Acurácia do escore de referência endoscópico para esofagite eosinofílica em crianças / Accuracy of the eosinophilic esophagitis endoscopic reference score in children

ABSTRACT Background: To assess the efficacy of applying the endoscopic reference score for EoE (EREFS) in children with symptoms of esophageal dysfunction naïve to proton pump inhibitor (PPI) therapy. Methods: An observational cross-sectional study was conducted by reviewing reports and photographs of upper gastrointestinal endoscopies (UGE) and esophageal biopsies of patients with symptoms of esophageal dysfunction. Patients who were treated with PPI or had other conditions that may cause esophageal eosinophilia were excluded. Results: Of the 2,036 patients evaluated, endoscopic findings of EoE were identified in 248 (12.2%) and more than one abnormality was observed in 167 (8.2%). Among all patients, 154 (7.6%) presented esophageal eosinophilia (≥15 eosinophils per high power field) (P<0.01). In this group, 30 patients (19.5%) had normal endoscopy. In patients with EoE, edema (74% vs 6.5%, P<0.01) and furrows (66.2% vs 2.4%, P<0.01) were more prevalent than in the control group. Association of edema and furrows was more frequent in patients with EoE than in the control group (29.2% vs 1.6%, P<0.01, OR=24.7, CI=15.0-40.5). The presence of more than one endoscopic finding had sensitivity of 80.5%, specificity of 93.4%, positive predictive value (PPV) of 50%, negative predictive value (NPV) of 98.3%, and accuracy of 92.4%. Conclusion: In conclusion, this study showed that endoscopic features suggestive of EoE had high specificity and NPV for diagnosing EoE in children naïve to PPI therapy. These findings highlight the importance of the EREFS in contributing to early identification of inflammatory and fibrostenosing characteristics of EoE, making it possible to identify and to avoid progression of the disease.

RESUMO Contexto: Avaliar a eficácia da aplicação do escore de referência endoscópico para EoE (EREFS) em crianças com sintomas de disfunção esofágica sem tratamento prévio com inibidores da bomba de prótons (IBP). Métodos: Foi realizado um estudo transversal observacional por meio de revisão de laudos e fotos de endoscopia digestiva alta (EDA) e biópsias de esôfago de pacientes com sintomas de disfunção esofágica. Pacientes tratados com IBP ou com outras condições que podem causar eosinofilia esofágica foram excluídos. Resultados: Dos 2.036 pacientes avaliados, os achados endoscópicos de EoE foram identificados em 248 (12,2%) e mais de uma anormalidade foi observada em 167 (8,2%). Entre todos os pacientes, 154 (7,6%) apresentaram eosinofilia esofágica (≥15 eosinófilos por campo de grande aumento) (P<0,01). Nesse grupo, 30 pacientes (19,5%) apresentaram endoscopia normal. Em pacientes com EoE, edema (74% vs 6,5%, P<0,01) e linhas verticais (66,2% vs 2,4%, P<0,01) foram mais prevalentes quando comparados ao grupo controle. A associação de edema e linhas verticais foi mais frequente em pacientes com EoE do que no grupo controle (29,2% vs 1,6%, P<0,01, OR=24,7, IC=15,0-40,5). A presença de mais de um achado endoscópico teve sensibilidade de 80,5%, especificidade de 93,4%, valor preditivo positivo de 50%, valor preditivo negativo de 98,3% e acurácia de 92,4%. Conclusão: Em conclusão, esse estudo mostrou que as características endoscópicas sugestivas de EoE apresentam especificidade e VPN elevados para o diagnóstico da enfermidade em crianças sem tratamento prévio com IBP. Estes achados reforçam a importância do EREFS em contribuir para a identificação precoce de características inflamatórias e fibroestenosantes, possibilitando identificar e evitar a progressão da doença.

Filling in a biogeographic gap: the first Trichomycteridae from the Parnaíba River basin (Siluriformes: Trichomycteridae)

Trichomycterid catfishes have long been considered as absent in the Parnaíba River basin, Northeastern Brazil, in what constitutes their most conspicuous gap in geographic distribution. Herein we report on the first occurrence of the family in that basin. The new species is described from the riacho da Volta, right tributary to the upper rio Parnaíba, Piauí State. It is distinguished from its congeners by the combination of two or three pairs of ribs; 36­38 post Weberian vertebrae; a color pattern composed of round, similar-sized, non-coalescent spots; I,5 pectoral-fin rays; the first haemal arch on the 5th or 6th vertebrae; and the first completely fused (to the tip) haemal spine on the 15th vertebra. A putative autapomorphy is the partial (minimally 50% of their length) or total fusion between the anterior arms of the basipterygium. Preliminary evidence suggests that the new species can be related to northern South American forms, a pattern that fits the general Amazonian relationships of the fishes in the Parnaíba River drainage. Although the new species fills in an important qualitative gap in trichomycterid continental distribution, the taxon is apparently rare and extremely restricted in distribution, with the type series being its only record so far. The paucity of trichomycterids in the Parnaíba remains a puzzling biogeographical phenomenon.(AU)

Os bagres tricomicterídeos têm estado surpreendentemente ausentes na bacia do rio Parnaíba, Nordeste do Brasil, no que constitui sua lacuna mais evidente na distribuição. Relatamos a primeira ocorrência da família na bacia. A espécie nova é descrita do riacho da Volta, tributário do lado direito do alto rio Parnaíba em Uruçuí, Piauí. Ela é distinguida de suas congêneres pela combinação de dois ou três pares de costelas; 36­38 vértebras pós weberianas; padrão de coloração composto de manchas arredondas, de tamanhos semelhantes e não coalescentes; I,5 raios nas nadadeiras peitorais; o primeiro arco haemal na 5° ou 6° vértebra, e o primeiro espinho haemal completamente fusionado (até a extremidade) na 15° vértebra. Uma possível autapomorfia é a fusão parcial (mínimo de 50% do seu comprimento) ou total entre os braços anteriores do basiopterígio. Evidências preliminares sugerem que a espécie nova pode estar relacionada com as formas do norte da América do Sul, padrão que se encaixa nas relações amazônicas dos peixes da drenagem do rio Parnaíba. Embora a espécie nova preencha uma importante lacuna na distribuição continental dos tricomicterídeos, o táxon é aparentemente raro e extremamente restrito em distribuição, sendo a série-tipo seu único registro até o momento.(AU)

