was safe and effective in reducing proptosis for non-thyroid eye disease indications in this series. The amount of exophthalmometry improvement was less in the inflammatory orbitopathy group compared with other proptosis etiology groups.Orbital decompression may have a role in improving proptosis in non-thyroid eye disease entities.

Pancreatitis Subtypes Survey in 852 Childhood-Onset Systemic Lupus Erythematosus Patients.

OBJECTIVE: Pancreatitis is a rare and a life-threatening systemic lupus erythematosus (SLE) manifestation in childhood-onset SLE (cSLE). The objective of this study was to systematically classify pancreatitis in cSLE according to the International Study Group of Pediatric Pancreatitis and determine the overall prevalence, clinical features, laboratory, and first episode outcomes. METHODS: A multicenter cohort study in 10 pediatric rheumatology centers, including 852 patients with cSLE. RESULTS: Pancreatitis was diagnosed in 22 of 852 (2.6%) patients with cSLE. It was classified as acute pancreatitis in 20 (91%), acute recurrent pancreatitis in 2 (9%), and none of them had chronic pancreatitis. None of them had gallstones, traumatic pancreatitis, or reported alcohol/tobacco use. The comparison of patients with pancreatitis (first episode) and without this complication revealed a shorter disease duration (1 [0-10] vs 4 [0-23] years, P < 0.0001) and higher median of Systemic Lupus Erythematosus Disease Activity Index 2000 (21 [0-41] vs 2 [0-45], P < 0.0001). The frequencies of fever (P < 0.0001), weight loss (P < 0.0001), serositis (P < 0.0001), nephritis (P < 0.0001), arterial hypertension (P < 0.0001), acute renal failure (P < 0.0001), macrophage activation syndrome (P < 0.0001), and death (P = 0.001) were also higher in patients with pancreatitis. The frequencies of intravenous methylprednisolone use (P < 0.0001) and the median of prednisone dose (55 [15-60] vs 11 [1-90] mg/day, P < 0.0001) were significantly higher in patients with pancreatitis. Of note, the 2 patients with acute recurrent pancreatitis had 2 episodes, with pain-free interval of 1 and 4 years. CONCLUSIONS: This was the first study characterizing pancreatitis using the International Study Group of Pediatric Pancreatitis standardized definitions in patients with cSLE showing that the predominant form is acute pancreatitis seen in association with glucocorticoid treatment and active severe disease.

Exploring the role of environmental enrichment and early life adversity on emotional development.

Early life adversity has been linked with a higher probability of developing behavioral impairments and environmental manipulation is a strategy that may reduce the negative effects of exposure to adversity in early life. Here, we focused on exploring the influence of environmental enrichment (EE) as a protective factor in the context of early life adversity. We hypothesized that 24 hours of maternal deprivation (MD), in the second week of life, could induce anxiety-like behavior alterations and that exposure to EE could induce resilience to these behaviors due to alterations in the serotonergic system. Male Wistar rats were exposed to MD, on postnatal days 11 and 13, and to EE, after weaning. In adulthood, we performed a series of behavioral tests for fear, anxiety, and locomotor activity. We also measured the levels of serotonin in the amygdala and dorsal raphe nucleus. Our results revealed that MD does not impact fear behavior or the levels of serotonin, while EE decreases locomotor activity in a novel environment and enhances exploration in the predator odor test. EE also decreases serotonin in the amygdala and increases its turnover rate levels. Our findings provide insights into the critical timeframe during which stress exposure impacts the development and confirm that exposure to EE has an independent and protective effect for anxiety-like behaviors later in life.

Influence of Docosahexaenoic and Eicosapentaenoic Acid Ratio and Temperature on the Growth Performance, Fatty Acid Profile, and Liver Morphology of Dusky Grouper (Epinephelus marginatus) (Teleostei: Serranidae) Juveniles.

