Artéria ulnar superficial diagnosticada por ultrassom vascular: relato de caso / Superficial ulnar artery diagnosed by vascular ultrasound: case report

Resumo O maior ramo da divisão terminal da artéria braquial é a artéria ulnar, que se origina após a fossa cubital. Essa artéria usualmente tem trajeto profundo aos músculos do antebraço anterior e é responsável pela vascularização da musculatura superficial e profunda da região ulnar do antebraço e hipotênar da mão, sendo a principal responsável pela formação do arco palmar superficial após o retináculo dos flexores. Reportamos uma variação anatômica após diagnóstico com ultrassom vascular na qual a artéria ulnar situava-se em posição superficial no antebraço. A ocorrência da artéria ulnar superficial é rara, porém de grande importância para clínicos, cirurgiões e profissionais de enfermagem.

Abstract The largest branch of the terminal division of the brachial artery is the ulnar artery, which arises after the cubital fossa. This artery usually has a deep path in the muscles of the anterior forearm and is responsible for vascularization of the superficial and deep musculature on the ulnar side of the forearm and hypothenar area of the hand. We report an anatomical variant diagnosed by Doppler ultrasound in which the ulnar artery had a superficial position in the forearm. Occurrence of a superficial ulnar artery is rare, but it is an important fact for clinicians, surgeons, and nursing professionals.

Immunohistochemical detection of Treponema pallidum in skin samples with clinical and histopathological correlations and Warthin-Starry staining critical analysis

Abstract Background: Syphilis in its different phases may be a difficult diagnosis in clinical and histopathological grounds. Objectives: The present study objectives were to evaluate the detection and tissue distribution of Treponema pallidum in skin lesions of syphilis. Methods: A blinded diagnostic accuracy study was performed with immunohistochemistry and Warthin-Starry silver staining in skin samples from patients with syphilis and other diseases. Patients attended two tertiary hospitals between 2000 and 2019. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were calculated for the association between immunohistochemistry positivity and clinical-histopathological variables. Results: Thirty-eight patients with syphilis and their 40 biopsy specimens were included in the study. Thirty-six skin samples were used as non-syphilis controls. The Warthin-Starry technique was unable to accurately demonstrate bacteria in all samples. Immunohistochemistry showed spirochetes only in skin samples from patients with syphilis (24/40) with 60% sensitivity (95% CI 44.8-75.2). Specificity was 100% and accuracy, 78.9% (95% CI 69.8-88.1). Most cases had spirochetes in both dermis and epidermis and there was a high bacterial load. Study limitations: Correlation between immunohistochemistry and clinical or histopathological characteristics was observed but was limited statistically due to the small sample size. Conclusions: Spirochetes were promptly seen in an immunohistochemistry protocol, which can contribute to the diagnosis of syphilis in skin biopsy samples. On the other hand, the Warthin-Starry technique showed to be of no practical value.

The conventional diagnosis challenge: Real-time PCR and nested PCR correlation with the scoring system for individuals at high-risk of Pneumocystis jirovecii pneumonia

Introduction. Pneumocystis jirovecii is an opportunistic fungus that affects mainly people living with HIV (CD4 cell count lower than 200 cells/ml) and other immunosuppressed patients. Since P. jirovecii does not grow on routine mycological media, diagnosis of P. jirovecii pneumonia relies on indirect evidence of its presence in respiratory samples. Objectives. To associate the results of direct immunofluorescence and two molecular methods with a score to predict P. jirovecii pneumonia in patients with AIDS. Materials and methods. A prospective study was conducted with 40 patients. A respiratory sample collected before treatment was subjected to direct immunofluorescence using the Merifluor kit, to nested PCR targeting the mitochondrial large subunit ribosomal RNA, and to the VIASURE real-time PCR kit. Results. These three techniques revealed P. jirovecii in 6, 12, and 15 samples, respectively. All positive samples by direct immunofluorescence were positive by nested PCR, and all positive samples by nested PCR amplified by real-time PCR. There was a statistically significant association between the P. jirovecii pneumonia score and the molecular methods. Two patients were early diagnosed and responded well to treatment. Conclusion. Molecular methods, especially real-time PCR, are recommended for early diagnosis of P. jirovecii pneumonia in AIDS patients.