Art and science: impact of semioccluded vocal tract exercises and choral singing on quality of life in subjects with congenital GH deficiency

ABSTRACT Objectives: Currently, not much is known about the interactions between voice and growth hormone (GH). We have described large kindred with isolated GH deficiency (IGHD) due to a GHRH receptor mutation, resulting in severe short stature and high-pitched voice. These IGHD individuals have little interest in GH treatment, as they consider themselves "short long-lived people", rather than patients. Interestingly, they report normal general quality of life, but they rate their Voice-Related Quality of Life (V-RQOL) as low. Here, we assessed the social and auditory-perceptual impacts of artistic-intervention voice therapy with semioccluded vocal tract exercises (SOVTE) and choral singing, on their voices. Material and methods: Seventeen GH-naïve adult IGHD individuals were enrolled in a single-arm interventional pre-post study with 13 weekly sessions of choir singing over 90 days. Outcome measures were V-RQOL scores, self-assessment of voice, and auditory-perceptual analysis (GRBAS scale, G: grade of the severity of dysphonia; R: roughness; B: breathiness; A: asthenia; and S: strain). Results: Marked improvements in total (p = 0.0001), physical (p = 0.0002), and socioemotional (p = 0.0001) V-RQOL scores and in self-assessment of voice (p = 0.004) were found. The general grades of vocal deviation (p = 0.0001), roughness (p = 0.0001), breathiness (p = 0.0001) and strain (p = 0.0001) exhibited accentuated reductions. Conclusions: Voice therapy with semioccluded vocal tract exercises and choral training improved social impact and perceptual voice assessments in IGHD subjects and markedly improved their voice-related quality of life. This is particularly important in a setting where GH replacement therapy is not widely accepted.

Staphylococcus spp. Resistente a meticilina y Enterococcus spp. Resistente a Vancomicina aislados de pacientes del servicio de Medicina y emergencia de un hospital al norte del Perú / Methicillin-resistant Staphylococcus spp. and vancomycin-resistant Enterococcus spp. isolated from patients attending the medicine and emergency service at a hospital in northern Peru

Objetivo: Determinar la frecuencia de Staphylococcus spp. resistentes a meticilina y Enterococcus spp. resistente a vancomicina en pacientes asintomáticos procedentes del servicio de medicina y emergencia del Hospital Regional Lambayeque, Perú. Métodos: Durante los meses de abril a agosto del 2017 se estudiaron 101 pacientes de los servicios de medicina y emergencia del Hospital Regional Lambayeque. Para la toma de muestra se consideraron las regiones: nasal, faringe y rectal. El aislamiento primario se realizó en placas de agar manitol salado y agar bilis esculina, suplementadas con 6 µg/mL de oxacilina y 6 µg/mL de vancomicina, respectivamente. La identificación se llevó a cabo por bioquímica clásica. Para las pruebas de susceptibilidad antimicrobiana se emplearon los métodos de Kirby-Bauer y concentración mínima inhibitoria. Resultados: Se determinó una frecuencia de portadores de 83,17 por ciento. El 94,07 por ciento de los aislamientos de Staphyloccocus fueron meticilino resistentes mecA+ en 75 por ciento, el 43,33 por ciento presentó resistencia de alto nivel (>128 µg/mL) a este antimicrobiano; no se hallaron aislamientos resistentes a glicopéptidos. Enterococcus tuvo una frecuencia de 54,29 por ciento de resistencia a vancomicina, 42,84 por ciento a teicoplanina, fue el fenotipo van A (37,14 por ciento) el de predominio. También se determinó resistencia de alto nivel (>128 µg/mL) en este género en el 27,50 por ciento de los aislamientos. Conclusión: Se encontró una alta frecuencia de portadores de los géneros Staphylococcus y Enterocccus. Existen cepas multirresistentes a los antimicrobianos en portadores asintomáticos(AU)

Objective: Determine the frequency of methicillin-resistant Staphylococcus spp. and vancomycin-resistant Enterococcus spp. in asymptomatic patients attending the Medicine and Emergency Service at Lambayeque Regional Hospital in Peru. Methods: A total 101 patients attending the Medicine and Emergency Service at Lambayeque Regional Hospital were studied from April to August 2017. The nasal, pharyngeal and rectal regions were considered for sample taking. Primary isolation was performed on mannitol salt agar and bile aesculin agar plates supplemented with 6 µg/ml oxacillin and 6 µg/ml vancomycin, respectively. Identification was carried out by classic biochemistry. Antimicrobial susceptibility tests were based on the Kirby-Bauer and minimum inhibitory concentration methods. Results: A carrier frequency of 83.17 percent was determined. 94.07 percent of the Staphylococcus isolates were mecA+ methicillin-resistant in 75 percent, and 43.33 percent displayed high-level resistance (>128 µg/ml) to this antimicrobial. Glycopeptide-resistant isolates were not found. Enterococcus exhibited a resistance frequency of 54.29 percent to vancomycin and 42.84 percent to teicoplanin. Van A was the prevailing phenotype (37.14 percent). High-level resistance was also determined in this genus (>128 µg/ml) in 27.50 percent of the isolates. Conclusion: A high frequency was observed of carriers of the genera Staphylococcus and Enterococcus. Antimicrobial-multiresistant strains are present in asymptomatic carriers(AU)

