Educommunication as a strategy to face Syphilis: an analysis of the open educational resources available at AVASUS / Educomunicação como estratégia de enfrentamento à Sífilis: uma análise dos recursos educacionais abertos disponíveis no AVASUS

Introduction: Syphilis is a problem for the Brazilian Public Health. Therefore, the Brazilian Ministry of Health has been promoting actions to fight this disease; among them, the "No Syphilis Project" stands out, and develops open educational resources (OER), among several activities. Objective: To analyze the open educational resources available in the SUS (the Brazilian Unified Health System) Virtual Learning Environment, focused on syphilis. Methods: This qualitative study, based on epistemology in the field of phenomenology, is a content analysis operated with the meanings constructed to parts of a set of texts and the objects of its analysis were the teaching plans of 19 educational resources available at AVASUS, which dealt with the theme "Syphilis". The analysis was organized into two unitss: The main purpose of the educational resource and Thematic focus of the educational resource. Results: The overlapping of clinical aspects of the disease to the detriment of socio-environmental aspects and the prevalence of informational objectives can be observed, with the exception of one resource that presented an objective that sought a more active action by the course participant. In the analysis unit 1 it was possible to identify the prevalence of objectives such as 'presenting' or 'conveying' content/information related to the disease. In the analysis unit 2 it was possible to identify the "classic" biomedical cycle of approaching a disease, focusing on diagnosis. Conclusion: The study contributed to the identification of gaps from the thematic and methodological point of view that can guide the planning for the construction of new educational resources.

Introdução: A sífilis é um problema de saúde pública do Brasil, que via seu Ministério da Saúde vem promovendo ações de enfrentamento da doença, entre as quais se destaca o "Projeto Sífilis Não", que desenvolve, entre diversas atividades, recursos educacionais abertos. Objetivo: Analisar os recursos educacionais abertos, disponíveis no ambiente virtual de aprendizagem do Sistema Único de Saúde (AVASUS), circunscritos na temática da sífilis. Métodos: Este estudo qualitativo, com base espistemológica no campo da fenomenologia, constitui-se em uma análise de conteúdo que operou com os significados contruídos com base em um conjunto de textos e teve como objetos de análise os planos de ensino de 19 recursos educacionais disponíveis no AVASUS e que versavam sobre o tema "sífilis". A análise foi organizada em duas unidades: objetivo principal do recurso educacional; e foco femático do recurso educacional. Resultados: Pode-se observar a sobreposição de aspectos clínicos da doença aos aspectos socioambientais e a prevalência de objetivos informacionais ­ com exceção de um recurso, cujo objetivo buscava uma ação mais ativa por parte do cursista. Na unidade de análise 1, foi possível identificar a prevalência de objetivos como "apresentar" ou "dar a conhecer" conteúdos/informação relacionados à doença. Na unidade de análise 2, foi possível verificar o ciclo biomédico "clássico" de abordagem de uma doença, com foco no diagnóstico. Conclusão: O estudo contribuiu para a identificação de lacunas dos pontos de vista temático e metodológico, que pode orientar o planejamento para a construção de novos recursos educacionais.

Hanseniasis in the municipality of Western Amazon (Acre, Brazil): are we far from the goal of the World Health Organization?

ABSTRACT Background: Hanseniasis is a public health concern in developing countries. Although a decrease in the number of new cases in Brazil has been reported, there is a prevalence above that recommended in some regions. Aims: Considering the goal of the World Health Organization (WHO) to accelerate towards a leprosy-free world from 2020, the aim of this study was to analyze the epidemiological profile and leprosy trends in the city of Cruzeiro do Sul, Acre, Brazil. Methods: This retrospective cohort study analyzed the epidemiology and trends of hanseniasis between 2005 and 2018, monitoring socioeconomic and clinical epidemiological variables obtained from the Information System of Notifiable Diseases of Hanseniasis (SINAN) database. Results: A total of 422 cases of hanseniasis (284 male, 138 female) were included. The questionnaire of six patients was incomplete. The highest number of cases (89) was recorded in 2006 (11.7/10,000 inhabitants). The borderline clinical form was most common, with 45.4% of cases. Throughout the historical series, the rate of annual percentage change in the detection of new cases and cases with grade 2 disability showed a decreasing profile, at −13.9 [95% CI: −19.1, −8.2] and −13.1 [95% CI: −21.8, −5.5], respectively. The same rates were observed in patients below 15 years of age. Limitations: This study reflects the scenario in one reference center and data were obtained retrospectively. Conclusions: The incidence of hanseniasis in this reference center is declining gradually; however, the indicators show active disease transmission and late diagnosis.

