Inorganic content of rock dust waste from northwest of Rio de Janeiro, Brazil: do environmental risks incur from its use as natural fertilizer?

The ornamental rock exploration and coating industry has led to significant environmental impacts due to the inadequate manner in which these residues are released into the environment. This impact may be reduced by using these residues for soil enrichment, as they contain high levels of inorganic nutrients. However, some elements may be potential contaminants, thus requiring a thorough previous research before employing these substances in agriculture. In this context, this study aims to determine potentially toxic elements present in rock dust residues, As, Cd, Cr, Cu, Pb, and V, through Inductively Coupled Plasma Optical Emission Spectroscopy (ICP OES) after wet decomposition. Cd concentrations in residual rock dust waste surpassed the maximum limit established by the Brazilian Ministry of Agriculture, Livestock and Supply stipulated in normative instruction No. 5/2016 for remineralizers and substrates for plants intended for agriculture. In addition, the official digestion method adopted by the Brazilian Agricultural Research Corporation Embrapa (used for soil analysis) was used for a rock dust waste analysis and compared to two different block digester-based procedures. Accuracy was confirmed by using the Certified Reference Material (CRM) NIST SRM 1646a (Estuarine Sediments) and addition/recovery tests. The limits of detection for the aforementioned elements, after aqua-regia-induced digestion, were of 0.07 mg kg-1 for As, 0.06 mg kg-1 for Cd, 0.01 mg kg-1 for Cr, 0.2 mg kg-1 for Cu, 0.03 mg kg-1 for Pb, and 0.09 mg kg-1 for V.

Comparison of Blended Learning With Traditional Dermatology Learning for Medical Students: Prospective Evaluation Study.

BACKGROUND: Novel internet-based applications and associated technologies have influenced all aspects of society, ranging from commerce and business to entertainment and health care, and education is no exception. In this context, this study was designed to evaluate the impact of a dermatology e-learning program on the academic performance of medical students in dermatology. OBJECTIVE: The aim of this study is to develop a dermatology blended-learning course for undergraduate medical students, evaluate the knowledge gained by students exposed to this course, and compare the results to those of traditional teaching methods. METHODS: In this prospective study, we evaluated the performance of fourth-semester medical students at the Federal University of Bahia, Brazil. Students who had been in their second year of the medical course in 2019 were considered the control group, while students in their second year in 2020 were considered the blended or hybrid group. The first group attended traditional classes, using printed material (books and handouts), while the second group used our web-based course and e-book as a supplement in a hybrid web-plus-traditional fashion. Neither participants nor evaluators were blinded. The students in both groups were subjected to the same pre- and postcourse face-to-face, multiple-choice, paper-based evaluations, and we compared their performances. The content of the classes was the same for both groups. All didactic activities were developed by a team of certified dermatologists and professors from the university. RESULTS: A total of 129 students were selected and divided into 2 groups: the control group (n=57) and the hybrid group (n=72). The precourse tests did not indicate any difference between the control group (mean score 2.74, SD 1.25) and the hybrid group (mean score 3.2, SD 1.22 SD; P>.05). The hybrid group had better final-term grades (mean 8.18, SD 1.26) than the traditional group (mean 7.11, SD 1.04). This difference was statistically significant (P<.05). CONCLUSIONS: This study explores pedagogical possibilities in the field of dermatology teaching for medical school students. The results suggest that the performance of undergraduate students who attended the course with additional e-learning material was superior when compared to the performance of those who participated in the traditional course alone.

A one-class classification approach for authentication of specialty coffees by inductively coupled plasma mass spectroscopy (ICP-MS).

Due to the lucrative nature of specialty coffees, there have been instances of adulteration where low-cost materials are mixed in to increase the overall volume, resulting in illegal profit. A widely used and recommended approach to detect possible adulteration is the application of one-class classifiers (OCC), which only require information about the target class to build the models. Thus, this work aimed to identify adulterations in specialty coffees with low-quality coffee using multielement analysis determined by ICP-MS and to evaluate the performance of one-class classifiers (dd-SIMCA, OCRF, and OCPLS). Therefore, authentic specialty coffee samples were adulterated with low-quality coffee in 25 % to 75 % (w/w) proportions. Samples were subjected to acid decomposition for analysis by ICP-MS. OCPLS method presented the best performance to detect adulterations with low-quality coffee in specialty coffees, showing higher specificity (SPE = 100 %) and reliability rate (RLR = 94.3 %).