Identification and characterization of pestiviruses isolated from individual fetal bovine serum samples originated in Rio Grande do Sul state, Brazil / Identificação e caracterização de pestivírus isolados de amostras individuais de soro fetal bovino originárias do Rio Grande do Sul, Brasil

The identification of diversity of bovine pestiviruses circulating in the field is fundamental for continuous evaluation of diagnostic tests and vaccine composition. In this article we performed the genetic and antigenic characterization of twelve bovine pestiviruses isolated in the western region of Rio Grande do Sul, Brazil. The viruses were isolated from sera of bovine fetuses or from animals with clinical presentations suggestive of pestivirus infection. Genetic characterization by sequencing and phylogenetic analysis of the 5'UTR region of the viral genome allowed for the identification of bovine viral diarrhea virus (BVDV-1a, 4/12, 33.3%), BVDV-1b (6/12, 50%) and BVDV-2 (2/12, 16.7%). The reactivity of the isolates with a panel of monoclonal antibodies raised against envelope proteins (Erns, E1 and E2) demonstrated a high antigenic variability among isolates. Thus, the active circulation of bovine pestivirus infection, with high genetic and antigenic variability, in cattle on the western border of RS was confirmed, demonstrating the importance of continuous characterization of the pestiviruses circulating in the cattle herds to keep the diagnostic and control measures up to date.(AU)

A identificação da diversidade de pestivírus bovinos que circulam no campo é fundamental para a avaliação contínua dos testes de diagnóstico e composição de vacina. Neste artigo, realizamos a caracterização genética e antigênica de doze pestivírus bovinos isolados na região oeste do Rio Grande do Sul, Brasil. Os vírus foram isolados de soros de fetos bovinos ou de animais com apresentações clínicas sugestivas de infecção por pestivírus. A caracterização genética por sequenciamento e análise filogenética da região 5'UTR do genoma viral permitiu a identificação do vírus da diarréia viral bovina (BVDV-1a, 4/12, 33,3%), BVDV-1b (6/12, 50%) e BVDV-2 (2/12, 16,7%). A reatividade dos isolados com um painel de anticorpos monoclonais criados contra proteínas do envelope (Erns, E1 e E2) demonstrou uma alta variabilidade antigênica entre os isolados. Assim, confirmou-se a circulação ativa da infecção por pestivírus bovino, com alta variabilidade genética e antigênica, em bovinos na fronteira oeste do RS, demonstrando a importância da contínua caracterização dos pestivírus circulantes em bovinos para manter atualizadas as medidas de diagnóstico e controle.(AU)

Abordaje laparoscópico simultáneo del cáncer de colon con metástasis hepáticas / Simultaneous laparoscopic approach for colon cancer and liver metastases

Antecedentes: la hemicolectomía derecha laparoscópica con abordaje suprapúbico (HDLS) y empleo de tecnología. En los pacientes con cáncer de colon con metástasis hepáticas sincrónicas (CCMHS), la resección completa del tumor primario con las metástasis es la única opción de tratamiento con intención curativa. Se conocen varios informes de series de casos en el mundo; sin embargo, no existe ningún estudio aleatorizado controlado. Objetivo: el objetivo es evaluar la factibilidad y seguridad del abordaje laparoscópico simultáneo de la resección del tumor primario de colon y de la metástasis hepática. Material y métodos: es un estudio retrospectivo; a tal fin se recolectaron todos los pacientes con sospecha de CCMHS abordados por laparoscopia con intención de resección simultánea del tumor primario de colon con las metástasis hepáticas. Se analizaron variables preoperatorias, operatorias, resultados a corto y largo plazo, y anatomopatológicas. Resultados: en el período de estudio se realizaron 89 resecciones hepáticas laparoscópicas (RHL). En 28 pacientes se realizó ‒en forma simultánea con la RHL‒ otro procedimiento, en 21 de los cuales fue una colectomía laparoscópica. El tiempo quirúrgico promedio total de los dos procedimientos llegó a 407 minutos. El promedio de días de estadía hospitalaria fue de 8 días. No hubo mortalidad en la serie, y la morbilidad global fue del 71%, pero un solo caso con morbilidad mayor. La sobrevida global y la sobrevida libre de recurrencia a los 3 años fue de 55,2% y 16,3%, respectivamente. Conclusión: Esta es la primera publicación acerca del tema en nuestro país. Podemos decir que, en casos bien seleccionados, el abordaje laparoscópico simultáneo es factible de realizar, con aceptable morbimortalidad y sin comprometer los resultados oncológicos.

Background: In patients with colorectal cancer with synchronous liver metastases (CLM), complete resection of the primary tumor with the metastases is the only option for curative treatment. Several case series have been reported but no randomized controlled trials have been published. Objective: The aim was to evaluate if the simultaneous laparoscopic resection of the primary colon tumor and liver metastases is feasible and safe. Material and methods: A retrospective study was conducted with patients with suspected CLM scheduled for simultaneous laparoscopic resection of the primary tumor of the colon and liver metastases. The preoperative and operative variables, short- and long-term outcomes and pathological variables were analyzed. Results: A total of 89 laparoscopic liver resections (LLR) were performed during the study period. In 28 patients, LLR was simultaneous with other procedures, 21 of which corresponded to laparoscopic colon resection. Mean surgical time for both procedures was 407 minutes. Mean hospital length of stay was 8 days. None of the patients died and overall morbidity rate was 71% with only one major complication. Overall survival and relapse-free survival at three years was 55.2% and 16.3%, respectively. Conclusion: This is the first publication analyzing this approach in our country. In well selected cases, the simultaneous laparoscopic approach is feasible, with low morbidity and mortality and acceptable oncological results.