An 8-week trial was performed to evaluate the influence of docosahexaenoic (DHA) and eicosapentaenoic acid (EPA) ratios and temperature on the fatty acid (FA) metabolism and liver morphology of Epinephelus marginatus. A basal diet was manufactured, and DHA (D1:0.5%; D2:0.75%; D3:1%; and D4:1.5%) and EPA (D1:1.0%; D2:0.75%; D3:0.5%; and D4:0%) levels were added. E. marginatus were kept in twelve tanks with a lower temperature (LT, 23.17 ± 0.12 °C) and twelve with a higher temperature (HT, 28.63 ± 0.06 °C). The DHA/EPA ratio did not affect performance, regardless of the temperature, but the animals fed with the D4 diet showed better growth at HT. A higher lipid deposition and a large lipid vacuole area in the hepatocytes at HT were observed, regardless of the diet. Triacylglycerol (TG) in reflected the diet FA profile mainly in the muscle and liver, whereas the phospholipid (PL) was less influenced by the diet. The same DHA content in the TG fraction of muscle (D3 and D4) were observed at LT; however, only the DHA/EPA ratio of D4 could be differentially stored in the TG fraction of muscle (HT). Monounsaturated and polyunsaturated FA increased in the PL of the eyes at HT, whereas saturated FA was reduced in the TG and PL fractions at LT. These results evidence the importance of temperature and a balanced DHA/EPA ratio in the diet of marine fish.

Post-feeding Molecular Responses of Cobia (Rachycentron canadum): RNA-Sequencing as a Tool to Evaluate Postprandial Effects in Hepatic Lipid Metabolism.

We used transcriptome sequencing to investigate the hepatic postprandial responses of Rachycentron canadum (cobia), an important commercial fish species. In total, 150 cobia juveniles (50 per tank, triplicate) were fed ad libitum with a commercial diet for 7 days, fasted for 24 h, and fed for 10 min. The liver was sampled 10 min prior to feeding and 30 min, 1, 2, 4, 8, 12, and 24 h after the feeding event. Each sample was evaluated in terms of liver fatty acid profile and gene expression. Differential gene expressions were evaluated, focusing on fatty acid synthesis and oxidation pathways. In general, the liver fatty acid profile reflected diet composition. Docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and n-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFA) levels increased at 8 to 12 h but decreased at 24 h after the feeding event. A high number of differentially expressed genes (DEGs) were observed comparing fish that fasted for 8 h with those fasted for 30 min and 24 h, while a reduced number of DEGs was observed comparing individuals who fasted for 30 min compared with those who fasted for 24 h. Similarly, the main differences in the expression of genes related to the fatty acid biosynthesis and oxidation pathways were noticed in individuals who fasted for 8 h compared with those who fasted for 30 min and 24 h. The results suggested that the adequate time to sample the individuals ranged between 8 and 12 h after the meal since, apparently, after 24 h, differential gene expression was not necessarily influenced by food intake.

Alterations in Gene Expression and the Fatty Acid Profile Impact but Do Not Compromise the In Vitro Maturation of Zebrafish (Danio rerio) Stage III Ovarian Follicles after Cryopreservation.

The vitrification of ovarian follicles is a strategic tool that may contribute to advances in aquaculture and the conservation of many important species. Despite the difficulties inherent to the cryopreservation of oocytes, some successful protocols have been developed for different species, but little is known about the capacity of oocytes to develop after thawing. Therefore, the profiles of the reproductive pathway genes and fatty acid membrane composition during the initial stages of development were analyzed in fresh ovarian follicles and follicles after the vitrification process. There were differences in the expression of the hypothalamic-pituitary-gonad axis genes during the follicular development in the control group as well as in the vitrified group. Similarly, alterations in the composition of fatty acids were observed after vitrification. Despite this, many alterations were observed in the vitrified group; more than half of the stage III ovarian follicles were able to grow and mature in vitro. Therefore, the vitrification of ovarian follicles may impact them at molecular and membrane levels, but it does not compromise their capability for in vitro maturation, which indicates that the technique can be a strategic tool for aquaculture.