Introducción. Pneumocystis jirovecii es un hongo oportunista que afecta principalmente a personas con HIV (recuento de CD4 menor de 200 células/ml) y a otros pacientes inmunosuprimidos. Como P. jirovecii no crece en los medios micológicos de rutina, el diagnóstico de neumonía por P. jirovecii se basa en la evidencia presente en muestras respiratorias. Objetivos. Asociar los resultados de la inmunofluorescencia directa y los de dos métodos moleculares con un puntaje para predecir la neumonía causada por P. jirovecii en pacientes con sida. Materiales y métodos. Se realizó un estudio prospectivo de 40 pacientes. Se recolectó una muestra respiratoria antes del inicio de tratamiento y se sometió a una prueba de inmunofluorescencia directa con el kit Merifluor, una PCR anidada para la amplificación de la subunidad larga del ribosoma mitocondrial y una PCR en tiempo real usando el kit VIASURE. Resultados. Estas tres técnicas evidenciaron la presencia de P. jirovecii en 6, 12 y 15 muestras, respectivamente. Todas las muestras positivas por inmunofluorescencia directa fueron positivas en la PCR anidada y todas las muestras positivas en la PCR anidada amplificaron por PCR en tiempo real. Se encontró una asociación estadística entre los valores de la neumonía causada por P. jirovecii y los métodos moleculares. Dos pacientes con diagnóstico temprano respondieron satisfactoriamente al tratamiento. Conclusión. Se recomiendan los métodos moleculares, especialmente la PCR en tiempo real, para el diagnóstico temprano de neumonía causada por P. jirovecii en pacientes con sida.

A arte de partejar um programa de pós-graduação em história: os 20 anos do Programa de Pós-graduação em História das Ciências e da Saúde: entrevista com Margarida de Souza Neves / The art of giving birth to a graduate program in history: on the 20th anniversary of the Graduate Program in the History of the Sciences and Health: interview with Margarida de Souza Neves

Resumo A entrevista aborda a participação de Margarida de Souza Neves, professora emérita da Pontifícia Universidade Católica do Rio de Janeiro, na criação do Programa de Pós-graduação em História das Ciências e da Saúde da Casa de Oswaldo Cruz. Para celebrar os 20 anos de existência do PPGHCS, professores que passaram pela coordenação se reúnem com a entrevistada para refletir sobre os significados da formação de um programa na área de história especializado em pesquisas sobre ciências e saúde no Brasil.

Abstract This interview explores the participation of Margarida de Souza Neves, professor emeritus at Pontifícia Universidade Católica do Rio de Janeiro, in the creation of the Graduate Program in the History of the Sciences and Health at Casa de Oswaldo Cruz. To celebrate the twentieth anniversary of this graduate program, professors who have served as coordinators met with Professor Neves to reflect on the meanings of shaping a program in the area of history specializing in research on science and health in Brazil.

O valor prognóstico da reserva microvascular isquêmica periférica na sepse não está vinculado ao peptídeo relacionado ao gene da calcitonina ou à substância P / The prognostic value of peripheral ischemic microvascular reserve in sepsis is not related to calcitonin gene-related peptide or substance P

RESUMO Objetivo: Avaliar possíveis mecanismos atribuídos ao valor prognóstico da reserva microvascular isquêmica periférica em pacientes com sepse. Métodos: Este estudo de coorte observacional incluiu 46 pacientes consecutivos com sepse em uma unidade de terapia intensiva entre novembro de 2020 e outubro de 2021. Após a ressuscitação volêmica com fluidos, avaliou-se a reserva microvascular isquêmica periférica mediante a associação dos testes hiperemia reativa pós-oclusão e índice de perfusão periférica. Adicionalmente, amostras de sangue venoso periférico foram coletadas para avaliar os níveis dos neuropeptídeos substância P e peptídeo relacionado ao gene da calcitonina no membro superior do paciente antes e imediatamente após o teste de hiperemia reativa pós-oclusão. Resultados: Não houve correlação estatisticamente significativa (p > 0,05) entre os valores basais ou variações dos níveis de neuropeptídeos e a reserva microvascular isquêmica periférica. Conclusão: Embora o peptídeo relacionado ao gene da calcitonina e a substância P possam desempenhar papel prognóstico na sepse, esses neuropeptídeos não parecem contribuir para a reserva microvascular isquêmica periférica.

ABSTRACT Objective: To evaluate the mechanisms attributed to the prognostic value of peripheral ischemic microvascular reserve in patients with sepsis. Methods: This observational cohort study enrolled 46 consecutive septic patients in the intensive care unit between November 2020 and October 2021. After fluid resuscitation, the peripheral ischemic microvascular reserve was evaluated using the association of postocclusion reactive hyperemia with the peripheral perfusion index. Additionally, peripheral venous blood samples were used to evaluate the neuropeptide calcitonin gene-related peptide and substance P levels in the upper limb before and immediately after postocclusion reactive hyperemia Results: There was no statistically significant correlation (p > 0.05) between basal values (pg/mL) or variations from neuropeptide levels (%) and the peripheral ischemic microvascular reserve (%). Conclusion: Although calcitonin gene-related peptide and substance P may have a prognostic role in sepsis, these neuropeptides do not appear to contribute to peripheral ischemic microvascular reserve.