Invaginación de colon causado por lipoma / Colon invagination caused by lipoma

Los lipomas del colon ocupan el tercer lugar en frecuencia de aparición de tumores benignos. Estos tumores están formados por tejido adiposo bien diferenciado con un estroma fibroso. La gran mayoría de estos lipomas es asintomática, algunos en raras ocasiones presentan complicaciones de urgencia. El fin de esta publicación es presentar un caso de obstrucción de colon por lipoma. (AU)

Benign colonic lesions are infrequent and account for a low percentage of all colonic tumors. Among the benign tumors, lipomas are third in frequency. They are composed of mature adipose tissue with fibrous stroma. Most of them are asymptomatic but in rare instances, they may present as surgical emergencies. We present one case of colonic obstruction caused by lipomas. (AU)

Atendimento homeopático no Centro de Saúde da Barra Funda, SP: uma contribuição à atenção primária à saúde / Homeopathic care at Health Center of Barra Funda, São Paulo: a contribution to primary health care

Os autores analisam o conceito de doença e de doente, suas implicações no tratamento médico, na assistência médica e na adequação do tratamento homeopáticos aos pacientes que se tratam em Centros de Saúde. Estão executando um projeto de atendimento a pacientes no Centro de Saúde da Barra Funda em São Paulo, onde se propõem a analisar a eficiência terapêutica homeopática, através dos resultados do tratamento dos doentes, do tempo gasto nas consultas, das intercorrências durante o tratamento e o custo medicamentoso. O trabalho está em andamento e somente alguns dados preliminares foram avaliados. Este trabalho constitui uma contribuição para a estruturação do atendimento homeopático na rede pública. (au)

The authors analyze the notions of disease/sick person, their implications for medical treatment, medical care and the suitability of homeopathic treatment for patients cared at primary healthcare services. The authors are carrying out a project involving care delivery to patients at Health Care Center of Barra Funda, São Paulo, to analyze the efficiency of homeopathic treatment based on the outcomes of treatment, visit duration, intercurrent problems and cost. This project is in progress and only some preliminary data were evaluated. The present study represents a contribution to the implementation of homeopathic care within the public healthcare system. (au)

Epidemiologia de micoses, pitiose e micotoxicoses em equinos no sudeste do Rio Grande do Sul / Epidemiology of mycoses, pitiosis and micotoxicosis in horses in southeastern Rio Grande do Sul, Brazil

Descrevem-se os aspectos epidemiológicos das doenças causadas por fungos e oomicetos na população de equinos na região sudeste do Rio Grande do Sul, estabelecendo as taxas epidemiológicas, suas causas e sua importância sanitária na região. Foi realizada a epidemiologia descritiva por meio do cálculo da incidência das doenças encontradas ao longo dos anos e verificada a existência de associação entre a ocorrência dessas enfermidades e o sexo, a raça e a estação do ano. Entre os anos de 1978 e 2014 a pitiose teve prevalência de 49,71% (86/173), as micotoxicoses 30,05% (52/173), sendo 45 casos de leucoencefalomalácia e sete de ergotismo. As micoses tiveram prevalência de 19,65% (34/173), sendo as dermatofitoses as mais prevalentes com 58,82% (20/34) dos casos. As espécies de dermatófitos mais frequentemente isoladas foram Trichophyton mentagrophytes 60% (12/20), Trichophyton equinum 25% (5/20) e Microsporum gypseum, Microsporum canis e Trichophyton verrucosum ambos responsáveis por 5% (1/20) das infecções. Rinosporidiose foi diagnosticada em 35,29% (12/34) dos casos. Micoses uterinas causadas por Candida albicans e Cryptococcus laurentii foram observadas em 5,88% (2/34) dos casos. Alergia por Cladosporium sp. teve um registro. De acordo com as incidências calculadas entre 1990 e 2014 a pitiose teve incidência mediana (IM) 2,98 e distância interquartil (DI) =3,82, as fêmeas tiveram chance 4,18 vezes maiores de desenvolver a doença, a enfermidade ocorre independente das estações climáticas. A leucoencefalomalácia teve IM=0,0; DI 1,00 e equinos machos tiveram 3,4 vezes mais chance de desenvolver a doença que fêmeas, no inverno a possibilidade de ocorrência dessa enfermidade foi seis vezes maior. O ergotismo teve IM = 0,00; DI = 0,000, rinosporidiose IM=0,00; DI=0,088 e dermatofitose IM=0,00; DI=0,935. A pitiose foi mais prevalente entre as doenças encontradas, podendo ser considerada endêmica na região. Considera-se que a magnitude das doenças possa ser ainda maior dentro do rebanho equino, uma vez que as doenças descritas não são de notificação obrigatória e algumas são bem conhecidas por veterinários e proprietários, que muitas vezes não fazem a confirmação laboratorial do diagnóstico.(AU)

