Chondroblastic osteosarcoma of the mandible: case report / Osteossarcoma condroblástico em mandíbula: relato de caso

ABSTRACT We report the case of a 32-year-old male patient, who was subjected to cone-beam tomography for planning the removal of an unerupted tooth. Cone-beam CT scans revealed the presence of a mixed lesion with poorly defined limits in the left posterior mandibular region, with "sun-ray" periosteal reaction. An incisional biopsy was performed and the diagnosis was chondroblastic osteosarcoma. In this paper, a discussion of the differential diagnosis criteria and treatment of this unusual malignant neoplasm is performed. Thus, it is intended to provide information that will help in the study of management protocols for the increasingly effective treatment of gnathic osteosarcomas.

RESUMO Relatamos o caso de um paciente do sexo masculino, 32 anos de idade, que realizou tomografia cone-beam para planejamento de remoção de dente incluso. O exame revelou presença de lesão mista de limites mal definidos na região posterior mandibular esquerda, com reação periosteal em "raios de sol". Foi realizada biópsia incisional, e o diagnóstico foi de osteossarcoma condroblástico. Neste trabalho, será realizada uma discussão dos critérios de diagnóstico diferencial e do tratamento dessa neoplasia maligna. Pretende-se, dessa forma, trazer informações que auxiliem no estudo de protocolos de conduta para o tratamento cada vez mais efetivo dos osteossarcomas gnáticos.

Uso oportuno de vasoprotectores en choque séptico / Timely use of vasoprotectors in septic shock

El estado de choque septico es una afección grave que ocurre en presencia de una posible infección con posterior fallo multiorgánico, corresponde a una de las primeras causas por las que pacientes son ingresados a la unidad de cuidado intensivo y ocurre con mayor frecuencia en pacientes de edad avanzada por ello es de vital importancia la temprana identificación, manejo guiado mediante metas y la acertada resolución, para ello se establece el oportuno uso de vasopresores como parte de la terapia...AU)

The state of septic shock is a serious condition that occurs in the presence of a possible infection with subsequent multi-organ failure, corresponds to one of the first causes for which patients are admitted to the intensive care unit and occurs more frequently in elderly patients. advanced, therefore, it is vitally important the early identification, guided management through goals and the correct resolution, for this the opportune use of vasopressors is established as part of the therapy ... AU)

Utilization of Agro-Industrial Waste Residues for the Production of Amylase from Aspergillus oryzae IIB-6.

Aims: The aim of this study was to evaluate different solid substrates and moistening agents for the production of an extracellular 1, 4-α-D-glucan glucohydrolase from a newly isolated Aspergillus oryzae IIB-6 by solid state fermentation and optimization of culture conditions for the maximal production of enzyme. Study Design: Six different agro-industrial waste residues (rice straw, rice bran, corn flakes, wheat bran, wheat flakes, and grinded wheat kernel) were procured from the local market. These substrates (10 g) were moistened (1:1) with different moistening agents (distilled water, tap water, mineral salts solution (FeSO4.7H2O 0.02, MgSO4.7H2O 1.0, (NH4)2SO4 4.0, KH2PO4 0.6, K2HPO4 1.4 mg/gds at pH 5), 0.1 N HCl, sodium acetate buffer (pH 5.5), sodium phosphate buffer pH 7.5) and screened for the production of 1,4-α- D-glucan glucohydrolase for 96 hours in static cultures. The substrate and moistening agent that gave maximum enzyme production were selected and their fermentation conditions were further optimized. Place and Duration of Study: Institute of Industrial Biotechnology (IIB), GC University Lahore, Kachery Road Lahore, Pakistan, between February 2011 and March 2012. Methodology: The levels of selected solid substrate, moistening agent and fermentation conditions such as pH, temperature, time of incubation, inoculum size etc. were optimized by one variable at a time method. Results: Wheat bran at the level of 5 g and mineral salts solution containing FeSO4.7H2O 0.016, MgSO4.7H2O 0.8, (NH4)2SO4 3.5, KH2PO4 0.48, K2HPO4 1.12 mg/gds gave relatively best enzyme production. The maximum enzyme activity 7800 U/gds (407 Umg-1 protein) were achieved when wheat bran with 80% moisture content was incubated at 30°C, pH 5, after inoculating with 10% spore suspension (1.2×106 CFU/gds) for 72 h. Conclusion: Aspergillus oryzae IIB-6 was a good producer of 1,4-α-D-glucan glucohydrolase in wheat bran medium containing mineral salts as an additional trace elements so that it can be used for biotechnological purposes.