[Surgical Approaches to Petroclival Meningiomas Part 1: Microsurgical Anatomy]. / Abordajes quirúrgicos de meningiomas petroclivales parte 1: anatomía microquirúrgica.

Background: Most petroclival meningiomas are benign tumors, but their neurosurgical treatment is one of the greatest challenges in this field. Acquiring a deep practical knowledge of brain anatomy is the first step on the path to successfully meeting this challenge. To this end, the present paper is divided into two parts. The first regards the microsurgical anatomy and surgical approaches used in the management of petroclival meningiomas. The second correlates the brain anatomies of the 30 cases of petroclival meningiomas which the senior author (GRI) has operated on. Methods: Eight cadaver heads were dissected using surgical microscopes at the University of Arkansas microsurgery laboratory. The heads were stabilized in a Mayfield device to simulate surgical conditions and colored silicon was injected to highlight the differences between arteries and veins. The approaches performed were: cranio-orbital zygomatic, posterior and anterior petrosectomy, and retrosigmoid. Results: Three main surgical approaches were chosen to treat petroclival meningiomas: the pterional approach and its variants, the petrous approach and its variants, and the retrosigmoid approach. To rationalize the choice of approach, the clivus was separated into superior, middle, and inferior thirds. Conclusion: Several surgical approaches are useful in accessing the petroclival region. Acquiring a practical knowledge of this anatomy in a microsurgical laboratory is fundamental for any surgeon who intends to operate on petroclival meningiomas.

[Surgical approaches to petroclival meningiomas Part 2: narrative review of what we learned with 30 cases]. / Abordajes quirúrgicos de los meningiomas petroclivales Parte 2: revisión narrativa y lo que aprendimos con 30 casos.

Background: The surgical ressection of petroclival meningiomas is challenging due to its deep location and relationship with vital neurovascular structures. Usually they are benign injuries, but they can involve or infiltrate skull base bones, dura mater and brainstem. This makes the total removing very difficult or impossible without causing neurological deficits. The objective of this study is to review the surgical approaches used on the treatment of petroclival meningiomas and the knowledge which we achieved upon the surgical management of 30 cases. Methods: Series of 30 petroclival meningioma-cases. In the beginning of our series we used petrous approach for all the cases, however, with the acquiring of experience, we are indicating the retrosigmoid approach, leaving the petrous and skull-orbito-zigomatics approaches for selected cases. Results: Owing to the difficulty of the access, the petroclival meningiomas usually require different surgical approaches and have distint surgical difficulties. There are three main approaches: fronto-orbito-zigomatics and variants; petrous and variants and retrosigmoid, and they can be combined. The choice for a surgical approach is usually on the location and size of the tumor, on the skull shape, the involvement of venous structures and according to the surgeon´s experience. Conclusion: Petroclival meningiomas are rare and complex on the skull base. The adequate choice is crucial to achieve the good surgical result.

Long-Chain Polyunsaturated Fatty Acids n-3 (n-3 LC-PUFA) as Phospholipids or Triglycerides Influence on Epinephelus marginatus Juvenile Fatty Acid Profile and Liver Morphophysiology.

Phospholipids (PL) are membrane components composed of fatty acids (FA), while triglycerides (TG) are a main source of energy and essential FA. Polyunsaturated FA (PUFA), such as docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA), are essential for marine carnivorous fish; thus, an 8-week experiment was performed to evaluate the influence of DHA and EPA, provided as PL and TG, on the morphophysiology of Epinephelus marginatus juveniles. A basal diet was manufactured, and DHA and EPA in PL form (PL1-low amount PL2-high amount) and TG form (TG1-low amount; TG2-high amount) were added. Dusky grouper juveniles were equally distributed in 12 tanks of 20 animals each, and liver and muscle were sampled for metabolic analysis. The total hepatic lipids in PL1 and PL2 were higher when compared to the initial, TG1 and TG2 groups. Total lipids in muscle were higher in PL2 and TG1 than PL1 and TG2, respectively. Diets rich in DHA and EPA in PL and TG resulted in higher deposition of these FA in the muscle polar fraction. However, fish fed diets containing lower amounts of DHA and EPA in PL and TG stored those in the muscle neutral fraction and liver, centralizing the storage of DHA and EPA.