The epidemiological aspects of diseases caused by fungi and oomycetes in horses in southeastern Rio Grande do Sul, Brazil, is described. The epidemiological rates, their causes, and health importance in the region were established. A descriptive epidemiology study was carried out in relation of potential risk factors. The impact on these diseases in the region was measured. From 1978 to 2014, pythiosis had a prevalence of 49.71% (86/173), and mycotoxicoses of 30.05% (52/173), with 45 cases of leukoencephalomalacia and 7 of ergotism. The prevalence of fungal infections was 19.65% (34/173) of cases. Dermatophytosis was the most prevalent fungal infection with 58.82% (20/34) of cases. The most isolated dermatophyte species were Trichophyton mentagrophytes 60% (12/20), Trichophyton equinum 25% (5/20) and Microsporum gypseum, Microsporum canis, and Trichophyton verrucosum, both responsible for 5% (1/20) of infections. Rhinosporidose was diagnosed in 35.29% (12/34) of cases. Uterine mycosis caused by Candida albicans and Cryptococcus laurentii was observed at 5.88% (2/34) of cases. Cladosporium sp. allergy was noted in one record. According to the incidence from 1990 to 2014, pythiosis had median incidence (MI) of 2.98 and interquartile range (DI) of 3.82. Mares were 4.18 times likely to develop the disease then males. The disease occurs in the region in every season. Leukoencephalomalacia had MI of 0.0; DI 1.00 and male horses were 3.4 times more likely than mares to develop the disease. Leukoencephalomalacia was 6 times more likely to occur during winter. Ergotism had MI of 0.00; DI of 0.000, rhinosporidiosis MI of 0.00, DI of 0.088 and ringworm MI of 0.00, and DI of 0.935. In the study pythiosis had the highest prevalence among the diseases observed, and may be considered endemic in the region. The magnitude of the diseases observed may be even greater within the equine herd, since these diseases are not of obligatory notification and some are well known by veterinarians and owners, who often do not obtain a laboratory confirmation of the diagnosis.(AU)

A history of the biogeography of Amazonian fishes

The history of knowledge about Amazonian biogeography is as rich as its fish community, and a fascinating theme of study in itself. Several current paradigms and controversies about Amazonian fish biogeography are rooted in principles dating from the second half of the 18th to the first half of the 19th centuries. The present work establishes a relationship between current biogeographical ideas and their old predecessors, on the basis of a chronologically-oriented historical continuity analysis. The advent of evolutionary theory has not contributed significantly to a transformation of the knowledge on the biogeography of Amazonian fishes. On the other hand, the two main schools of biogeographical thought (dispersalist and vicariant) had major implications on how Amazonian fish distribution is interpreted. The process was gradual and many hypotheses have combined elements from each of the two schools. Chronologically, practically the entire tradition of Amazonian biogeography takes place within the evolutionary paradigm, although its founder Louis Agassiz was himself an anti-evolutionist. The birth of Amazonian biogeography is Agassiz´s travel in Amazon. That document makes it clear that the author did not consider dispersal as a valid explanation for the biogeographical patterns he found. Later, Carl Eigenmann helps to spread the dispersalist tradition as a model for biogeographical explanations in fish distributions, a phase which lasted until the late 20th century. A major shift occurs with the contributions of Marylin Weitzman, Stanley Weitzman and Richard Vari, who associated the temporal framework of phylogenetic hypotheses with distribution patterns, underscoring the predictive power of vicariant biogeography. The present-day paradigm begins with the work of John Lundberg and attempts to incorporate geomorphological and phylogenetic information into integrative biogeographical hypotheses. Some emblematic problems have delayed proposition of general hypotheses on the phylogenetic biogeography of South American fishes, such as the poor state of knowledge of their species-level systematics; an incomplete distributional record for most species and sparse or non-existent data on the phylogenetic history of most supraspecific taxa. Such drawbacks are now being corrected at a fast pace. Recent advances on geographical distribution and an increasing number of phylogenetic hypotheses will allow unprecedented large-scale biogeographic analyses, including those based on event models and Bayesian inference. Thus, the biogeography of South American fishes, especially Amazonian ones, should soon experiment a new age of progress. The success of that new phase will depend on its ability to recognize and segregate multiple overlapping temporal layers of hydrological changes, and to develop analytical tools that can deal with temporal mixing.(AU)

A história do conhecimento da biogeografia amazônica é tão rica quanto sua comunidade de peixes e um tema fascinante de estudo em si. Vários paradigmas e controvérsias atuais sobre a biogeografia de peixes amazônicos estão enraizados em princípios que datam da segunda metade do século 18 até a primeira metade do século 19. O presente trabalho estabelece uma relação entre as idéias biogeográficas atuais e seus antecessores antigos a partir de uma análise histórica cronologicamente orientada. O advento da teoria evolutiva não contribuiu significativamente para a transformação do conhecimento sobre a biogeografia dos peixes amazônicos. Por outro lado, as duas principais escolas de pensamento biogeográfico (dispersalista e vicariante) tiveram grandes implicações sobre a interpretação da distribuição de peixes amazônicos. O processo foi gradual e muitas hipóteses combinaram elementos de cada uma das duas tradições. Cronologicamente, praticamente toda a história da biogeografia amazônica ocorre dentro do paradigma evolutivo, embora seu fundador Louis Agassiz fosse ele próprio um anti-evolucionista. O nascimento da biogeografia amazônica é o relatório de viagem de Agassiz na Amazônia. Esse documento deixa claro que o autor não considerou o dispersalismo como uma explicação válida para os padrões biogeográficos que encontrou. Mais tarde, Carl Eigenmann ajuda a disseminar a tradição dispersalista como modelo para explicações biogeográficas na distribuição de peixes, uma fase que perdurou até o final do século 20. Uma grande mudança ocorre com as contribuições de Marylin Weitzman, Stanley Weitzman e Richard Vari, que associaram a dimensão temporal de hipóteses filogenéticas com padrões de distribuição, revelando o poder preditivo da biogeografia vicariante. O paradigma atual começa com o trabalho de John Lundberg e busca incorporar informações geomorfológicas e filogenéticas em hipóteses biogeográficas integrativas. Alguns problemas emblemáticos atrasaram a proposição de hipóteses gerais sobre a biogeografia vicariante de peixes da América do Sul, como o mau estado de conhecimento de sua sistemática em nível de espécie; o registro de distribuição geográfica incompleto para a maioria das espécies e dados escassos ou inexistentes sobre a história filogenética da maioria dos táxons supraespecíficos. Essas desvantagens agora estão sendo corrigidas em um ritmo acelerado. Avanços recentes na distribuição geográfica e um número crescente de hipóteses filogenéticas permitirão inéditas análises biogeográficas de grande escala, inclusive aquelas baseadas em modelos de eventos e inferência bayesiana. Assim, a biogeografia dos peixes sul-americanos, especialmente os amazônicos, deve experimentar em breve uma nova era de progresso. O sucesso dessa nova fase dependerá de sua capacidade de reconhecer e segregar múltiplas camadas temporais sobrepostas de mudanças hidrológicas e desenvolver ferramentas analíticas que possam lidar com a mistura temporal.(AU)