Prevalence and predisponent factors of molar-incisor hypomineralization in primary dentition

Aim: To evaluate the prevalence and predisposing factors for hypomineralization of second molars in children in primary dentition. Methods: A questionnaire was applied to parents to analyze predisposing factors and to assist in the diagnosis of hypomineralization in children between 2 and 6 years old, followed by an intraoral examination based on indices of non-fluorotic enamel defects in the primary dentition, according to the "Modified Index DDE" to determine demarcated opacity and HSPM presence / severity index to assess hypomineralization. Children from public and private schools were dived into two groups: if they presented HSPM-Group 1 (G1) and if they did not have HSPM-Control group (CG). Results: The most frequent predisposing factors associated with the child were Illness in the first year of life (X2= 6.49; p=0.01) and antibiotic use in the first year of life (X2= 41.82; p= 0.01). The factors associated with the mother were hypertension (X2= 9.36; p=0.01), infections during pregnancy (X2=14.80; p=0.01) and alcohol consumption during pregnancy (X2=97.33; p=0.01). There was a prevalence of 3.9% of HSPM in 14 children, with statistical difference regarding gender (X2 = 4.57; p <0.05), with boys presenting a higher frequency. In G1 hypomineralization was of the type with demarcated opacity, with more prevalent characteristics the yellowish spot, with moderate post-eruptive fracture and acceptable atypical restorations. All lesions were located in the labial region with 1/3 of extension. Conclusion: The prevalence of HSPM in children between 2 and 6 years old was 3.9%, with a predominance in males, with tooth 65 being the most affected. There was an association between HSPM and infection in the first year of life, as well as the use of antibiotics and sensitivity in the teeth affected by the lesion. There was an association between HSPM and hypertension, infection and mothers' alcohol use during pregnancy

Quality by Design-driven investigation of the mechanical properties of mucoadhesive films for needleless anesthetics administration

Objectives: To systematically evaluate the effects of hydroxypropyl methyl cellulose (HPMC) type (E5LV, E15LV, and K100LV); plasticizer type (glycerol and mannitol), plasticizer loading (0.12 and 0.24% w/w); and loading of prilocaine and lidocaine hydrochlorides combined at 1:1 ratio (0 and 47 mg/cm2) in the mechanical properties of buccal films. Methods: A quality by design (QbD) approach based on a full factorial design (3 x 23) and complementarily multivariate statistical tools i.e., principal component analysis (PCA), response surface methodology (RSM), and correlation matrix were used in this pursuit. The thickness, elongation at break, tensile strength, force at break, and Young`s modulus of the anesthetic buccal films obtained by solvent casting were assessed. Results: The QbD, PCA and RSM altogether demonstrated that all studied formulation variables, mainly the drug loading, affect the mechanical properties of the films at different significance levels. The multivariate analysis yielded the modelling of elongation at break, tensile strength, and force at break, which significantly correlated with each other. The drugs exerted a synergic plasticizing effect on the films, and the use of HPMC K100 LV (with greater hydroxypropyl substitution degree and viscosity) and mannitol favored their elasticity and resistance. Furthermore, the majority of the films fulfilled the requirements for buccal administration due to their softness and mechanical resistance. Conclusion: Mannitol is suitable plasticizer for manufacturing HPMC anesthetic buccal films with improved mechanical properties. These results are a step forward in the rational development of formulations for the replacement of needles in dentistry

Fístula arteriovenosa traumática em região temporal: um desafio terapêutico / Traumatic arteriovenous fistula in the temporal region: a therapeutic challenge

Resumo As fistulas arteriovenosas podem ser congênitas ou traumáticas, sendo as primeiras mais comuns e diagnosticadas na infância e as últimas mais raras e com diagnóstico mais tardio. Ambas necessitam de tratamento intervencionista, que pode ser endovascular ou correção cirúrgica, sendo que cada caso deve ser estudado individualmente. Este artigo apresenta o caso de um paciente de 46 anos, com fístula arteriovenosa na artéria temporal superficial esquerda com suas veias correspondentes decorrente de trauma contuso na região temporal na infância. O diagnóstico foi confirmado por exame de imagem, e o paciente foi submetido a tratamento cirúrgico convencional, apresentando melhora dos sintomas. O caso chama atenção para uma afecção rara, sua investigação diagnóstica e condutas terapêuticas. As fistulas arteriovenosas traumáticas apresentam baixa incidência, ocorrem em variadas localizações e podem causar sintomas, requerendo tratamento, às vezes desafiador, com melhora da qualidade de vida do paciente.