Lethality by pneumonia and factors associated to death / Letalidade por pneumonia e fatores associados ao óbito

OBJECTIVE: To describe the case-fatality rate (CFR) and risk factors of death in children with community-acquired acute pneumonia (CAP) in a pediatric university hospital. METHOD: A longitudinal study was developed with prospective data collected from 1996 to 2011. Patients aged 1 month to 12 years were included in the study. Those who left the hospital against medical orders and those transferred to ICU or other units were excluded. Demographic andclinical-etiological characteristics and the initial treatment were studied. Variables associated to death were determined by bivariate and multivariate analysis using logistic regression. RESULTS: A total of 871 patients were selected, of whom 11 were excluded; thus 860 children were included in the study. There were 26 deaths, with a CFR of 3%; in 58.7% of these, penicillin G was the initial treatment. Pneumococcus was the most common pathogen (50.4%). From 1996 to 2000, there were 24 deaths (93%), with a CFR of 5.8% (24/413). From 2001 to 2011, the age group of hospitalized patients was older (p = 0.03), and the number of deaths (p = 0.02) and the percentage of disease severity were lower (p = 0.06). Only disease severity remained associated to death in the multivariate analysis (OR = 3.2; 95%CI: 1.2-8.9; p = 0.02). CONCLUSION: When the 1996-2000 and 2001-2011 periods were compared, a significant reduction in CFR was observed in the latter, as well as a change in the clinical profile of the pediatric in patients at the institute. These findings may be related to the improvement in the socio-economical status of the population. Penicillin use did not influence CFR. .

OBJETIVO: Descrever a taxa de letalidade (TL) e os fatores de risco de óbito em crianças com pneumonia grave adquirida na comunidade (CAP) em um hospital universitário pediátrico. MÉTODO: Foi desenvolvido um estudo longitudinal com dados prospectivos coletados de 1996 a2011. Foram incluídos no estudo pacientes com idade entre 1 mês e 12 anos de idade. Foram excluídos aqueles que deixaram o hospital desconsiderando as recomendações médicas e aqueles transferidos para UTI ou outras unidades. Foram estudadas as características demográficas, clínicas e etiológicas e o tratamento inicial. As variáveis associadas a óbito foram determinadas por análise bivariada e multivariada utilizando regressão logística. RESULTADOS: Foi selecionado um total de 871 pacientes, dos quais 11 foram excluídos; assim, foram incluídas no estudo 860 crianças. Houve 26 óbitos, com uma TL de 3%; em 58,7% desses, penicilina G foi o tratamento inicial. Pneumococo foi o patógeno mais comum (50,4%). De 1996 a 2000, houve 24 óbitos (93%), com uma TL de 5,8% (24/413). De 2001 a 2011, a faixa etária de pacientes internados foi mais velha (p = 0,03) e o número de óbitos (p = 0,02) e o percentual de gravidade das doenças foram menores (p = 0,06). Apenas a gravidade das doenças continuou associada a óbito na análise multivariada (RC = 3,2; IC de 95%: 1,2-8,9; p = 0,02). CONCLUSÃO: Quando os períodos de 1996-2000 e 2001-2011 foram comparados, foi observada uma redução significativa na TL no último período, bem como uma alteração no perfil clínico dos pacientes hospitalizados no instituto. Esses achados podem estar relacionados à melhora na situação socioeconômica da população. O uso de penicilina não influenciou a TL. .