Effects of training volume on lower-body muscle strength in untrained young men: a contralateral control study

The purpose of this study was to examine the effects of training volume (1 vs. 3 sets) on lower-body muscle strength in untrained young men. Methodsː Eighteen untrained young men were recruited and their legs were trained with 1 or 3 sets (in a contralateral design) for 6 weeks, using a knee extension machine. Isokinetic peak torque and one repetition maximum (1RM) were assessed at pre- and post-training. Resultsː There was a similar improvement in the 1RM strength (1SET: +14.8% vs. 3SET: 16.3%, P > 0.05) and peak torque (1SET: +8.1% vs. 3SET: 9.3%, P > 0.05) for both conditions from pre- to post-training. The effect size (ES) for the change in 1RM was moderate for both conditions (1SET: 1.39 vs. 3SET: 1.41), and peak torque was trivial and small for 1SET (0.47) and 3SET (0.55), respectively. Additionally, there were no significant (P > 0.05) differences in the dietary intakes from pre- to post-training. Conclusionsː Our results indicate that 1 set is as effective as 3 sets for increasing lower-body muscle strength after a short-term RT period (6 weeks) in untrained young men.(AU)

Do immunoglobulin G and immunoglobulin E anti-l-asparaginase antibodies have distinct implications in children with acute lymphoblastic leukemia? A cross-sectional study

Abstract Background l-Asparaginase is essential in the treatment of childhood acute lymphoblastic leukemia. If immunoglobulin G anti-l-asparaginase antibodies develop, they can lead to faster plasma clearance and reduced efficiency as well as to hypersensitivity reactions, in which immunoglobulin E can also participate. This study investigated the presence of immunoglobulin G and immunoglobulin E anti-l-asparaginase antibodies and their clinical associations. Methods Under 16-year-old patients at diagnosis of B-cell acute lymphoblastic leukemia confirmed by flow cytometry and treated with a uniform l-asparaginase and chemotherapy protocol were studied. Immunoglobulin G anti-l-asparaginase antibodies were measured using an enzyme-linked immunosorbent assay. Intradermal and prick skin testing was performed to establish the presence of specific immunoglobulin E anti-l-asparaginase antibodies in vivo. Statistical analysis was used to investigate associations of these antibodies with relevant clinical events and outcomes. Results Fifty-one children were studied with 42 (82.35%) having anti-l-asparaginase antibodies. In this group immunoglobulin G antibodies alone were documented in 10 (23.8%) compared to immunoglobulin E alone in 18 (42.8%) patients. Immunoglobulin G together with immunoglobulin E were simultaneously present in 14 patients. Children who produced exclusively immunoglobulin G or no antibodies had a lower event-free survival (p-value = 0.024). Eighteen children (35.3%) relapsed with five of nine of this group who had negative skin tests suffering additional relapses (range: 2-4), compared to none of the nine children who relapsed who had positive skin tests (p-value < 0.001). Conclusion Children with acute lymphoblastic leukemia and isolated immunoglobulin G anti-l-asparaginase antibodies had a higher relapse rate, whereas no additional relapses developed in children with immunoglobulin E anti-l-asparaginase antibodies after the first relapse.

Guia prático de atualização em dermatite atópica - Parte I: etiopatogenia, clínica e diagnóstico. Posicionamento conjunto da Associação Brasileira de Alergia e Imunologia e da Sociedade Brasileira de Pediatria / Updated practical guide on atopic dermatitis - Part I: etiopathogenesis, clinical features, and diagnosis. Joint position paper of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

A dermatite atópica (DA) é uma doença crônica e recidivante que acomete principalmente pacientes da faixa etária pediátrica. A fisiopatologia inclui fatores genéticos, alterações na barreira cutânea e imunológicas. A prevalência da DA no Brasil, entre adolescentes, oscila entre 7,1% e 12,5%, com tendência à estabilização. O diagnóstico é clínico, e exames complementares auxiliam na determinação dos fatores desencadeantes. A identificação dos fatores irritantes e/ou desencadeantes envolvidos permite melhor controle das crises. Entre os fatores desencadeantes destacam-se os agentes infecciosos, alérgenos alimentares e aeroalérgenos. Tomando-se como ponto de partida o "Guia Prático para o Manejo da Dermatite Atópica ­ opinião conjunta de especialistas em alergologia da Associação Brasileira de Alergia e Imunopatologia e da Sociedade Brasileira de Pediatria" publicado em 2006, foi realizada revisão e atualização dos conceitos apresentados por grupo de alergologistas, dermatologistas e pediatras especializados no tratamento de pacientes com DA. O objetivo desta revisão foi elaborar um documento prático e que auxilie na compreensão dos mecanismos envolvidos na DA, assim como dos possíveis fatores de risco associados a sua apresentação, bem como sobre a avaliação subsidiária disponível para a identificação dos fatores associados à DA.