Abstract Arteriovenous fistulas can be congenital or traumatic, the former being more common and diagnosed in childhood, and the latter being rarer and diagnosed later in life. Both require interventional treatment, which may be endovascular, or surgical repair and each case must be studied individually. This article presents the case of a 46-year-old patient with an arteriovenous fistula (AVF) between the left temporal artery and its corresponding veins resulting from a blunt trauma to the parietal region during childhood. The diagnosis was confirmed by imaging examination and he underwent conventional surgical treatment with improvement of symptoms. The case calls attention to a rare condition, its diagnostic investigation, and therapeutic approaches. The incidence of traumatic arteriovenous fistulas is low. They can occur in a variety of ways and can cause symptoms, requiring treatment, which is sometimes challenging, resulting in improvement in the patient's quality of life.

Prevalência de lesões cervicais não cariosas na dentição decídua / Prevalence of non-carious cervical lesions in the primary dentition

Objetivo: Determinar a prevalência de lesões cervicais não cariosas em crianças na dentição decídua e possíveis fatores etiológicos associados. Métodos:Após a aprovação do Comitê de Ética ­ CEP/UESPI (3.289.732), o estudo transversal foi realizado em 360 crianças com idade entre 2 a 6 anos, de escolas públicas e privadas, divididas em dois grupos: G1 (com lesões cervicais) e G2 (sem lesões cervicais). Foi aplicado um questionário aos pais, seguido do exame clínico das crianças. Foram consideradas lesões detectadas pelo tato e visualmente. Foram realizadas avaliações das médias e dos desvios padrão para variáveis quantitativas. Obteve-se porcentagens e frequências, realizando-se análises de associação entre as variáveis qualitativas a partir do qui-quadrado e comparação da idade média a partir do teste t (p < 0,05). Resultados: Somente lesões do tipo abfração foram encontradas na amostra (5%) e os indivíduos de raça branca apresentaram uma maior prevalência em relação aos demais (55,5%). Houve diferença estatisticamente significativa (p < 0,001) e essas lesões foram identificadas somente em escolas privadas. Quanto ao sexo, em G1, houve diferença estatisticamente significativa, (p = 0,01) com maior prevalência no masculino (66,7%). Os dentes mais acometidos em ordem decrescente foram os caninos e incisivos centrais superiores seguidos dos caninos e incisivos centrais inferiores. Conclusão: A prevalência de lesões cervicais não cariosas, do tipo abfração, em crianças de 2 a 6 anos de idade foi de 5%, tendo sido encontradas somente em escolas privadas, com predominância no sexo masculino. Houve associação entre a abfração e o tipo de escova utilizada na escovação dentária, apresentando maior frequência de lesões quando escovas duras eram utilizadas e escovação forte era executada.

Aim:To determine the prevalence of non-carious cervical lesions in children in the primary dentition and possible associated etiological factors. Method: After approval by the Ethics Committee - CEP / UESPI (3,289,732) ­ this cross-sectional study was carried out on 360 children, from 2 to 6 years of age, from public and private schools, divided into two groups: G1 (with cervical lesions) and G2 (without cervical lesions). A questionnaire was applied to the parents, followed by the children's clinical examination. Lesions detected by touch and visually were considered. Evaluations of means and standard deviations were performed for quantitative variables. Percentages and frequencies were obtained, analyzing the association between qualitative variables based on the chi-square test and comparing the average age using the t test (p < 0.05). Results:Only abfraction-type lesions were found in the sample (5%), and white individuals presented a higher prevalence in relation to the others (55.5%). There was a statistically significant difference (p < 0.001), and these lesions were found only in private schools. As for sex, in G1, there was a statistically significant difference (p = 0.01) with a higher prevalence in males (66.7%). The most affected teeth in decreasing order were the canines and upper central incisors, followed by the canines and lower central incisors. Conclusion: The prevalence of non-carious cervical lesions of the abfraction type in children from 2 to 6 years of age was 5%, which was only found in private schools, with a predominance in males. An association was found between the abfraction and the type of brush used in toothbrushing, with a higher frequency of lesions when hard brushes were used and strong brushing was performed.

Das salas de autopsias e microscopias para a vida: mentoria informal em um programa de residência médica de patologia / From autopsy rooms and microscopes to life: informal mentoring in a pathology medical residency program

Resumo: Introdução: Além de demorada, a mentoria em Medicina ocorre em vários níveis e é complexa, pois pode incluir várias combinações de ensino, prática clínica, atendimento ao paciente e pesquisa. Relato de experiência: Trata-se de um relato de experiência individual de uma mentorada em um programa de residência médica em patologia do Hospital Universitário Getúlio Vargas, de Manaus, no Amazonas. Descrevem-se os benefícios individuais e coletivos de uma mentoria fora de um programa formal, orientada pelo discernimento e pela maturidade de relacionamento entre mentor e mentorada. Discussão: Discentes de programa de residência médica podem se beneficiar sobremaneira, pessoal e profissionalmente, de mentorias bem conduzidas. Conclusão: No relacionamento de mentoria, são imprescindíveis qualidades como respeito mútuo, discernimento e abnegação, para que o mentorado cresça e desenvolva uma identidade profissional independente, ainda que atrelada à relação de mentoria, e amadurecida, em seu pleno desenvolvimento, a fim de que ele seja um novo mentor e novos alunos sejam beneficiados.