Tuberculose em adolescentes em duas capitais brasileiras / Tuberculosis among adolescents in two Brazilian State capitals / Tuberculosis en adolescentes de dos capitales brasileñas

Analisamos o perfil clínico-radiológico da tuberculose (TB) em adolescentes de duas capitais brasileiras, segundo a revisão de 2010 das normas do Programa Nacional de Controle da Tuberculose; estudo descritivo, retrospectivo, transversal de casos notificados de TB em Manaus e Salvador, de 1996 a 2003, em dois grupos: 10 a 14 anos e ≥ 15 a 19 anos com estatística descritiva. Havia 1.781 adolescentes [928 (52,1%) do sexo masculino]. A média de idade = 16 anos (mediana = 16; DP = 2,3). Encontramos 1.447 (82,9%) pacientes com TB pulmonar; 179 (10,3%) com TB pleural e 81 (4,6%) com ganglionar periférica. A tosse ocorreu mais no grupo ≥ 15 anos (p < 0,001). A baciloscopia foi positiva em 150 (72,1%) com TB pulmonar no grupo de 10 a 14 anos, e em 870 (84,4%) no grupo de ≥ 15 anos. Havia radiografias de tórax do tipo adulto em 1.088 (98.6%) no grupo de ≥ 15 anos, e em 58 (98.1%) no grupo < 15 anos (p < 0.0001). Houve tendência à maior ocorrência de TB bacteriológica do tipo adulto na medida em que o paciente aumentava de idade.

The study analyzed clinical, laboratory, and radiological characteristics of tuberculosis (TB) among adolescents from two Brazilian State capitals, according to the 2010 Updated Guidelines of the National TB Control Program (NTPC) through a descriptive, retrospective cross-sectional study of reported TB cases from Manaus and Salvador from 1996 to 2003. Patients were divided into two groups: 10 to 14 years and 15 to 19 years of age. Variables were studied through descriptive statistics; 1,781 adolescents were included; 928 (52.1%) were males. Median age was 16 years (SD = 2.3). Pulmonary TB (PTB) occurred in 1,447 patients (82.9%), pleural TB in 179 (10.3%), and peripheral adenopathy in 81 (4.6%). Cough was more frequent in the ≥ 15-year PTB group (p < 0.001). Chest x-rays were classified as: adult-type TB in 1,088 (98.6%) in the ≥-15 year group; 258 (98.1%) in the < 15-year group (p < 0.0001). Adult type bacteriological PTB increased in proportion to age.

Analizamos el perfil clínico-radiológico de la tuberculosis (TB) en adolescentes de dos capitales brasileñas, según la revisión de 2010 de las normas del Programa Nacional de Control de la Tuberculosis, estudio descriptivo, retrospectivo, transversal de casos notificados de TB en Manaus y Salvador, de 1996 a 2003, en dos grupos: 10 a 14 años y ≥ 15 a 19 años con estadística descriptiva. Había 1.781 adolescentes [928 (52,1%) del sexo masculino]. La media de edad = 16 años (mediana = 16; DP = 2,3). Encontramos 1.447 (82,9%) pacientes con TB pulmonar; 179 (10,3%) con TB pleural y 81 (4,6%) con ganglionar periférica. La tos ocurrió más en el grupo ≥ 15 años (p < 0,001). La baciloscopia fue positiva en 150 (72,1%) con TB pulmonar, en el grupo de 10 a 14 años, y en 870 (84,4%) en el grupo de ≥ 15 años. Había radiografías de tórax del tipo adulto en 1.088 (98.6%) en el grupo de ≥ 15 años, y en 58 (98.1%) en el grupo < 15 años (p < 0.0001). Hubo tendencia a una mayor ocurrencia de TB bacteriológica de tipo adulto, a medida que el paciente aumentaba de edad.

Resistência antimicrobiana do pneumococo aos antibióticos Beta-Lactâmicos / Pneumococcal Antimicrobial Resistance to Beta-Lactam Antibiotics