Population growth of Tetranychus urticae Koch (Acari: Tetranychidae) and predation rate of the pest mite by Neoseiulusidaeus Denmark & Muma (Acari: Phytoseiidae) in two grape cultivars

The two-spotted spider mite, Tetranychus urticae Koch, has caused significant damage to vineyards in the valley of the São Francisco River in Brazil. Neoseiulus idaeus Denmark & Muma is one of the most abundant species of predatory mites on vines in this region. This study evaluated the population growth rates of T. urticae on leaves of two grape (Vitis vinifera L.) cultivars ('Italia' and 'Superior Seedless') and jack bean [Canavalia ensiformis (L.) DC.] and, also, to estimate the predation rates of the pest mite by N. idaeus on leaves of both grape cultivars and jack bean. A higher oviposition rate of T. urticae was observed on 'Superior Seedless' than on 'Italia' grape leaves; however, there was no significant difference in the instantaneous growth rates of T. urticae for these grape cultivars. For 'Superior Seedless', the spider mite egg viability was significantly lower than on 'Italia' grape, indicating a resistance factor in this grape cultivar. The phytoseiid N. idaeus preyed higher number of T. urticae females on 'Superior Seedless' leaves than on 'Italia' grape and jack bean leaves for the densities of 10 and 20 pest mites per leaf arena (9 cm2). Evaluations of leaf trichomes in both grape cultivars indicated the occurrence of longer trichomes on the basal portion of the main veins of 'Superior Seedless' leaves. The presence of these longer trichomes may be associated with the better performance of N. idaeus on 'Superior Seedless' leaves.

Snakebites in Rio Branco and surrounding region, Acre, Western Brazilian Amazon

Abstract INTRODUCTION Snakebites are considered a neglected tropical disease in many countries in Latin America, including Brazil. As few studies have assessed snakebites in the Amazon region and especially in the state of Acre, epidemiological studies are of great importance. The present study aimed to describe the epidemiological characteristics of snakebites in the Rio Branco region, observing their characteristics in rural and urban areas and their correlation with rainfall and river outflow. METHODS This retrospective, descriptive study analyzed epidemiological information obtained from snakebite notifications registered on the Information System for Notifiable Diseases that occurred from March, 2018 to February, 2019. The cases of snakebite were correlated with rainfall and flow. RESULTS A total of 165 cases of snakebite were registered in the period. Most cases were caused by Bothrops and affected mainly individuals of the male sex who were between 21 and 30 years old. Most of the snakebites occurred in Rio Branco (71.52%; 29 cases per 100,000 inhabitants). Of these, 60.2% occurred in the urban area and 39.8% in the rural area and the majority occurred during the rainy season. CONCLUSIONS Although studies have shown that a majority of cases occur in rural areas, in this study, urbanization of snakebites was observed. The Bothrops genus was responsible for the highest number of snakebites and, during the rainy season, bites occurred more frequently. Educational prevention campaigns, population advice, and first aid in case of snakebites for the population are thus suggested.