Abstract: Introduction: Mentoring in medicine is time-consuming on several levels and complex, as it can include various combinations of teaching, clinical practice, patient care, and research. Experience report: This report is on the individual experience of a mentee in a medical residency program in Pathology at the Getúlio Vargas University Hospital (Manaus-AM). The individual and collective benefits of mentoring outside a formal program are described, guided by the discernment and maturity of the relationship between mentor and mentee. Discussion: Medical residency program students can benefit greatly, both personally and professionally, from well-conducted mentoring. Conclusion: In the mentoring relationship, qualities such as mutual respect, discernment, and selflessness are essential so that the mentee grows and develops a fully developed and independent professional identity, albeit bound to the mentoring relationship, in order for him become a new mentor and to benefit new students.

Associação entre Vaginose Bacteriana e Anormalidades Citológicas nos Exames Citopatológicos Analisados em um Laboratório Escola de Goiânia-GO / Association Between Bacterial Vaginosis and Cytological Abnormalities in Cytopathological Exams Analyzed in a Laboratory School of Goiânia-GO / Asociación entre Vaginosis Bacteriana y Anormalidades Citológicas en Exámenes Citopatológicos Analizados en una Escuela de Laboratorio de Goiânia-GO

Introdução: A Gardnerella vaginalis facilita a infecção pelo papilomavírus humano (HPV). Objetivo: Verificar a associação entre anormalidades citológicas e presença de Gardnerella vaginalis nos esfregaços cervicovaginais encaminhados ao Laboratório Clínico da Pontifícia Universidade Católica de Goiás (LAC/PUC Goiás) estratificadas por faixa etária. Método: Estudo transversal realizado no LAC/PUC Goiás entre janeiro de 2013 a dezembro de 2015. Para análises estatísticas, a variável idade foi categorizada em ≤39 anos e >40 anos, utilizando o programa IBM SPSS Statistics (Version 2.0, 2011®) para o teste de qui-quadrado (X²), com intervalo de confiança de 95% e valor p<0,05. Resultados: Foram analisados 4.558 exames citopatológicos, a maioria com presença de Lactobacillus spp. (46,97%). A prevalência dos agentes patogênicos foi a Gardnerella vaginalis (79,6%), seguida de Candida spp. (16,8%), Trichomonas vaginalis (2,2%), Herpes simplex (0,4 %) e Chlamydia trachomatis (0,1%). As anormalidades citológicas foram observadas em 9,1%, sendo atypical squamous cells of undetermined significance (ASC-US) 2,57%, low grade squamous intraepithelial lesion (LSIL) 1,78%, atypical squamous cells of undetermined significance cannot exclude high grade squamous intraepithelial lesion (ASC-H) 3,52%, high grade squamous intraepithelial lesion (HSIL) 1,08%, atypical endocervical cells, favor neoplastic (AGC-NEO) 0,22% e carcinoma 0,02%. Houve uma associação significante entre anormalidades citológicas graves e mulheres ≥40 anos, OR 3,01 (IC 95% 2,0-4,58) (p<0,0001). Mulheres ≤40 anos mostraram significância à presença de Gardnerella vaginalis (p<0,0004). Conclusão: Uma elevada prevalência de Gardnerella vaginalis foi encontrada associada com as anormalidades citológicas, principalmente em mulheres sexualmente ativas.

Introduction:Gardnerella vaginalis facilitates human papillomavirus (HPV) infection. Objective: To verify the association between cytological abnormalities and the presence of Gardnerella vaginalis in cervicovaginal smears sent to the Clinical Laboratory of the Pontifical Catholic University of Goiás (LAC/PUC Goiás) stratified by age range. Method: Cross-sectional study carried out at LAC/PUC Goiás from January 2013 to December 2015. For statistical analysis, the variable age was categorized as ≤39 years and >40 years, using the IBM SPSS Statistics program (Version 2.0, 2011®) for the chi-square test (X²), with a 95% confidence interval and p<0.05. Results:4,558 cytopathological exams were analyzed, most of them with the presence of Lactobacillus spp (46.97%). The prevalence of pathogens was Gardnerella vaginalis (79.6%), followed by Candida spp. (16.8%), Trichomonas vaginalis (2.2%), Herpes simplex (0.4%) and Chlamydia trachomatis (0.1%). Cytological abnormalities were observed in 9.1%, being atypical squamous cells of undetermined significance (ASC-US) 2.57%, low grade squamous intraepithelial lesion (LSIL) 1.78%, atypical squamous cells of undetermined significance cannot exclude high intraepithelial lesion (ASC-H) 3.52%, high grade squamous intraepithelial lesion (HSIL) 1.08%, atypical endocervical cells, neoplastic favor (AGC-NEO) 0.22% and carcinoma 0.02%. There was a significant association between severe cytological abnormalities and women >40 years old OR 3.01 (95% CI 2.0-4.58) (p<0.0001). Women ≤40 years old showed the presence of Gardnerella vaginalis (p<0.0004). Conclusion:A high prevalence of Gardnerella vaginalis was found and its association with cytological abnormalities, especially in sexually active women.