Detection of encephalitis-causing viruses reveals predominance of chikungunya virus in the state of Bahia, Brazil.

OBJECTIVES: Encephalitis is a severe neurological syndrome for which herpesvirus and enteroviruses are the most common etiological agents. Arboviruses, a wildly diverse group of pathogens, are also critical epidemiological agents associated with encephalitis. In Brazil, little is known about the causative agents of encephalitis. METHODS: We conducted a hospital surveillance for encephalitis between 2020 and 2022. Molecular (RT-PCR and qPCR) and serological (virus-specific IgM and viral antigens) techniques were performed in cerebrospinal fluid and serum samples obtained from study participants. RESULTS: In the 43 participants evaluated, the etiologic agent or the presence of IgM was detected in 16 (37.2%). Nine (20.9%) cases were positive for chikungunya virus (CHIKV), three (7.0%) for dengue virus, two (4.7%) for human adenovirus, one (2.3%) for varicella-zoster virus, and one (2.3%) for enterovirus. Whole-genome sequencing revealed that the CHIKV identified belongs to the East/Central/South African lineage. CONCLUSION: Herein, CHIKV is a common pathogen identified in encephalitis cases. Our results reinforce previous evidence that chikungunya represents a significant cause of encephalitis during CHIKV outbreaks and epidemics and add to existing information on the epidemiology of encephalitis in Brazil.

Translation, cross-cultural adaptation, and validation of the Behavioral Activity Rating Scale (BARS) for the Brazilian population.

INTRODUCTION: Few instruments are available in Brazil to evaluate psychomotor activity in psychiatric emergency, clinical, and research settings. This study aimed to perform a cross-cultural adaptation of the Behavioral Activity Rating Scale (BARS) into Brazilian Portuguese and assess the adapted scale's psychometric properties. METHOD: An expert consensus committee conducted a translation and back-translation of the original scale, resulting in the BARS-BR. Four pairs of physicians administered the BARS-BR and the Sedation-Agitation Scale (SAS) to patients in a hospital psychiatry emergency room and patients in the hospital's psychiatric wards. The BARS-BR was compared to the SAS to assess concurrent validity and internal consistency was evaluated with the Bland-Altman technique. RESULTS: In the emergency room, the correlation coefficients between the first and second assessments were rho = 0.997 and rho = 1.0, respectively. In the hospital wards, the correlation coefficient between the pair of evaluators was rho = 0.951. There were strong correlations between the BARS-BR score of the first examiner and the SAS score of the second examiner (rho = 0.903) and between the SAS score of the first examiner and the BARS-BR score of the second examiner (rho = 0.893). CONCLUSION: The BARS-BR showed good psychometric properties, and we recommend its use because it constitutes an easy method for assessment of changes in psychomotor activity. Further studies are suggested to evaluate adoption and comprehension of the BARS-BR scale by all classes of healthcare professionals.

Oculometric parameters of hyperopia in children with esotropic amblyopia.

PURPOSE: To study the oculometric parameters of hyperopia in children with esotropic amblyopia, comparing amblyopic eyes with fellow eyes. METHODS: Thirty-seven patients (5-8 years old) with bilateral hyperopia and esotropic amblyopia underwent a comprehensive ophthalmic examination, including cycloplegic refraction, keratometry and A-scan ultrasonography. Anterior chamber depth, lens thickness, vitreous chamber depth and total axial length were recorded. The refractive power of the crystalline lens was calculated using Bennett's equations. Paired Student's t-tests were used to compare ocular biometric measurements between amblyopic eyes and their fellow eyes. The associations of biometric parameters with refractive errors were assessed using Pearson correlation coefficients and linear regression. Multivariable models including axial length, corneal power and lens power were also constructed. RESULTS: Amblyopic eyes were found to have significantly more hyperopic refraction, less corneal power, greater lens power, shorter vitreous chamber depth and shorter axial length, despite similar anterior chamber depth and lens thickness. The strongest correlation with refractive error was observed for the axial length/corneal radius ratio (r(36) = -0.92, p < 0.001 for amblyopic and r(36) = -0.87, p < 0.001 for fellow eyes). Axial length accounted for 39.2% (R(2)) of the refractive error variance in amblyopic eyes and 35.5% in fellow eyes. Adding corneal power to the model increased R(2) to 85.7% and 79.6%, respectively. A statistically significant correlation was found between axial length and corneal power, indicating decreasing corneal power with increasing axial length, and they were similar for amblyopic eyes (r(36) = -0.53, p < 0.001) and fellow eyes (r(36) = -0.57, p < 0.001). A statistically significant correlation was also found between axial length and lens power, indicating decreasing lens power with increasing axial length (r(36) = -0.72, p < 0.001 for amblyopic eyes and r(36) = -0.69, p < 0.001 for fellow eyes). CONCLUSIONS: We observed that the correlation among the major oculometric parameters and their individual contribution to hyperopia in esotropic children were similar in amblyopic and non-amblyopic eyes. This finding suggests that the counterbalancing effect of greater corneal and lens power associated with shorter axial length is similar in both eyes of patients with esotropic amblyopia.