A resistência antimicrobiana aos beta-lactâmicos representa um desafio na prática diária do pneumologista, haja vista a alta frequência de infecções respiratórias que requerem sua prescrição. Nesta revisão, enfatiza-se a faixa etária pediátrica, principalmente os menores de cinco anos, que ainda hoje apresentam elevadas morbidade e mortalidade por pneumonia adquirida na comunidade por pneumococos e que podem se beneficiar do uso de antibióticos beta-lactâmicos. Apesar de a elevada prevalência de resistência do pneumococo aos antibióticos beta-lactâmicos ser observada em diversos países, o mesmo não ocorre no Brasil. A resistência elevada do pneumococo à penicilina é rara em nosso meio e, do ponto de vista prático, não se observam diferenças significativas na evolução clínica ou na gravidade das infecções pulmonares causadas por cepas resistentes ou suscetíveis à penicilina. A resistência ou a sensibilidade intermediária também não representa uma limitação ao uso da penicilina porque corresponde a cepas da bactéria que necessitam de níveis séricos mais elevados do antibiótico, os quais já são normalmente obtidos com as doses usadas habitualmente para o tratamento.Conclui-se que o tratamento das infecções respiratórias agudas, como a pneumonia adquirida na comunidade, em nosso meio, é eficaz com a penicilina e seus derivados, tanto a nível ambulatorial quanto hospitalar.

Antimicrobial resistance to beta-lactam antibiotics represents a challenge in daily pulmonology practice, because of the high frequency of respiratory infections that require the prescription of those antibiotics. In this chapter, we focus on pediatric patients, especially those under five years of age, among whom the morbidity andmortality related to community-acquired pneumococcal pneumonia remain high and who can benefit from the use of betalactam antibiotics. Although the prevalence of pneumococcal resistance to beta-lactam antibiotics is high in various othercountries, it is not so in Brazil. High pneumococcal resistance topenicillin is rare in Brazil, and, from a practical point ofview,there are no significant differences in the clinical course or severity of pulmonary infections caused by penicillin-resistant orpenicillin-susceptible strains. The intermediate susceptibility or resistance also imposes no restrictions on the use of peni-cillin, because it corresponds to strains of bacteria that require higher serum levels of the antibiotic, which are typicallyachieved at the standard doses.We conclude that treatment of acute respiratory infections such as community acquired pneumonia, in our midst, is effectivewith penicillin and its derivatives, both as outpatient hospital.

Medicinal plants at the Sítio do Gois, Apodi, Rio Grande do Norte State, Brazil

Rural communities have accumulated knowledge about survival techniques in the midst of difficulties, such as ecological, economic or social, and one of the transformation spaces and extraction of resources to these communities is the natural vegetation and homegarden. The aim of this study was to list medicinal plants and characterize the use of these plants at the Sítio do Gois, Apodi-RN, Brazil. Open-interview, semi-structured and guided tours by local experts (field guide person, foresters, herb doctors, healers, farmers, housewives) were realized. Medicinal plants are distributed in 34 families, 46 genera and 52 species. The family with the greatest number of individuals was Lamiaceae (seven species). The species most mentioned were Amburana cearensis (77 percent) followed by 69 percent de citation of Myracrodruon urundeuva, Sideroxylon obtusifolium, Ximenia americana. Informants are aware of specific uses of native medicinal plants of the caatinga and homegardens. The most common preparations are teas and syrups, used part is the leaf and stem bark and great number of citations for disorders of the digestive and respiratory systems. The most important species with greater use agreement were A. cearensis M. urundeuva, S. obtusifolium and X. americana they deserve pharmacological studies and validation.

Oligohydramnios at third trimester and perinatal outcome.

Objectives: The purpose of this study to assess the effect of oligohydramnios on perinatal outcome especially at third trimester of pregnancy. Methods: This prospective and observational study was conducted in a private specialized hospital at Dhaka city from January to December 2009. In this study 78 singleton pregnant females with gestational age from 28 - 42 weeks with less amniotic fluid index (AFI) were analyzed for perinatal outcome. Data were expressed as number (percentage). Proportion test was performed for comparison between two groups , P value <0.05 was taken as level of significance. Results:Women with oligohydramnios were significantly associated with an abnormal antepartum fetal heart rate (FHR), meconium stained fluid, Apgar score less than 7 or NICU admission. Also subjects with AFI of 5.0 cm or less had a higher rate of cesarean section for fetal distress. Conclusions: Antepartum oligohydramnios is associated with an increased risk of fetal heart rate abnormalities. Although in our population it is not predictive of adverse perinatal outcome as measured by low apgar score and NICU admission, yet this may be reflective of the aggressive antepartum and intrapartum management that these patients received.