Introducción:Gardnerella vaginalis facilita la infección por el virus del papiloma humano (VPH). Objetivo: Verificar la asociación entre anormalidades citológicas y la presencia de Gardnerella vaginalis en frotis cervicovaginales enviadas al Laboratorio Clínico de la Pontificia Universidad Católica de Goiás (LAC/PUC Goiás) estratificadas por grupo de edad. Método: Estudio transversal realizado en LAC/PUC Goiás desde enero de 2013 hasta diciembre de 2015. Para el análisis estadístico, la edad variable se clasificó como ≤39 años y >40 años, utilizando el programa IBM SPSS Statistics (Versión 2.0, 2011®) para la prueba de chi-cuadrado (X²), con un intervalo de confianza del 95% y p <0,05. Resultados: Se analizaron 4.558 exámenes citopatológicos. La prevalencia de Lactobacillusspp. con 46,97%. Los patógenos como Gardnerella vaginalis fueron 79,6%, Candidaspp. 16,8%, Trichomonas vaginalis 2,2%, Herpes simplex 0,4%, y Chlamydia trachomatis 0,1%. Se observaron anormalidades citológicas en 9,1%, con células escamosas atípicas de significado indeterminado (ASC-US) 2,57%, lesión intraepitelial escamosa de bajo grado (LSIL) 1,78%, células escamosas atípicas de significación indeterminada no pueden excluir lesión intraepitelial (ASC-H) 3,52%, lesión intraepitelial escamosa de alto grado (HSIL) 1,08%, células endocervicales atípicas, favor neoplásico (AGC-NEO) 0,22% y carcinoma 0,02%. Hubo una asociación significativa entre anormalidades citológicas severas y mujeres >40 años OR 3,01 (IC 95% 2,0-4,58) (p<0,0001). Las mujeres ≤40 años mostraron la presencia de Gardnerella vaginalis (p<0,0004). Conclusión: Se encontró una alta prevalencia de Gardnerella vaginalis y su asociación con anomalías citológicas, especialmente en mujeres sexualmente activas.

Pathological findings and morphologic correlation of the lungs of autopsied patients with SARS-CoV-2 infection in the Brazilian Amazon using transmission electron microscopy

Abstract INTRODUCTION: Electron microscopy (EM) is a rapid and effective tool that can be used to create images of a whole spectrum of virus-host interactions and, as such, has long been used in the discovery and description of viral mechanisms. METHODS: Electron microscopy was used to evaluate the pulmonary pathologies of postmortem lung sections from three patients who died from infection with SARS-associated coronavirus 2 (SARS-CoV-2), a new member of the Coronaviridae family. RESULTS: Diffuse alveolar damage (DAD) was predominant in all three patients. The early exudative stage was characterized principally by edema and extravasation of red blood cells into the alveolar space with injury to the alveolar epithelial cells; this was followed by detachment, apoptosis, and necrosis of type I and II pneumocytes. The capillaries exhibited congestion, exposure of the basement membrane from denuded endothelial cells, platelet adhesion, fibrin thrombi, and rupture of the capillary walls. The proliferative stage was characterized by pronounced proliferation of type II alveolar pneumocytes and multinucleated giant cells. The cytopathic effect of SARS-CoV-2 was observed both in degenerated type II pneumocytes and freely circulating in the alveoli, with components from virions, macrophages, lymphocytes, and cellular debris. CONCLUSIONS: Viral particles consistent with the characteristics of SARS-CoV-2 were observed mainly in degenerated pneumocytes, in the endothelium, or freely circulating in the alveoli. In the final stage of illness, the alveolar spaces were replaced by fibrosis.