Analytical validation using a gas mixing system for the determination of gaseous formaldehyde.

Formaldehyde levels in the atmosphere are a concern in the indoor and outdoor air and many methods for determining this compound have been developed. The use of 2,4-dinitrophenylhydrazine (DNPH) for reaction with formaldehyde, catalyzed by acid, forming a hydrazone derivative in cartridges is considered the standard method for analyzing formaldehyde compounds in the air. However, formaldehyde is quantified using an analytical curve, created by diluting liquid standards of the formaldehyde-DNPH product. The analysis aims to quantify the gas phase formaldehyde, and it may be subject to experimental biases from the differences in the matrix of the sample (gas) and calibration standard (liquid). The objective of this work was to build an analytical curve in the gaseous phase using a synthetic air/formaldehyde mixing system (SFMS) and sampling with SPE-DNPH-tubes, comparing with the analytical curve in the liquid phase adopted by the Environmental Protection Agency (EPA). Parameters of linearity, sensitivity, limit of detection (LOD), limit of quantification (LOQ), precision and accuracy (recovery) were determined from the analytical curve in the gaseous phase. The best recovery in DNPH-tubes was obtained using the range of 400-1600 mL min-1 of flow rates in the gaseous phase. The sampling and reaction/elution of formaldehyde using DNPH-tubes presented adequate linearity and a similar sensitivity in the liquid analytical curve. Considering the LOD and LOQ in the gaseous phase, the values in nanograms are higher than those in the liquid phase. This study suggests that the quantification of formaldehyde in ambient air may be subject to bias due to differences in derivatization reaction efficiency. However, the results prove the efficiency of formaldehyde recovery from the atmosphere and the validity of the use of this DNPH-tube method.

Intraosseous Schwannoma: Case Report and Review of the Literature.

Schwannoma is a benign neural sheath tumor of the soft tissue, and its intraosseous presentation is very rare. It is estimated that intraosseous schwannomas represent 0.2% of all bone tumors. The tumor may affect any site of the skeleton, including the mandible, the sacrum, vertebral bodies, the ulna, the humerus, the femur, the tibia, the patella, the scapula, the ribs, and small bones of the hand. The involvement of the calcaneus has only been reported four times in the literature. The present study reports the case of a 49-year-old male with right hindfoot pain and a radiological finding of an osteolytic bone lesion in the calcaneus. The diagnosis was confirmed by histopathological study. The treatment of choice was an intralesional resection with adjuvant local control, and bone defect substitution with polymethylmethacrylate and fixation with two cannulated screws. The patient had a satisfactory postoperative evolution; after 1 year, he is asymptomatic, with good functional response and no evidence of disease. The present case report shows the clinical, radiological, and pathological features of a rare benign bone neoplasm. Moreover, intraosseous schwannoma should be included in the differential diagnosis of osteolytic calcaneal lesions.

Holocentric Karyotype Evolution in Rhynchospora Is Marked by Intense Numerical, Structural, and Genome Size Changes.