INitial Steps of Insulin Action in Parotid Glands of Male Wistar Rats.

The parotid gland is the largest salivary gland. It produces watery saliva, rich in proteins (amylase, lysozymes, and antibodies). Due to the gland's morphological cytoarchitecture composed of only serous acini, it contributes almost 50% of total salivary volume upon stimulation. It has been reported that the prevalence of saliva secretion impairments, periodontitis, delayed wound healing, and xerostomia increase in diabetic patients. Herein we evaluated the acute effects of insulin on insulin receptor phosphorylation status and its substrates IRS-1 and IRS-2 in the parotid glands of adult male Wistar rats, using Western blot analyses. We confirmed an acute effect of insulin on IR/IRS/PI3K/Akt and MAPK intracellular pathway activation in the parotid glands of male Wistar rats similar to the classical metabolic targets of the hormone, like the liver.

Eutrophication effects on fatty acid profiles of seston and omnivorous fish in tropical reservoirs.

It has been postulated that eutrophication causes replacement of n3 highly unsaturated fatty acids (n3 HUFA) rich taxa, such as Bacillariophyta, Cryptophyta and Dinophyta, with taxa poor in these fatty acids (FA), such as Chlorophyta and Cyanobacteria. Such a change in community composition at the basis of the food web may alter the FA composition of consumer tissues. Here, we investigated the effects of eutrophication on phytoplankton composition and FA profiles of seston and muscle of two omnivorous fish species (Astyanax fasciatus and Astyanax altiparanae) from reservoirs of different trophic status in Southeast Brazil. The phytoplankton composition and seston FA profiles reflected the degree of eutrophication at most of the studied sites. Three of the five most eutrophic sites were dominated by cyanobacteria and had the highest saturated fatty acid (SFA) and lowest polyunsaturated fatty acid (PUFA) relative contents among all sites. In contrast, the remaining two sites presented a higher phytoplankton diversity and higher relative contribution of sestonic PUFAs with 18 carbons (C18) and HUFAs than less eutrophic systems. However, there were no clear effects of sestonic FA profiles on the FA profiles of muscle of both fish species. A higher percentage of n3 HUFAs was found in the fish samples from a hypereutrophic and cyanobacteria dominated reservoir than in those from sites with a more diverse phytoplankton community in which fish mainly showed higher percentages of C18 PUFA. These results suggest a lack of a direct relationship between the degree of eutrophication and the percentage of n3 HUFAs in both fish species, which can be caused by specific characteristics of the reservoirs that may modulate eutrophication effects. Therefore, consumer FA biochemistry seemed to be dictated by their ability to select, accumulate, and modify dietary FAs, rather than by the eutrophication degree of the studied tropical reservoirs.

Characterization of atrial arrhythmias in body surface potential mapping: A computational study.