Light, temperature and sowing depth on germination of garden spurge / Efeito da luz, temperatura e profundidade de semeadura na germinação de erva-de-santa-luzia

ABSTRACT: Knowledge on weed biology and ecology is fundamental to provide suitable control practices in weed management systems. The objective of this research was to understand the effect of light and temperature on germination of Chamaesyce hirta, as well as to evaluate the effect of depth of seed placement in the soil in the emergence of the plant. Two experiments were conducted. In the first one, in the laboratory, the seeds were placed to germinate in plastic boxes and kept in a B.O.D. germination chamber, under constant temperatures of 20, 25, 30 and 35 ºC, either in the dark or under continuous light. Daily germination assessments were performed. The percentage of germinated seeds in the 10-day period and the germination speed index (GSI) were calculated. In the second trial, carried out in greenhouse conditions, 100 seeds were planted, under six levels of seeding depth (0, 1, 2, 3, 4 and 5 cm) and three soil cover conditions: no straw, under black oats (Avena strigosa) straw and under corn (Zea mays) straw. Daily plant emergence was counted along 30 days and total emergence and GSI were calculated. Germination of C. hirta seeds occurs both in the presence and absence of light. For the highest temperature, both increased germination and GSI were reported in the presence of light. The highest levels of emergence were obtained with the absence of plant cover and under corn straw at 0 cm depth. The presence of black oat straw on the soil reduced the emergence of C. hirta.

RESUMO: O conhecimento a respeito da biologia e ecologia das plantas daninhas é fundamental para a adoção de práticas de controle adequadas dentro dos sistemas de manejo. O objetivo do trabalho foi avaliar o efeito da luz e da temperatura na germinação de Chamaesyce hirta, e o efeito de profundidade de semeadura na emergência das plantas, com a presença e ausência de cobertura vegetal no solo. Foram instalados dois experimentos. No primeiro, conduzido em laboratório, as sementes foram colocadas para germinar em caixas plásticas, do tipo "gerbox", e mantidas em câmara de germinação do tipo B.O.D., sob temperaturas constantes de 20, 25, 30 e 35 ºC no escuro ou sob luz contínua. Foram realizadas avaliações diárias de germinação. Calculou-se a porcentagem total de sementes germinadas no período de 10 dias e o índice de velocidade de germinação (IVG). No segundo, conduzido em casa-de-vegetação, 100 sementes foram colocadas em vasos com solo, sob seis níveis de profundidade de semeadura (0, 1, 2, 3, 4 e 5 cm) e três condições de cobertura do solo: sem palhada, com palha de aveia-preta (Avena strigosa) e com palha de milho (Zea mays). A emergência das plântulas foi registrada diariamente por um período de 30 dias, calculando-se a porcentagem total de emergência para cada tratamento e o índice de velocidade de emergência (IVE). A germinação das sementes de C. hirta ocorreu tanto na presença quanto na ausência de luz. Para a temperatura mais elevada houve maior porcentagem de germinação, bem como maior IVG, na presença de luz. Os maiores níveis de emergência ocorreram na ausência de cobertura vegetal e sob palhada de milho na profundidade de 0 cm. A presença de palha de aveia-preta sobre o solo reduziu a emergência de C. hirta, mostrando-se como uma boa medida de controle cultural.

Alterações cardiorrespiratórias em indivíduos hemiparéticos crônicos pós-acidente vascular cerebral / Cardiorespiratory changes in chronic post-stroke hemiparetic patients

Objetivo: Analisar a função cardiorrespiratória em pacientes he- miparéticos crônicos pós-acidente vascular cerebral. Métodos: Estudo retrospectivo, por meio da análise de dados de prontuários de pacientes submetidos ao teste de caminhada de 6 minutos e manovacuometria em uma clínica de fisioterapia de um centro universitário. Foram analisados os dados de sete prontuários. Re- sultados: A média de metros percorridos pelos participantes no teste de caminhada de 6 minutos foi de 199,5. Os valores percentuais da manovacuometria foram de -41,34 na pressão inspiratória máxima e de 57,85 na pressão expiratória máxima. Conclusão: Os dados desta pesquisa sugerem que indivíduos hemiparéticos crônicos apresentam fadiga respiratória e muscular, diminuição da capacidade funcional durante a marcha e fraqueza dos músculos respiratórios.

Objective: To analyze the cardiorespiratory function in chronic post-stroke hemiparetic patients. Methods: This is a retrospective study, through data analysis of medical records from patients who underwent the 6-minute walk test and manovacuometry, in a physical therapy clinic of a university center. Results: The mean number of meters walked by participants in the 6-minut walk test was 199.5 meters. The percentage values of manovacuometry were -41,34 in the maximun inspiratory pressure and 57.85 in the maximun expiratory pressure. Conclusion: The data from this survey suggest that chronic hemiparetic individuals have respiratory and muscle fatigue, decreased functional capacity during gait, and respiratory muscle weakness.