Cyperaceae is a family of Monocotyledons comprised of species with holocentric chromosomes that are associated with intense dysploidy and polyploidy events. Within this family the genus Rhynchospora has recently become the focus of several studies that characterize the organization of the holocentric karyotype and genome structures. To broaden our understanding of genome evolution in this genus, representatives of Rhynchospora were studied to contrast chromosome features, C-CMA/DAPI band distribution and genome sizes. Here, we carried out a comparative analysis for 35 taxa of Rhynchospora, and generated new genome size estimates for 20 taxa. The DNA 2C-values varied up to 22-fold, from 2C = 0.51 pg to 11.32 pg, and chromosome numbers ranged from 2n = 4 to 61. At least 37% of our sampling exhibited 2n different from the basic number x = 5, and chromosome rearrangements were also observed. A large variation in C-CMA/DAPI band accumulation and distribution was observed as well. We show that genome variation in Rhynchospora is much larger than previously reported. Phylogenetic analysis showed that most taxa were grouped in clades corresponding to previously described taxonomic sections. Basic chromosome numbers are the same within every section, however, changes appeared in all the clades. Ancestral chromosome number reconstruction revealed n = 5 as the most likely ancestral complements, but n = 10 appears as a new possibility. Chromosome evolution models point to polyploidy as the major driver of chromosome evolution in Rhynchospora, followed by dysploidy. A negative correlation between chromosome size and diploid number open the discussion for holokinetic drive-based genome evolution. This study explores relationships between karyotype differentiation and genome size variation in Rhynchospora, and contrasts it against the phylogeny of this holocentric group.

[Generalized eruptive syringoma: case report]. / Siringoma eruptivo disseminado: Relato de caso.

Syringomas are benign adnexal tumors derived from the intraepidermal portion of eccrine sweat ducts. Clinically, they usually appear as small yellow or skin-colored papules ranging from 1-3 mm in diameter on the lower eyelids. The condition of eruptive syringomas is a clinically distinct, uncommon variant of syringomas. This entity was first recognized by Darier and Jacquet in 1887. Since the initial description, less than 100 cases have been reported to date. Although eruptive syringomas can develop on various sites of the body, instances of widespread involvement, known as generalized eruptive syringoma, are rare. In this paper, we present a case of generalized eruptive syringoma on a 26-year-woman. She exhibited multiple, eruptive asymptomatic papules, symmetrically distributed on the face, scalp, upper and lower extremities, chest, and abdomen.

Relationship between the biomechanical properties of the cornea and anterior segment measurements.

OBJECTIVE: To evaluate the relationship of biomechanical properties, corneal hysteresis and corneal resistance factor with age, sex and various corneal parameters measured with a Pentacam in normal subjects. METHODS: A total of 226 eyes from 113 patients were enrolled in this study. The subjects underwent Ocular Response Analyzer and Pentacam evaluations. A varying-intercept multilevel regression was implemented using Bayesian inference. The predictor variables were age, sex, central corneal thickness, corneal volume at a 7-mm diameter, anterior chamber angle and volume, anterior chamber depth, mean radius of the corneal curvature and corneal astigmatism. RESULTS: Corneal hysteresis ranged from 5.5 to 14.8 mmHg (mean 10.42±1.74 mmHg), and the corneal resistance factor ranged from 5.7 to 15.5 mmHg (mean 10.23±1.88 mmHg). No predictor variable other than gender and central corneal thickness had a significant correlation with either corneal hysteresis or corneal resistance factor. Corneal hysteresis was positively associated with female sex and with central corneal thickness, and corneal resistance factor was positively associated with central corneal thickness. CONCLUSION: Despite the associations found, only a small fraction of the variance in biomechanical measurements could be explained by the descriptors that were evaluated, indicating the influence of other corneal aspects on the biomechanical characteristics.

O efeito provocado pela sirene na saúde dos profissionais de batalhões do corpo de bombeiros / The effect of the siren on the health of professionals in fire battalions / El efecto de la sirene en la salud de los profesionales de batalla en el cuerpo de la bomba