Substitution of ractopamine by safflower or coconut oil as an additive in finishing pig diets / Substituição da ractopamina por óleo de cártamo ou óleo de coco como aditivos em dietas para suínos em terminação

ABSTRACT: The objective of this study was to explore the substitution of ractopamine by coconut or safflower oil in finishing pig diets. The study included 24 crossbred barrows weighing 78.00 ± 8.76 kg distributed in a randomized block design with four treatments and six replicates composed of: basal ration (BR), BR + 10 ppm ractopamine, BR + four 1 g capsules of safflower oil, and BR + four 1 g capsules of coconut oil. Performance evaluation showed that safflower oil, ractopamine, and coconut oil supplementation had a significant effect (P < 0.05) on weight gain and feed conversion. Carcass-related variables were also affected by the treatments (P < 0.05), with fat thickness 3 (FT3) reduced by the use of safflower oil, ractopamine, and coconut oil. Rib eye area was positively affected (P < 0.05) by diet, with ractopamine, coconut oil, and safflower oil supplementation treatments showing higher values than control diet treatment. The diets also affected fatty acid profiles (P < 0.05), with decreased myristic acid content in animals supplemented with ractopamine and safflower oil and increased deposition of palmitoleic and oleic acids in animals supplemented with coconut oil and safflower oil, respectively. Results suggested that both safflower oil and coconut oil can be used as substitutes for ractopamine.

RESUMO: Objetivou-se avaliar a substituição da suplementação da ractopamina pelo uso dos óleos de coco ou cártamo nas dietas de suínos em terminação. Foram utilizados 24 suínos machos castrados mestiços com peso médio de 78,00±8,76 kg, distribuídos em um delineamento de blocos casualizados, contendo quatro tratamentos e seis repetições compostos por: Ração Basal (RB); RB + 10 ppm de ractopamina; RB + 4 cápsulas de 1 grama cada de óleo de cártamo e RB + 4 cápsulas de 1 grama cada de óleo de coco. Na avaliação do desempenho foi observado o efeito (P<0,05) da suplementação das dietas com óleo de cártamo, ractopamina e coco no ganho de peso e conversão alimentar. As variáveis relacionadas com as carcaças também foram afetadas pelos tratamentos (P<0,05), sendo a espessura de toucinho 3 (ET3) reduzida pelo uso do óleo de cártamo, ractopamina e coco. Na avaliação da área de olho de lombo foram observados efeitos positivos (P<0,05), com maiores valores para os tratamentos suplementados com ractopamina, óleo de coco e com óleo de cártamo, quando comparados com a dieta controle. As dietas também afetaram o perfil dos ácidos graxos (P<0,05) de forma positiva, com a redução do ácido míristico do toucinho nas dietas com ractopamina e óleo de cártamo e aumento na deposição dos ácidos graxos palmitoleico e oleico do lombo nas dietas suplementadas com óleo de coco e cártamo, respectivamente. Conclui-se que tanto o óleo de coco quanto o de cártamo podem ser utilizados como substitutos da ractopamina.

Clinical and manometric investigation in constipated Chagasic patients with and without megacolon / Investigação clínica e manométrica de pacientes chagásicos constipados com e sem megacolon

ABSTRACT Background: Chagasic colopathy is the second most common digestive manifestation, and constipation is the main symptom. The absence of the Rectoanal Inhibitory Reflex plays an important role in constipation and anal manometry is crucial for appropriate evaluation. Purpose: Evaluate anal manometry findings (mainly Rectoanal Inhibitory Reflex) in Chagasic patients with chronic constipation, with and without megacolon and correlate these findings with clinical and demographic data. Methods: Cross-sectional study of patients with chronic constipation who underwent Chagasic serologic test, barium enema, and anal manometry. The absence of Rectoanal Inhibitory Reflex was evaluated using the mid-P Exact Test. Results: 64 Patients were included: 23 Chagasic patients with megacolon/megarectum (G1), 21 Chagasic patients without megacolon/megarectum (G2) and 20 non-Chagasic patients without megacolon/megarectum (G3). Chagasic patients with megacolon had a higher incidence of fecaloma (39%) compared to the other two groups (9.5% and 10% for G2 and G3, respectively, p = 0.03). Rectal capacity on manometry was statically higher for G1 patients. Rectoanal Inhibitory Reflex was absent in 91.3% of patients in G1, 47.29% in G2 and present in all patients in G3. There was a significant difference in the absence of the Rectoanal Inhibitory Reflex when comparing the groups (G1 vs. G2: p = 0.002, G1 vs. G3: p < 0.001, G2 vs. G3: p < 0.001). Conclusion: The absence of RAIR confirms the diagnosis of Chagasic colopathy and endorses surgical treatment whenever clinical treatment fails. The presence of the RAIR in patients with positive serology for Chagas disease without megacolon/megarectum might not be due chagasic colopathy and other causes should be considered.