Atopic dermatitis (AD) is a chronic, recurrent skin disease that mainly affects pediatric patients. The pathophysiology of AD includes genetic factors, skin barrier abnormalities, and immunological factors. The prevalence of AD in Brazil, among adolescents, ranges from 7.1% to 12.5%, with a trend towards stabilization. The diagnosis of AD is clinical, and complementary tests can help determine the triggering factors. Identification of the irritating and/or triggering factors involved allows better control of exacerbations. Among the triggering factors, infectious agents, food allergens, and aeroallergens stand out. Taking as a starting point the Practical Guide for the Management of Atopic Dermatitis ­ joint opinion of specialists in allergology of the Brazilian Association of Allergy and Immunopathology and of the Brazilian Society of Pediatrics, published in 2006, the present paper describes the results of the review and update of different concepts related to AD, conducted by a group of allergists, dermatologists, and pediatricians specializing in the treatment of patients with AD. The objective of this review was to design a practical document that can help improve our understanding of the mechanisms involved in AD, possible risk factors associated with its presentation, as well as ancillary tests available to identify factors associated with AD.

Guia prático de atualização em dermatite atópica - Parte II: abordagem terapêutica. Posicionamento conjunto da Associação Brasileira de Alergia e Imunologia e da Sociedade Brasileira de Pediatria / Updated practical guide on atopic dermatitis - Part II: treatment approach. Joint position paper of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

Nas últimas décadas o conhecimento sobre a etiopatogenia da dermatite atópica (DA) avançou muito. Além da identificação dos principais agentes desencadeantes e/ou agravantes envolvidos na expressão clínica da DA, verificou-se ser a integridade da barreira cutânea um dos pontos fundamentais para a manutenção da homeostase da pele. Assim, no tratamento do paciente com DA, além da evitação dos agentes desencadeantes e/ou irritantes, o uso de hidratantes é parte fundamental, e acredita-se que tenha ação preventiva de surtos agudos. Além disso, a aquisição de agentes anti-inflamatórios de uso tópico tem permitido o controle de pacientes com formas leves a moderadas da DA. Embora tenham uso mais restrito, os agentes imunossupressores sistêmicos também têm sido empregados no tratamento de pacientes com DA grave ou refratária aos procedimentos habituais. Comenta-se também a imunoterapia alérgeno-específica como tratamento adjuvante da DA para alguns pacientes, sobretudo alérgicos aos ácaros e com manifestações respiratórias associadas. A aquisição de novos agentes, os imunobiológicos, também são apresentados à luz das evidências científicas e clínicas atuais. O presente guia prático de atualização em dermatite atópica ­ abordagem terapêutica teve por objetivo rever os esquemas de tratamento disponíveis e empregados no acompanhamento de pacientes com DA, além de apresentar terapêuticas futuras, como os agentes imunobiológicos que em breve estarão à disposição para o tratamento de formas mais graves e/ou refratárias da DA.

Over the last few decades, knowledge of the etiopathogenesis of atopic dermatitis (AD) advanced greatly. The main triggering and/or aggravating factors involved in the clinical expression of AD have been identified, and cutaneous barrier integrity has been found to be key for the maintenance of skin homeostasis. Thus, when treating patients with AD, in addition to avoiding triggering and/ or irritating agents, recommending the use of skin moisturizers is paramount ­ and believed to have a preventive action against acute outbreaks. Moreover, topical anti-inflammatory agents have allowed AD control in patients with mild to moderate forms of the disease. Although more restricted, systemic immunosuppressive agents have also been used in the treatment of patients with severe or refractory AD. Specific allergen immunotherapy is presented as a possible adjunctive treatment for AD in some patients, especially those allergic to mites and presenting associated respiratory manifestations. Finally, the use of new immunobiological agents is discussed in the light of the scientific and clinical evidence currently available. The objectives of this updated practical guide on atopic dermatitis ­ treatment approach were to review the treatment regimens available and used in the follow-up of patients with AD and to present new therapies (e.g., immunobiological agents) that will soon be available for the treatment of more severe and/ or refractory forms of AD.

Correlación del score de gleason en biopsia prostática con el de pieza operatoria. ¿Cuál es nuestro porcentaje de upgrading? / Correlation between Gleason Score of prostate biopsy and prostatectomy specimen. ¿How high is our upgrading rate?

Introducción. El cáncer de próstata es el segundo cáncer más prevalente del mundo y ocupa el quinto lugar en mortalidad en hombres. El score de Gleason es el factor pronósticos más importante. Sin embargo, numerosos estudios han reportado diferencias entre el score de Gleason de la biopsia prostática y el obtenido de la pieza operatoria. Es por este motivo que el objetivo del presente estudio, es evaluar la concordancia entre el score de Gleason de la biopsia prostática transrectal comparado con el de la pieza operatoria de la prostatectomia radical.(AU)

Introduction. Prostate cancer is the second most prevalent cancer in the world, and occupies the fifth place in mortality among men. Gleason score (GS) is the most important prognostic factor. However, a number of studies have reported differences between the GS of the trans rectal biopsy and the prostatectomy specimen. That is the reason of the this study, our objective is to evaluate concordance between Gleason scores, of the biopsy and the prostatectomy specimen.(AU)

Electroencephalographic findings in patients with major depressive disorder during cognitive or emotional tasks: a systematic review

Objective: Major depressive disorder (MDD) is a prevalent psychiatric condition characterized by multiple symptoms that cause great distress. Uncovering the brain areas involved in MDD is essential for improving therapeutic strategies and predicting response to interventions. This systematic review discusses recent findings regarding cortical alterations in depressed patients during emotional or cognitive tasks, as measured by electroencephalography (EEG). Methods: A search of the MEDLINE/PubMed and Cochrane databases was carried out using the keywords EEG and depression, confined to article title. Results: The studies identified reveal the frontal cortex as an important brain structure involved in the complex neural processes associated with MDD. Findings point to disorganization of right-hemisphere activity and deficient cognitive processing in MDD. Depressed individuals tend to ruminate on negative information and respond with a pattern of relatively higher right frontal activity to emotional stimuli associated with withdrawal and isolation. Conclusion: Patients with MDD may have altered dynamic patterns of activity in several neuroanatomical structures, especially in prefrontal and limbic areas involved in affective regulation. Identification of these alterations might help predict the response of patients to different interventions more effectively and thus maximize the effects both of pharmacotherapeutic and of psychotherapeutic strategies.