Introdução: O ruído é um som que provoca efeitos nocivos ao ser humano, sendo uma sensação auditiva desagradável que interfere na percepção do som desejado. Indivíduos expostos a níveis elevados de ruídos por um longo período de tempo podem sofrer danos mentais, socias e físicos. Os bombeiros são uma classe profissional que está frequentemente exposta a ruídos, dentre eles, de sirenes, veículos, ferramentas e alarmes. Objetivo: Investigar o efeito provocado pela sirene na saúde dos profissionais dos batalhões do Corpo de Bombeiros do Distrito Federal. Método: Foi aplicado questionário para avaliar o desconforto gerado pelo ruído e feita medição dos níveis de pressão sonora dos veículos e equipamentos utilizados em resgate. Foram aplicados os testes estatísticos pertinentes, adotando o nível de significância menor que 0,05. Resultados: O ambiente de trabalho foi classificado, na presente pesquisa, como ruidoso por 80,5 % dos participantes, sendo que 72% destes o classificaram como moderado e 15% como excessivo. As queixas mais citadas após a entrada na incorporação foram alteração no sono, o desconforto com sons altos, a intolerância e a irritabilidade. O tempo de serviço, como profissional do Corpo de Bombeiros, interferiu nas questões emocionais relacionadas a aspectos de estresse e distúrbios do sono. Conclusão: O ruído excessivo pode desencadear queixas auditivas e extra-auditivas nos bombeiros. Isso pode causar irritabilidade, distúrbios do sono e desconforto com sons altos. Dessa forma, é imprescindível a implementação de medidas de proteção, visando prevenir efeitos deletérios à saúde dos profissionais.

Introduction: Noise is a sound that causes harmful effects to the human being, being an unpleasant hearing sensation that interferes with the perception of the desired sound. Individuals exposed to high levels of noise over a long period of time may suffer mental, social, and physical harm. Firefighters are a professional class that is often exposed to noises, among them sirens, vehicles, tools and alarms. Objective: To investigate the effect of the siren on the health of the professionals of the Federal District Fire Department battalions. Method: A questionnaire was applied to evaluate the discomfort generated by noise and measurement of the sound pressure levels of vehicles and equipment used in rescue. Relevant statistical tests were applied, adopting the level of significance below 0.05. Results: The working environment was classified, in the present study, as noisy by 80.5% of the participants, 72% of them classified it as moderate and 15% as excessive. The most cited complaints after entry into incorporation were alteration in sleep, discomfort with loud sounds, intolerance and irritability. The length of service, as a Fire Department professional, interfered with the emotional issues related to aspects of stress and sleep disorders. Conclusion: Excessive noise can trigger hearing and extra-hearing complaints in firefighters. This can cause irritability, sleep disturbances, and discomfort with loud sounds. In this way, it is essential to implement protective measures, with a view to preventing harmful effects on the health of professionals.

Introducción: el ruido es un sonido que causa efectos nocivos en los seres humanos, y es una sensación de oído desagradable que interfiere con la percepción del sonido deseado. Las personas expuestas a altos niveles de ruido durante un largo período de tiempo pueden sufrir daños mentales, sociales y físicos. Los bomberos son una clase profesional que a menudo está expuesta al ruido, entre ellos sirenas, vehículos, herramientas y alarmas. Objetivo: Investigar el efecto de la sirena en la salud de los trabajadores del batallón en el Departamento de Bomberos del Distrito Federal. Método: Se aplicó un cuestionario para evaluar la incomodidad generada por el ruido y para medir los niveles de presión acústica de los vehículos y equipos utilizados con fines de rescate. Se aplicaron las pruebas estadísticas pertinentes, con un nivel significativo inferior a 0,05. Resultados: El entorno de trabajo fue clasificado en esta encuesta como ruidoso por el 80,5 % de los participantes, de los cuales el 72 % lo clasificó como moderado y el 15 % como excesivo. Las quejas más citadas después de la incorporación fueron malestar del sueño, intolerancia e irritabilidad. La duración del servicio, como profesional en el Departamento de Bomberos, interfirió con problemas emocionales relacionados con aspectos de estrés y trastornos del sueño. Conclusión: El ruido excesivo puede desencadenar quejas auditivas y no auditivas en los bomberos. Esto puede causar irritabilidad, trastornos del sueño y molestias con sonidos fuertes. De este modo, es esencial aplicar medidas de protección para prevenir los efectos nocivos en la salud de los profesionales.