Qualidade de vida na asma pediátrica: revisão da literatura / Quality of life in asthmatic children: a literature review

OBJETIVO:Analisar as produções científicas que abordam a temática da qualidade de vida em crianças e adolescentes com asma, objetivando discutir o instrumento de pesquisa Pediatric Asthma Quality of Life Questionnaire (PAQLQ). FONTES DE DADOS: Revisão não sistemática da literatura incluindo artigos nos idiomas inglês, português e espanhol, a partir das bases de dados Medline, SciELO e Lilacs, no período de 1997 a 2009. Foram utilizados os termos "quality of life", "asthma pediatrics", "asthma quality of life" e "PAQLQ". SÍNTESE DOS DADOS: Os 26 artigos encontrados foram organizados em duas seções, a saber: estudos de validação do PAQLQ (n=12) e estudos de avaliação da qualidade de vida na asma pediátrica usando o questionário PAQLQ (n=14). CONCLUSÕES: A avaliação da qualidade de vida deve ser incorporada à avaliação clínica, uma vez que a doença crônica repercute nas diversas dimensões da vida dos pacientes. O PAQLQ é de fácil aplicação, reprodutível e constitui-se em instrumento para avaliar a qualidade de vida de crianças e adolescentes com asma.

OBJECTIVE:To analyze scientific articles that discuss the quality of life related to the health of children and adolescents with asthma, focusing the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) evaluation tool. DATA SOURCES: Non-systematic review of the literature including articles in English, Portuguese and Spanish identified via Medline, SciELO and Lilacs, published between 1997 and 2009.The following descriptors were searched: "quality of life", "asthma pediatrics", "asthma quality of life" and "PAQLQ". DATA SYNTHESIS: The 26 articles were organized in two sections: studies on validity of PAQLQ (n=12) and the assessment of quality of life in asthmatic children using the PAQLQ (n=14). CONCLUSIONS: The assessment of quality of life should be incorporated in clinical evaluations considering that chronic illnesses may affect diverse dimensions of life. The PAQLQ is reliable and easy to use, being an appropriate tool to evaluate quality of life in children and adolescents with asthma.

Radiologic findings of pulmonary tuberculosis in adolescents

OBJECTIVE: To describe radiologic findings of pulmonary tuberculosis (TB) in adolescents. METHODS: Retrospective, cross-sectional, observational study of 850 patients with TB, aged 10 to 19 years, and notified to the Brazilian Ministry of Health. Data were collected from the TB notification and medical records in the cities of Manaus, Amazonas State, and Salvador, Bahia State, in the 19962003 period. Data are shown in tables and analyzed using the chi-square and Mann-Whitney tests, with a 5 percent significance level. RESULTS: Mean age was 15.6 years; 443 (52.1 percent) patients were males. The most common radiologic lesion was the upper pulmonary lobe infiltrate (53.3 percent), and isolated cavitation was found in 32.4 percent of the patients. Both lungs were affected in 29.2 percent of the patients. The finding of bilateral radiologic lesions was significantly associated with longer disease duration (p = 0.0005). CONCLUSIONS: Pulmonary TB in adolescents has similar characteristics to TB in adults, evidencing the important role played by adolescents in community disease transmission.

A produção de teses e dissertações do PED: PUC-SP sobre afetividade no contexto escolar / The production of thesis and dissertations at PED: PUC-SP about affectivity on scholar context / La producción de tesis y disertaciones del PED: PUC-SP sobre afectividad en el contexto escolar

O estudo teve como objetivo identificar e analisar a produção de teses e dissertações defendidas no PED-PUC-SP, no período de 1969 a 2009, que priorizaram questões relativas à afetividade no contexto escolar, este concebido como o que envolve acontecimentos inseridos no âmbito da escola. O estudo corresponde a um "estado do conhecimento", consoante o posicionamento de Romanowski e Ens (2006). Foram identificadas 71 pesquisas, sendo 17 teses e 54 dissertações, algumas de cunho teórico e a maioria de cunho empírico. As pesquisas evidenciaram que a maneira de o professor expressar afetividade repercute diretamente no seu aluno, tanto na dimensão cognitiva como na forma de se relacionar com a matéria curricular e com a escola, e que o investimento no aprimoramento das relações interpessoais entre diferentes agentes educativos provoca avanços no desenvolvimento dos profissionais e dos alunos.