Pediatrician's knowledge on the approach of functional constipation / Conhecimento do pediatra sobre o manejo da constipação intestinal funcional

Abstract Objective: To evaluate the pediatrician's knowledge regarding the diagnostic and therapeutic approach of childhood functional constipation. Methods: A descriptive cross-sectional study was performed with the application of a self-administered questionnaire concerning a hypothetical clinical case of childhood functional constipation with fecal incontinence to physicians (n=297) randomly interviewed at the 36th Brazilian Congress of Pediatrics in 2013. Results: The majority of the participants were females, the mean age was 44.1 years, the mean time of professional practice was 18.8 years; 56.9% were Board Certified by the Brazilian Society of Pediatrics. Additional tests were ordered by 40.4%; including abdominal radiography (19.5%), barium enema (10.4%), laboratory tests (9.8%), abdominal ultrasound (6.7%), colonoscopy (2.4%), manometry and rectal biopsy (both 1.7%). The most common interventions included lactulose (26.6%), mineral oil (17.5%), polyethylene glycol (14.5%), fiber supplement (9.1%) and milk of magnesia (5.4%). Nutritional guidance (84.8%), fecal disimpaction (17.2%) and toilet training (19.5%) were also indicated. Conclusions: Our results show that pediatricians do not adhere to current recommendations for the management of childhood functional constipation, as unnecessary tests were ordered and the first-line treatment was not prescribed.

Resumo Objetivo: Identificar o conhecimento do pediatra quanto ao manejo diagnóstico e terapêutico da criança com constipação intestinal funcional. Métodos: Estudo transversal descritivo com amostra constituída de médicos (n=297) entrevistados no 36º Congresso Brasileiro de Pediatria de 2013. Foi usado um questionário autoadministrado referente a um caso clínico hipotético de constipação intestinal. Resultados: Foi observada maior proporção de pediatras do sexo feminino, média de 44,1 anos, tempo de formação médio de 18,8 anos, 56,9% portadores de título de especialista pela Sociedade Brasileira de Pediatria. Exames complementares foram solicitados por 40,4%, a radiografia abdominal foi o mais requisitado (19,5%), seguido por enema opaco (10,4%), exames laboratoriais (9,8%), ultrassonografia de abdome (6,7%), colonoscopia (2,4%), manometria e biópsia (ambas 1,7%). Para o manejo foi sugerida a prescrição de lactulose (26,6%), óleo mineral (17,5%), polietilenoglicol (14,5%), suplemento de fibras (9,1%) e leite de magnésia (5,4%). Orientação alimentar (84,8%), desimpactação fecal (17,2%) e treinamento de toalete (19,5%) também foram indicadas. Conclusões: Evidencia-se uma discordância entre o manejo sugerido pelos pediatras e a conduta preconizada pela literatura disponível atualmente, uma vez que foram solicitados exames complementares desnecessários e não foi recomendada a orientação terapêutica considerada de primeira linha.

The dawn of phylogenetic research on Neotropical fishes: a commentary and introduction to Baskin (1973), with an overview of past progress on trichomycterid phylogenetics

A review is made of the impact of the landmark Ph. D. Thesis of Jonathan N. Baskin from 1973 on the development of the phylogenetics of catfishes and some of its main subgroups and on neotropical ichthyology in general. Baskin's work is the first to propose a hypothesis of relationships for loricarioid catfishes and for the family Trichomycteridae on the basis of explicit Hennigian principles. It is arguably also the first application of phylogenetic methods to any group of neotropical fishes. The hypotheses presented by Baskin covered the monophyly of Siluriformes, the monophyly and relationships of loricarioid families and the relationships of Trichomycteridae (including the monophyly of the family and the relationships among its constituent genera). His discoveries are analyzed in view of the subsequent 40-odd years of progress on the understanding of the phylogeny of the respective groups. The ideas proposed in 1973 have resisted the test of time remarkably well, and a majority of them have been corroborated by additional characters and taxa (including molecular data and several taxa newly discovered in the meantime), as well as by modern quantitative analysis.

Um ensaio é realizado sobre o impacto da tese de doutorado pioneira de 1973 de Jonathan N. Baskin no desenvolvimento do conhecimento filogenético de Siluriformes e alguns dos seus principais subgrupos e na ictiologia neotropical em geral. O trabalho de Baskin é o primeiro a propor uma hipótese de relações para os bagres loricarioides e para a família Trichomycteridae com base em princípios Hennigianos explícitos. Provavelmente é também a primeira implementação de métodos filogenéticos em qualquer grupo de peixes de água doce neotropicais. As hipóteses apresentadas por Baskin cobrem o monofiletismo de Siluriformes, o monofiletismo e as relações filogenéticas das famílias de Loricarioidea, e as relações filogenéticas de Trichomycteridae (incluindo o monofiletismo da família e as relações entre seus gêneros constituintes). Suas descobertas são analisadas à luz dos mais de 40 anos de progresso no entendimento da filogenia dos respectivos grupos. As ideias propostas em 1973 resistiram ao teste do tempo bastante bem e a maioria delas foi corroborada por caracteres ou táxons adicionais (incluindo dados moleculares e muitos táxons descobertos no interim), assim como por análises quantitativas mais modernas.