Translation, cross-cultural adaptation, and validation of the Behavioral Activity Rating Scale (BARS) for the Brazilian population

Abstract Introduction Few instruments are available in Brazil to evaluate psychomotor activity in psychiatric emergency, clinical, and research settings. This study aimed to perform a cross-cultural adaptation of the Behavioral Activity Rating Scale (BARS) into Brazilian Portuguese and assess the adapted scale's psychometric properties. Method An expert consensus committee conducted a translation and back-translation of the original scale, resulting in the BARS-BR. Four pairs of physicians administered the BARS-BR and the Sedation-Agitation Scale (SAS) to patients in a hospital psychiatry emergency room and patients in the hospital's psychiatric wards. The BARS-BR was compared to the SAS to assess concurrent validity and internal consistency was evaluated with the Bland-Altman technique. Results In the emergency room, the correlation coefficients between the first and second assessments were rho = 0.997 and rho = 1.0, respectively. In the hospital wards, the correlation coefficient between the pair of evaluators was rho = 0.951. There were strong correlations between the BARS-BR score of the first examiner and the SAS score of the second examiner (rho = 0.903) and between the SAS score of the first examiner and the BARS-BR score of the second examiner (rho = 0.893). Conclusion The BARS-BR showed good psychometric properties, and we recommend its use because it constitutes an easy method for assessment of changes in psychomotor activity. Further studies are suggested to evaluate adoption and comprehension of the BARS-BR scale by all classes of healthcare professionals.

Importância da Educação em saúde na prevenção de complicações do diabetes mellitus: relato de experiência / Health Education Importance for preventing complications of diabetes mellitus: experience report / Importancia de la educación em salud em la prevención de complicaciones de la diabetes mellitus: relato de experiência

Objetivo: Descrever as experiências vivenciadas durante o processo de capacitação em Metas Internacionais de Segurança do Paciente focada em comunicação efetiva, realizada pelas bolsistas do PET-Saúde, para profissionais de um hospital especializado, visando estimular a formação de profissionais e docentes de elevada qualificação técnica, científica, tecnológica e acadêmica, além de praticar a indissociabilidade entre ensino, pesquisa e extensão, preconizado pelo MEC. Método: Trata-se de um relato de experiência com abordagem qualitativa e descritiva sobre atividades de educação em saúde realizadas na instituição. Resultados: As trocas de experiência entre bolsistas do PET-Saúde e profissionais da saúde, a identificação das limitações a respeito da comunicação efetiva na unidade e dificuldades no trabalho em equipe multiprofissional. Conclusão: Reafirma a importância da cultura de segurança do paciente entre os profissionais e a importância da aproximação entre instituições acadêmicas e as que promovem cuidados em saúde

Objective: To describe the experiences lived during the training process on International Patient Safety Goals focused on effective communication, carried out by PET-Saúde fellows, for professionals of a specialized hospital, aiming to stimulate the training of professionals and teachers with high technical qualification, scientific, technological and academic, in addition to practicing the inseparability between teaching, research and extension, recommended by the MEC. Method: This is an experience report with a qualitative and descriptive approach on health education activities carried out at the institution. Results: The exchange of experiences between PET-Health fellows and health professionals, the identification of limitations regarding effective communication in the unit and difficulties in working in a multidisciplinary team. Conclusion: It reaffirms the importance of a patient safety culture among professionals and the importance of approximation between academic institutions and those that promote health care

Objetivo: Describir las experiencias vividas durante el proceso de formación sobre Objetivos Internacionales de Seguridad del Paciente enfocados en la comunicación efectiva, realizado por becarios PET-Saúde, para profesionales de un hospital especializado, con el objetivo de estimular la formación de profesionales y docentes con alta calificación técnica. Científico, tecnológico y académico, además de practicar la inseparabilidad entre docencia, investigación y extensión, recomendada por el MEC. Método: Se trata de un relato de experiencia con abordaje cualitativo y descriptivo sobre las actividades de educación en salud realizadas en la institución. Resultados: El intercambio de experiencias entre los becarios del PET-Salud y los profesionales de la salud, la identificación de las limitaciones en cuanto a la comunicación efectiva en la unidad y las dificultades para trabajar en un equipo multidisciplinario. Conclusión: Se reafirma la importancia de una cultura de seguridad del paciente entre los profesionales y la importancia de la aproximación entre las instituciones académicas y las que promueven el cuidado de la salud.

Bilateral occipital infarcts associated with carotid atherosclerosis and a persistent hypoglossal artery.