This study aims to identify and analyze the production of thesis and dissertations defended at PED - PUC-SP, on the period from 1969 to 2009, that prioritized issues related to affectivity on scholar context - this one conceived as happenings occurred at school. The study corresponds to a "state of knowledge", consonant to Romanowski e Ens's (2006) positioning. Seventy-one researches have been identified - and from these, seventeen are thesis and fifty-four are dissertations. Some of them are of a theoretical approach, but most of them are empirical. Researches show that the way the teachers express affectivity directly reverberates on their students, as much on cognitive dimensiono for relating with the curricular subject and with the school, as for the investment on the improvement of interpersonal relationships amongst different educational agents that brings advances on the development of professionals and students.

El estudio tuvo como objetivo identificar y analizar la producción de tesis y disertaciones defendidas en el PED/PUC-SP, en el periodo de 1969 a 2009, que priorizaron cuestiones relativas a la afectividad en el contexto escolar, este concebido como lo que involucra acontecimientos inseridos en el ámbito de la escuela. El estudio corresponde a un "estado del conocimiento", según el posicionamiento de Romanowski y Ens (2006). Han sido identificadas 71 investigaciones, siendo 17 tesis y 54 disertaciones, algunas de carácter teórico y, la mayoría, de carácter empírico. Las investigaciones evidenciaron que el modo del profesor expresar afectividad repercute directamente en su alumno, tanto en la dimensión cognitiva como en la forma de relacionarse con la materia curricular y con la escuela, y que la inversión en el perfeccionamiento de las relaciones interpersonales entre distintos agentes educativos provoca avances en el desarrollo de los profesionales y de los alunos.

Eficácia do sistema de pontuação, preconizado pelo Ministério da Saúde, para o diagnóstico de tuberculose pulmonar em crianças e adolescentes infectados ou não pelo HIV / Efficacy of the scoring system, recommended by the Brazilian National Ministry of Health, for the diagnosis of pulmonary tuberculosis in children and adolescents, regardless of their HIV status

OBJETIVO: Verificar a eficácia do sistema de pontuação, preconizado pelo Ministério da Saúde (MS), para o diagnóstico de TB pulmonar em crianças e adolescentes, infectadas ou não pelo HIV. MÉTODOS: Estudo analítico transversal realizado entre janeiro de 2002 e dezembro de 2006, no qual foram incluídos 239 indivíduos menores de 15 anos. Os pacientes foram divididos em quatro grupos: grupo TB latente (TBL; n = 81); grupo não TB (NTB; n = 41); grupo TB (n = 104); e grupo TB/HIV (n = 13). Foram estudadas as características clínicas, radiológicas e laboratoriais segundo o sistema de pontuação. RESULTADOS: Os relatos de febre, tosse, astenia e emagrecimento há mais de duas semanas foram significativamente maiores no grupo TB (p < 0,0001). No grupo TB, 95,0 por cento dos casos tinham história de contato com indivíduo com TB, sendo que em 86,1 por cento esse contato era intradomiciliar. No grupo TB/HIV, 75,0 por cento dos casos haviam entrado em contato com TB e, em 58,3 por cento, esse contato era intradomiciliar. Nos grupos TB e TB/HIV, respectivamente, 75,0 por cento e 53,9 por cento dos casos apresentaram alterações radiológicas parenquimatosas, enquanto 18,2 por cento e 30,8 por cento apresentaram alterações ganglionares e parenquimatosas. Os resultados da prova tuberculínica não apresentaram diferenças significativas entre os grupos. No grupo TB, 16,3 por cento dos pacientes estavam desnutridos (p < 0,005 vs. o grupo TBL). A pontuação média utilizando o sistema MS foi a seguinte: grupo TBL, 24,2; grupo NTB, 18,5; grupo TB, 45,3; e grupo TB/HIV, 41,5. CONCLUSÕES: Os pacientes dos grupos TB e TB/HIV apresentaram pontuação significativamente maior do que aqueles nos outros grupos. Portanto, esse sistema de pontuação foi válido para o diagnóstico de TB pulmonar nessa população, independentemente do status HIV.