PURPOSE: Atrial tachycardia (AT), flutter (AFL) and fibrillation (AF) are very common cardiac arrhythmias and are driven by localized sources that can be ablation targets. Non-invasive body surface potential mapping (BSPM) can be useful for early diagnosis and ablation planning. We aimed to characterize and differentiate the arrhythmic mechanisms behind AT, AFL and AF from the BSPM perspective using basic features reflecting their electrophysiology. METHODS: 19 simulations of 567-lead BSPMs were used to obtain dominant frequency (DF) maps and estimate the atrial driving frequencies using the highest DF (HDF). Regions with |DF-HDF|≤1Hz were segmented and characterized (size, area); the spatial distribution of the differences |DF-atrialHDFestimate| was qualitatively analyzed. Phase singularity points (SPs) were detected on maps generated with Hilbert transform after band-pass filtering around the HDF (±1Hz). Connected SPs along time (filaments) and their histogram (heatmaps) were used for rotational activity characterization (duration, spatiotemporal stability). Results were reproduced in clinical layouts (252 to 12 leads) and with different rotations and translations of the atria within the torso, and compared with the original 567-lead outcomes using structural similarity index (SSIM) between maps, sensitivity and precision in SP detection and direct feature comparison. Random forest and least-square based algorithms were used to classify the arrhythmias and their mechanisms' location, respectively, based on the obtained features. RESULTS: Frequency and phase analyses revealed distinct behavior between arrhythmias. AT and AFL presented uniform DF maps with low variance, while AF maps were more heterogeneous. Lower differences from the atrial HDF regions correlated with the driver location. Rotational activity was most stable in AFL, followed by AT and AF. Features were robust to lower spatial resolution layouts and modifications in the atrial geometry; DF and heatmaps presented decreasing SSIM along the layouts. The classification of the arrhythmias and their mechanisms' location achieved balanced accuracy of 72.0% and 73.9%, respectively. CONCLUSION: Non-invasive characterization of AT, AFL and AF based on realistic models highlights intrinsic differences between the arrhythmias, enhancing the BSPM utility as an auxiliary clinical tool.

Assistência de enfermagem a população transexual na atenção básica / Nursing care for the transsexual population in primary care / Cuidados de enfermería a la población transexual en la atención primaria

Objetivo: analisar as evidências da literatura sobre aassistência de enfermagem à população transexual na atenção básica. Método:Revisão integrativa da literatura, realizada nas bases de dados Biblioteca Virtual em Saúde, Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS) e na Biblioteca Eletrônica Cientifica Online (SCIELO), utilizando os descritores Cuidados de enfermagem AND Pessoas transgênero AND Enfermagem de Atenção Primária. Resultados:Encontrados 2 artigos, publicados nos últimos 5 anos. Ficou evidenciado lacunas importantes que vem desde a formação acadêmica, no despreparo e desconhecimento acerca da sexualidade. Conclusão:Conclui-se, portanto, que foram encontrados poucos artigos com essa temática, evidenciando a necessidade de realização de mais pesquisas acerca do tema assistência de enfermagem à população transexual.

Objective: to analyze the evidence in the literature on nursing care for the transsexual population in primary care. Method:Integrative literature review, carried out in the Virtual Health Library, Latin American and Caribbean Literature in Health Sciences (LILACS) and Online Scientific Electronic Library (SCIELO) databases, using the descriptors Nursing care AND Transgender people AND Primary Care Nursing. Results:Found 2 articles, published in the last 5 years. It was evidenced important gaps that come from the academic formation, in the unpreparedness and lack of knowledge about sexuality. Conclusion:It is concluded, therefore, that few articles were found with this theme, highlighting the need to carry out more research on the topic of nursing care for the transsexual population.

Objetivo: analizar las evidencias en la literatura sobre el cuidado de enfermería a la población transexual en la atención primaria. Método:Revisión integrativa de la literatura, realizada en las bases de datos Biblioteca Virtual en Salud, Literatura Latinoamericana y Caribeña en Ciencias de la Salud (LILACS) y Biblioteca Científica Electrónica en Línea (SCIELO), utilizando los descriptores Cuidados de Enfermería Y Personas trans y Enfermería de Atención Primaria. Resultados: Se encontraron 2 artículos, publicados en los últimos 5 años. Se evidenció importantes lagunas que provienen de la formación académica, en la falta de preparación y conocimiento sobre la sexualidad. Conclusión:Se concluye, por lo tanto, que fueron encontrados pocos artículos con esta temática, destacando la necesidad de realizar más investigaciones sobre el tema del cuidado de enfermería a la población transexual.

Characterization of scrotal involvement in children and adolescents with IgA vasculitis.