RESUMO Fundamento: A colopatia chagásica é a segunda manifestação digestiva mais comum e a constipação é o principal sintoma. A ausência do Reflexo Inibitório Retoanal desempenha um papel importante na constipação e a manometria anal é crucial para avaliação adequada. Objetivo: Avaliar os achados da manometria anal (principalmente o Reflexo Inibitório Retoanal) em pacientes chagásicos com constipação crônica, com e sem megacólon, e correlacionar esses achados com dados clínicos e demográficos.Métodos: Estudo transversal de pacientes com constipação crônica submetidos ao teste sorológico para doença de chagas, enema de bário e manometria anal. A ausência de Reflexo Inibitório Retoanal foi avaliada por meio do Teste Exato de Ponto Médio. Resultados: Foram incluídos 64 pacientes: 23 chagásicos com megacólon/megarreto (G1), 21 chagásicos sem megacólon/megarreto (G2) e 20 não chagásicos sem megacólon/megarreto (G3). Os pacientes chagásicos com megacólon apresentaram maior incidência de fecaloma (39%) em comparação aos outros dois grupos (9,5% e 10% para G2 e G3, respectivamente, p = 0,03). A capacidade retal na manometria foi estatisticamente maior nos pacientes do G1. O Reflexo Inibitório Retoanal estava ausente em 91,3% dos pacientes do G1, em 47,29% no G2 e presente em todos os pacientes do G3. Houve diferença significativa na ausência do Reflexo Inibitório Retoanal quando comparados os grupos (G1 vs. G2: p = 0,002, G1 vs. G3: p < 0,001, G2 vs. G3: p < 0,001). Conclusão: A ausência de RIRA confirma o diagnóstico de colopatia chagásica e endossa o tratamento cirúrgico sempre que o tratamento clínico falhar. A presença de RIRA em pacientes com sorologia positiva para doença de Chagas, sem megacólon/megarreto, pode não ser devida à colopatia chagásica e outras causas devem ser consideradas.

Proportional weight loss in six months as a risk factor for mortality in stage IV non-small cell lung cancer / Perda de peso proporcional em seis meses como fator de risco para mortalidade no câncer de pulmão de células não pequenas estádio IV

ABSTRACT Objective: To evaluate different weight loss (WL) cut-off points as prognostic markers of 3-month survival after diagnosis of stage IV non-small cell lung cancer (NSCLC). Methods: This was a prospective study involving 104 patients with metastatic (stage IV) NSCLC who were admitted to a cancer treatment center in southern Brazil between January of 2014 and November of 2016. We evaluated total WL and WL per month, as well as WL and WL per month in the 6 months preceding the diagnosis. The patients were followed for 3 months after diagnosis. A Cox proportional hazards regression model and Kaplan-Meier curves were used in order to evaluate 3-month survival. Results: The median WL in the 6 months preceding the diagnosis was 6% (interquartile range, 0.0-12.9%). Patients with WL ≥ 5% had a median survival of 78 days, compared with 85 days for those with WL < 5% (p = 0.047). Survival at 3 months was 72% for the patients with WL ≥ 5% (p = 0.047), 61% for those with WL ≥ 10% (p < 0.001), and 45% for those with WL ≥ 15% (p < 0.001). In the multivariate analysis, the hazard ratio for risk of death was 4.51 (95% CI: 1.32-15.39) for the patients with WL ≥ 5%, 6.34 (95% CI: 2.31-17.40) for those with WL ≥ 10%, and 14.17 (95% CI: 5.06-39.65) for those with WL ≥ 15%. Conclusions: WL in the 6 months preceding the diagnosis of NSCLC is a relevant prognostic factor and appears to be directly proportional to the rate of survival at 3 months.