OBJECTIVE: To determine the efficacy of the scoring system, recommended by the Brazilian National Ministry of Health (NMH), for the diagnosis of pulmonary tuberculosis (TB) in children and adolescents, regardless of their HIV status. METHODS: This was a cross-sectional analytical study carried out between January of 2002 and December of 2006, involving 239 individuals less than 15 years of age. The patients were divided into four groups: latent TB (LTB group; n = 81); no-TB (NTB group; n = 41); TB group (n = 104); and TB/HIV group (n = 13). We studied the clinical, radiological and laboratory findings according to the scoring system. RESULTS: Reports of fever, cough, asthenia and weight loss for at least two weeks were significantly higher in the TB group (p < 0.0001). The proportion of cases with a history of any contact and household contact with a TB patient was, respectively, 95.0 percent and 86.1 percent in the TB group, versus 75.0 percent and 58.3 percent in the TB/HIV group. In the TB and TB/HIV groups, respectively, chest X-rays revealed parenchymal alterations in 75.0 percent and 53.9 percent, revealing combined parenchymal/lymph node alterations in 18.2 percent and 30.8 percent. There were no significant differences among the groups regarding the tuberculin skin test results. In the TB group, 16.3 percent of the patients were malnourished (p < 0.005 vs. the LTB group). The mean NMH system scores in the LTB, NTB, TB and TB/HIV groups were, respectively, 24.2, 18.5, 45.3 and 41.5. CONCLUSIONS: The NMH system scores were significantly higher in the TB and TB/HIV groups than in the other two groups. Therefore, this scoring system was valid for the diagnosis of pulmonary TB in this population, regardless of HIV status.

Allele frequency and selection efficiency in cross populations of Andean x Mesoamerican common beans (Phaseolus vulgaris L. Fabales, Fabaceae)

Strategies were investigated for improving efficiency in the use of segregating common bean (Phaseolus vulgaris) populations using crosses between the Andean cultivar BRS-Radiante and the Mesoamerican parent cultivar Carioca-MG by developing populations with 12.5%, 25%, 50%, 75% and 87.5% of the allele frequency of one of the parents. For each of the five populations we evaluated for two traits, the number of days to the beginning of flowering and grain yield (g plot-1), in the F2:3 (sown in February 2006) and F2:4 (sown in July 2006) generation progenies using 15 x 15 lattice design experiments, with 44 progenies (n = 220 plants) plus the two parents and three controls being evaluated for each generation. In terms of variability release, the populations with different parental allele frequencies presented no consistent tendency of alteration. In general, genetic variance was stated among progenies in all populations, indicating success with selection. For grain yield, the lowest mean was observed in the populations with 50% of the alleles of both parents. If, for instance, the objective is to develop earlier flowering lines, the best strategy is to perform two, or at least one, backcross with the earliest parent. The most suitable allele frequency is to be determined according to the desired grain type.

A família e a internação em UTI: a doença e a morte no hospital regional de Assis - SP / The family and the ICU impatient: the disease and death at Assis, Regional hospital - SP

O presente trabalho apresenta reflexões sobre a doença e a morte, pontuando os momentos de internação em uma Unidade de Terapia Intensiva, considerando o significado de adoecer, da história pessoal, familiar e social e de morte. Teóricos mostram a evolução do significado da morte ao longo dos anos, enquanto buscamos compreender os sentimentos dos pacientes e de seus familiares diante da internação na UTI. Ressaltamos a necessidade de atuação da equipe inerdisciplinar para o trabalho de atendimento sistematizado e individualizado, com o intuito de dar sentido às diferenças do outro, de cada paciente, com diferentes doenças e as diversas famílias.

Assistência ambulatorial na opinião de mulheres atendidas na periferia de Teresina-PI / Outpatient care according to female clientele attended in Teresina outskirts

Neste estudo qualitativo, teve como objetivo verificar a assistência prestada à mulher que utiliza serviço público ambulatorial de Saúde na periferia de Teresina-PI. Os dados foram coletados via roteiro estruturado, com perguntas abertas, definidas previamente por assunto. Utilizou-se como técnica o Grupo Focal em três encontros, cujos sujeitos da pesquisa, oito mulheres, participaram de todas as reuniões. Os resultados evidenciaram que, embora as mulheres afirmem ter tido bom atendimento, reconhecem as deficiências, apontando soluções alternativas. Espera-se, então, que se levantem questões que possam vir a ser discutidas e trabalhadas pelos administradores das unidades de Saúde, contribuindo para melhoria do atendimento à clientela assistida.