OBJECTIVE: To characterize scrotal involvement in children and adolescents with IgA vasculitis. METHODS: A cross-sectional retrospective study included 296 IgA vasculitis (EULAR/PRINTO/PRES criteria) patients, 150/296 (51%) were males and assessed by demographic/clinical/laboratory and treatments. Scrotal involvement was defined by the presence of scrotal edema and/or pain/tenderness in physical examination and/or testicular Doppler ultrasound abnormalities. RESULTS: Scrotal involvement was observed in 28/150 (19%) IgA vasculitis patients. This complication was evidenced at IgA vasculitis diagnosis in 27/28 (96%). Acute recurrent scrotal involvement was observed in 2/150 (1%) and none had chronic subtype. Further analysis of patients with scrotal involvement at first episode (n = 27) compared to those without this complication (n = 122) revealed that the median age at diagnosis [4.0 (2.0-12) vs. 6 (1.3-13) years, p = 0.249] was similar in both groups. The frequency of elevated serum IgA was significantly lower in IgA vasculitis patients with scrotal involvement versus without this manifestation (18% vs. 57%, p = 0.017), whereas glucocorticoid (93% vs. 49%, p < 0.0001) and ranitidine use (63% vs. 30%, p = 0.003) were significantly higher in the former group. CONCLUSIONS: The scrotal involvement occurred in almost one fifth of IgA vasculitis patients and was commonly evidenced as acute subtype at diagnosis. Scrotal signs/symptoms improved after a prompt use of glucocorticoid and was associated with low frequency of elevated IgA serum levels.

Assistência de enfermagem a pessoa vivendo com HIV/AIDS: reflexão à luz da teoria do autocuidado / El cuidado de enfermería a las personas que vivencon VIH/SIDA: reflexión a la luz de lateoríadel autocuidado / Nursing care for people living with HIV/AIDS: reflection in the light of self-care theory

Objetivo: Analisar as evidências científicas de como a Teoria do Autocuidado pode ser utilizada na assistência de enfermagem ao paciente comHIV/AIDS. Método: Revisão integrativa da literatura realizada entre agosto e setembro de 2022mediante a Biblioteca Virtual em Saúde (BVS) /Biblioteca Regional de Medicina (BIREME) e MEDLINE/PUBMED por meio dos descritores: Autocuidado (Self Care); HIV (HIV) e Teoria de Enfermagem (Nursing Theory).Foram selecionados para a revisão 10 artigos, através de buscas realizadas em intervalo atemporal.Resultados:A teoria do autocuidadopossibilita uma análise da construção ou mudança de uma realidade ao paciente com HIV/AIDS, cujo propósito é a apreensão de atitudes de práticas que proporcionem a autonomia e, promova uma saudável relação com o outro, social e com o meio. Conclusão: A teoria do autocuidado viabiliza subsídios teóricos proporcionandoao enfermeiro a realização de um atendimento qualificado e que atende as necessidades individuais dos pacientes com HIV/AIDS(AU)

Objective: To analyze the scientificevidence of how the Self-Care Theorycanbeused in nursing care for patientswith HIV/AIDS. Method:Integrativeliterature review carried out between August and September 2022 using the Virtual Health Library (VHL) / Regional Library of Medicine (BIREME) and MEDLINE/PUBMED using the descriptors: Self-Care; HIV (HIV) and Nursing Theory. Tenarticleswereselected for the review, throughsearchescarried out in a timelessinterval. Results: The theory of self-care enablesan analysis of the constructionorchange of a reality for the patientwith HIV/AIDS, whosepurpose is to apprehendattitudes of practicesthatprovideautonomy and promote a healthyrelationshipwith the other, social and with the quite. Conclusion: The theory of self-care providestheoreticalsupport, providing nurses withqualified care thatmeets the individual needs of patientswith HIV/AIDS.(AU)