The persistent hypoglossal artery (PHA) is the second most common persistent embryological carotid-basilar connection and usually represents an incidental finding in cerebral arteriograms. The hypoglossal artery connects the primordial carotid artery with the longitudinal neural arteries, which later form the basilar artery. The PHA leaves the internal carotid artery as an extracranial branch, enters the skull through the anterior condyloid foramen, the hypoglossal canal and joins the caudal portion of the basilar artery. We report magnetic resonance and digital subtraction angiography findings in the first case of bilateral occipital infarctions associated with PHA and carotid atherosclerosis. The probable mechanism underlying bilateral occipital infarcts was embolism from the carotid territory to the posterior cerebral arteries. PHA may present a challenge in diagnosis and management of patients with carotid atherosclerosis and vertebrobasilar ischemia.

Disseminated toxoplasmosis presenting as sepsis in two AIDS patients.

This report describes two patients who presented acute disseminated and severe toxoplasmosis as the first opportunistic disease related to acquired immunodeficiency syndrome. At admission, clinical and laboratory findings were similar to sepsis or septic shock and a fast evolutive course to death occurred in both cases. At necropsy, an inflammatory reaction and presence of a great number of Toxoplasma gondii cysts and tachyzoites were observed in most organs examined.

[Sensorial strabismus: a study of 191 cases]. / Estrabismo sensorial: estudo de 191 casos.

PURPOSE: To evaluate the charts of patients with sensorial strabismus regarding range of different aspects, such as etiology, the type and the amount of deviation, relationship between the type of deviation and the patient's age when the disease occurred and the surgical outcome. METHODS: A retrospective analysis of data charts of 191 patients seen at the section of Ophthalmology at the University of São Paulo, from September 1990 to July 2002. RESULTS: There were 84 male and 107 female patients. The most frequent diagnosis responsible for low vision in the squinted eye was atrophic chorioretinitis in 49 patients. Eighty-seven were exotropes and 97 were esotropes. Fifty patients were operated on, but 8 of them were lost to follow-up. In 90.5% the surgical outcome was successful: less than 15 prismatic diopters of hyper or undercorrection after surgery. CONCLUSIONS: The good surgical outcome seen in this and other studies enhances and justifies the need for surgical correction of this type of strabismus.

[Palpebral cryptococcosis: case report]. / Criptococose palpebral: relato de caso.

This paper is about a patient with acquired immunodeficiency syndrome empirically treated for miliary tuberculosis. During the clinical evolution the patient presented lesions compromising the right eyelid and tarsal conjunctiva. The initial diagnostic hypothesis was ocular tuberculosis with conjunctival and eyelid involvement. The biopsy of the conjunctival lesion identified an encapsulated yeast-like fungus: Criptococcus neoformans. After starting treatment with B anfotericin, the cutaneus lesions cleared.

[Cogan's Syndrome: case report]. / Síndrome de Cogan: relato de caso.

Non-luetic interstitial keratitis, deafness and vertigo characterize Cogan's syndrome. The most common ocular findings in early Cogan's syndrome are bilateral, peripheral, subepithelial numular corneal opacities. The report presents a patient with the evolution of the classic form of Cogan's syndrome.

Suspected melanoma only when the lesion is greater than 6mm may harm patients.

OBJECTIVE: To analyze the distribution of larger diameter in the pathological report of cutaneous melanoma patients. METHODS: Data were obtained from patients seen from 1994 to 2015. Date, sex, age, maximum diameter, histological subtype, primary site, microscopic thickness, mitoses, ulceration, vertical growth phase, and regression were the variables studied. This study was approved by the National Ethics Committee - Brazil Platform. Patients were grouped into smaller diameter (≤6mm) and larger diameter (>6mm). The statistical analysis used the χ2test (p<0.05). RESULTS: Of the 292 patients analyzed, 123 were seen between 1994 and 2004, and 169 between 2005 and 2015; in that, 151 women and 141 men, mean age of 52 years. The diameters ranged from 2 to 76mm (mean of 14mm), 81 patients with smaller diameter (≤6mm) and 211 with larger diameter (>6mm). Out of 81 patients with smaller diameter, 29 had invasive melanoma, while 179 of the 211 with larger diameter were invasive. A difference was observed in frequency of vertical growth phase. CONCLUSION: Pigmented skin lesions with diameter smaller than 6mm should not be an excluding factor for biopsies, especially when patients present risk of developing skin cancer.