Healthcare system capacity of the municipalities in the State of Rio de Janeiro: infrastructure to confront COVID-19 / Capacidad del sistema de salud en los municipios del estado de Río de Janeiro: infraestructura para enfrentar la COVID-19 / Capacidade do sistema de saúde nos municípios do Rio de Janeiro: infraestrutura para enfrentar a COVID-19

Abstract Considering the growing number of cases requiring emergency care as a result of SARS-CoV-2 in the Brazilian State of Rio de Janeiro, this study focuses on mapping the health infrastructure of the municipalities of the state, comparing the Structure Efficiency Index (IEE) before (2016) and after the COVID-19 pandemic. The article fills a gap in the academic literature, informing public health policies specialists and technicians, as well as policy and decision-makers, about the capacity of municipalities to face the problem. We calculated the Structure Efficiency Index (IEE) of the states' 92 municipalities and positioned them on the pandemic curve. It was possible to verify that the government of the State of Rio de Janeiro needs to start acting to suppress COVID-19, maintaining the policy of providing more hospital beds, and purchasing equipment. However, it is also necessary to consider the particularities and deficiencies of each region, as the policy to transfer patients to places with available beds can contribute to the spread of the disease.

Resumen Considerando el número creciente de casos de atención de emergencia procedentes del SARS-CoV-2, en el estado de Río de Janeiro, este estudio se centra en el mapeo de la infraestructura de salud en los municipios de dicho estado, con el fin de informar a los especialistas, técnicos, formuladores y tomadores de decisiones de políticas de salud pública sobre la capacidad de cada localidad para enfrentar el problema. Para esto, calculamos el índice de eficiencia de estructura (IEE) colocando los 92 municipios del estado en la curva de la pandemia. Se pudo verificar que el Gobierno del Estado de Río de Janeiro debe comenzar a actuar para suprimir la COVID-19 manteniendo la política de apertura o reapertura de camas y adquisición de equipos. Sin embargo, también se deben considerar las particularidades y deficiencias de cada región, ya que la política de traslado de pacientes postrados a otras regiones con camas disponibles puede propagar la enfermedad.

Resumo Considerando um número crescente de casos de atendimento de emergência, provenientes do SARS-CoV-2, no Estado do Rio de Janeiro, o presente estudo se concentra no mapeamento da infraestrutura de saúde nos municípios do Estado, comparando o Índice de Eficiência em Estrutura antes (2016) e após a pandemia da COVID-19. O artigo preenche uma lacuna acadêmica ao informar aos especialistas, técnicos, formuladores e tomadores de decisão de políticas públicas de saúde, sobre a capacidade de cada localidade para enfrentar o problema. Para isso, calculamos o Índice de Eficiência da Estrutura (IEE), alocando os 92 municípios do Estado na curva de pandemia. Foi possível verificar que o Governo do Estado do Rio de Janeiro precisa começar a atuar na supressão da COVID-19, mantendo a política de abertura, ou reabertura, de leitos e aquisição de equipamentos. No entanto, também é necessário considerar as particularidades e deficiências de cada região, pois a política de transferência dos acamados para outras regiões com leitos disponíveis pode espalhar a doença.

Validation of an algorithm based on clinical, histopathological and immunohistochemical data for the diagnosis of early-stage mycosis fungoides

Abstract Background: Diagnosis of mycosis fungoides is challenging due to the non-specificity of clinical and histopathological findings. The literature indicates an average delay of 4-6 years for a conclusive diagnosis. Refinement of the histopathological criteria for the diagnosis of patients in early stages of the disease is considered of interest. Objectives: To study the histopathological aspects of early-stage mycosis fungoides and the applicability, in a retrospective form, of the diagnostic algorithm proposed by Pimpinelli et al. Methods: Observational, retrospective, transversal study based on revision of histopathological exams of patients with suspected mycosis fungoides. Medical records were reviewed, and complementary immunohistochemistry performed. Results: Sixty-seven patients were included. The most frequent histopathological features were superficial perivascular lymphoid infiltrate (71.6%), epidermotropism (68.7%), lymphocytic atypia (63.8%), hyperkeratosis (62.7%) and acanthosis (62.7%). Forty-three patients scored 4 points at the algorithm, by clinical and histological evaluation. Immunohistochemistry was performed on 23 of the 24 patients with less than 4 points. Of those 23, 22 scored 1 point, allowing a total of 61 patients (91%) with the diagnosis of early-stage mycosis fungoides. Study limitations: Its retrospective character, reduced sample size and incomplete application of the algorithm. Conclusions: Application of the Pimpinelli et al. algorithm, even in an incomplete form, increased the percentage of cases diagnosed as mycosis fungoides. Routine application of the algorithm may contribute to earlier and specific management and improvement of the patients' outcome.

Histopathological changes in epithelium of hair follicles and acrosyringium caused by measles in child

Abstract Some epidermal alterations in measles has been described, such as keratinocytes apoptotic, parakeratosis, giant-cell formation, intranuclear and cytoplasmic inclusions, dyskeratosis, spongiosis, and intracellular edema. The authors report for the first time in human a case of measles with the presence of multinucleated giant cells in the hair follicle and dyskeratosis in acrosyringium.