Objetivo:Analizarlas evidencias científicas de cómolaTeoríadel Autocuidado puede ser utilizada enel cuidado de enfermería a pacientes con VIH/SIDA. Método:Revisión integrativa de la literatura realizada entre agosto y septiembre de 2022 através de la Biblioteca Virtual enSalud (BVS) / Biblioteca Regional de Medicina (BIREME) y MEDLINE/PUBMED utilizando losdescriptores: Autocuidado; VIH (VIH) y Teoría de Enfermería. Diez artículos fueronseleccionados para larevisión, a través de búsquedas realizadas enun intervalo atemporal. Resultados: La teoríadel autocuidado posibilitaunanálisis de laconstrucción o cambio de una realidad para el paciente con VIH/SIDA, cuyo propósito es aprehenderactitudes de prácticas que brindenautonomía y promuevan una sana relaciónconelotro, social y conel bastante.Conclusión: La teoríadel autocuidado proporciona sustento teórico, proporcionando a losenfermeros cuidados calificados que atiendanlasnecesidadesindividuales de los pacientes con VIH/SIDA.(AU)

[Childhood-onset systemic polyarteritis nodosa and systemic lupus erythematosus: an overlap syndrome?] / Poliartrite nodosa sistêmica e lúpus eritematoso sistêmico de início na infância: uma síndrome de sobreposição?

We described herein a patient who presented an overlap syndrome of childhood-onset systemic polyarteritis nodosa (c-PAN) and childhood-onset systemic lupus erythematosus (c-SLE). A 9-year-old girl presented tender subcutaneous nodules on feet, arterial hypertension, right hemiplegia and dysarthric speech. She was hospitalized due to stroke and left foot drop. Brain computer tomography showed ischemic stroke. Magnetic resonance angiography revealed stenosis in the middle cerebral and internal carotid arteries. Electroneuromyography identified a mononeuropathy of left posterior tibial nerve and she fulfilled the c-PAN validated criteria. She was treated with intravenous methylprednisolone pulse therapy followed by prednisone, that was progressively tapered, six months of intravenous cyclophosphamide and after that she received azathioprine for 19 months. At the age of 14 years and 9 months, she presented malar rash, photosensitivity, edema in lower limbs and arterial hypertension. The proteinuria was 1.7g/day. Antinuclear antibodies (ANA) were 1/1280 (homogeneous nuclear pattern) and anti-dsDNA antibodies were positive. Renal biopsy showed focal proliferative and membranous glomerulonephritis. Therefore, she fulfilled the American College of Rheumatology classification criteria for SLE and she was treated with prednisone, hydroxychloroquine and mycophenolate mofetil. In conclusion, we described herein a possible overlap syndrome of two autoimmune diseases, where c-PAN occurred five years before the c-SLE diagnosis.

Severe intestinal involvement as initial manifestation of systemic childhood polyarteritis nodosa: report of two cases.

Systemic childhood polyarteritis nodosa (C-PAN) is a rare primary vasculitis involving medium or small sized arteries. Abdominal angina is an important and serious complication of PAN, occurring usually 15 to 30 min after food intake, and particularly in adult patients. However, to our knowledge, this involvement as the first manifestation of C-PAN was not described. Therefore, we reported herein two C-PAN cases that fulfilled the new criteria for this vasculitis. These patients were young boys that had malignant arterial hypertension and recurrent post-prandial cramping with acute abdomen. Both of them were submitted to laparotomy that revealed multiple and diffuse intestinal necrosis. One of our cases had a severe post-prandial cramping, even after drinking water, and the laparotomy evidenced multiple intestinal perforations. In spite of use of antihypertensive therapies, immunosuppressive agents (corticosteroids, cyclophosphamide and/or methotrexate) and intravenous immunoglobulin, they died possibly due to severe and disseminated activity disease. In conclusion, we described herein the first two fatal cases of C-PAN that presented severe abdominal pain as initial manifestation. We suggest that the diagnosis of PAN should be considered in patients under acute abdominal angina with no apparent etiology.