A retrospective evaluation of a score system adopted by the Ministry of Health, Brazil in the diagnosis of pulmonary tuberculosis in childhood: a case control study

Based on a retrospective case-control study we evaluated the score system adopted by the Ministry of Health of Brazil (Ministério da Saúde - MS), to diagnose pulmonary tuberculosis (PTB) in childhood. This system is independent of bacteriological or histopathological data to define a very likely (> or = 40 points), possible (30-35 points) or unlikely (< or = 25 points) diagnosis of tuberculosis. Records of hospitalized non-infected HIV children at the Instituto de Puericultura e Pediatria Martagäo Gesteira of Federal University of Rio de Janeiro (IPPMG-UFRJ), were reviewed. Patients were adjusted for age and divided in two different groups: 45 subjects in the case group (culture-positive) [mean of age = 10.64 mo; SD 9.66]; and 96 in the control group (culture-negative and clinic criteria that dismissed the disease) [mean of age = 11.79 mo.; SD 11.31]. Among the variables analyzed, the radiological status had the greater impact into the diagnosis (OR = 25.39), followed by exposure to adult with tuberculosis (OR = 10.67), tuberculin skin test >10mm (OR = 8.23). The best cut-off point to the diagnosis of PTB was 30 points, where the score system was more accurate, with sensitivity of 88.9 percent and specificity of 86.5 percent

Clínicas sociais nos institutos de psicanálise / Social clinics in the institutes of psychoanalysis

A autora descreve neste trabalho as vantagens e dificuldades que surgem no funcionamento de uma Clínica Social. Fala sobre a recente experiência do Centro de Terapia Psicanalítica e Pesquisa fundada pela Sociedade Psicanalítica do Recife e ao final levanta questões para discussão tais como: a quem interessa uma Clínica Social e quais as contribuições que pode trazer para a preservação da psicanálise.

Fitofármaco, fitoterápico, plantas medicinais: o reducionismo e a complexidade na produção do conhecimento científico

Esse estudo tem por objetivo discutir como a forma de produção do conhecimento científico pode determinar a maneira do homem conhecer, lidar e apropriar-se da natureza, especificamente, em relação ao conhecimento associado ao estudo das plantas medicinais e seus derivados. Visando fornecer subsídios para a compreensão do que norteia os pesquisadores que buscam o entendimento sobre as plantas medicinais a partir de uma abordagem complexa, algumas questões de caráter epistemológico são formuladas e discutidas à luz dos referenciais teóricos construídos por Morin6 e Latour7.

This paper discusses how the form of production of scientific knowledge may determine the manner people know, deal with and appropriate nature, specifically, relatively to knowledge associated to medicinal plants and their derivatives. Some epistemologically questions are formulated and discussed under the light of theoretical referential after Morin6 and Latour7, to provide information to comprehend the reasons that direct researchers who search understanding about medicinal plants starting from a complex approach.

Uso de desfibriladores externos automáticos em empresa aérea brasileira. Experiência de um ano / Use of automated external defibrillators in a Brazilian airline. A 1-year experience

After the incorporation of automated external defibrilators by other airlines and the support of the Brazilian Society of cardiology, Varig Airlines Began the onboard defibrilation program with the initial purpose of equiping wide-body aircrafts frequently used in international flights and that airplanes use in the Rio - Säo Paulo route. With all fight attendants trained, the automated. External defibrilation devides were incorporated to 34 airplanes of a total pleet of 80 aircrats. The devices were intalled in the bagage compartments secured with velero straps and 2 pairs of electrods, one or which pre-conected to the device to minimize application time. Later, a portable monitor was addres to the ressocitation kit in the long flights. The expansion of the knowledge of the basic life support fundamentors and the correted implantation of the survival chain and of the automated external defibrilators will increase the extense of recovery of cardiorespiratory arrest victins in aircrafts.