RESUMO Objetivo: Avaliar diferentes pontos de corte da perda de peso (PP) como marcadores prognósticos de sobrevida em 3 meses após o diagnóstico de câncer de pulmão de células não pequenas estádio IV (CPCNP). Métodos: Estudo prospectivo envolvendo 104 pacientes com CPCNP metastático (estádio IV) que foram internados em um centro de tratamento de câncer no sul do Brasil entre janeiro de 2014 e novembro de 2016. Avaliamos a PP total e PP por mês, bem como PP e PP por mês nos 6 meses anteriores ao diagnóstico. Os pacientes foram acompanhados por 3 meses após o diagnóstico. Um modelo de regressão de riscos proporcionais de Cox e curvas de Kaplan-Meier foram utilizados para avaliar a sobrevida em 3 meses. Resultados: A mediana da PP nos 6 meses anteriores ao diagnóstico foi de 6% (intervalo interquartil, 0,0-12,9%). Pacientes com PP ≥ 5% tiveram uma sobrevida mediana de 78 dias, comparados a 85 dias para aqueles com PP < 5% (p = 0,047). A sobrevida em 3 meses foi de 72% para os pacientes com PP ≥ 5% (p = 0,047), 61% para aqueles com PP ≥ 10% (p < 0,001) e 45% para aqueles com PP ≥ 15% (p < 0,001). Na análise multivariada, a taxa de risco para óbito foi de 4,51 (IC95%: 1,32-15,39) para os pacientes com PP ≥ 5%, 6,34 (IC95%: 2,31-17,40) para aqueles com PP ≥ 10%, e 14,17 (IC95%: 5,06-39,65) para aqueles com PP ≥ 15%. Conclusões: A PP nos 6 meses anteriores ao diagnóstico de CPCNP é um fator prognóstico relevante e parece ser diretamente proporcional à taxa de sobrevida em 3 meses.

Development and characterization of an innovative synbiotic fermented beverage based on vegetable soybean

Abstract Soymilk was produced from vegetable soybean and fermented by probiotics (Lactobacillus acidophilus La-5, Bifidobacterium animalis Bb-12) in co-culture with Streptococcus thermophilus. The composition of the fermented beverage and oligosaccharides content were determined. The effect of fructooligosaccharides and inulin on the fermentation time and viability of probiotic microorganisms throughout 28 days of storage at 5 °C were evaluated. The soymilk from vegetable soybeans was fermented in just 3.2 h, when pH reached 4.8. Fermentation reduced the contents of stachyose and raffinose in soymilk. Prebiotics had no effect on acidification rate and on viability of B. animalis and S. thermophilus in the fermented beverage. The viable counts of B. animalis Bb-12 remained above 108 CFU mL-1 in the fermented soymilk during 28 days of storage at 5 °C while L. acidophilus La-5 was decreased by 1 log CFU mL-1. The fermented soymilk from vegetable soybeans showed to be a good food matrix to deliver probiotic bacteria, as well as a soy product with a lower content of non-digestible oligosaccharides.

High-resolution computed tomography findings of pulmonary tuberculosis in lung transplant recipients / Achados de tuberculose pulmonar na tomografia computadorizada de alta resolução em transplantados de pulmão

ABSTRACT Objective: Respiratory infections constitute a major cause of morbidity and mortality in solid organ transplant recipients. The incidence of pulmonary tuberculosis is high among such patients. On imaging, tuberculosis has various presentations. Greater understanding of those presentations could reduce the impact of the disease by facilitating early diagnosis. Therefore, we attempted to describe the HRCT patterns of pulmonary tuberculosis in lung transplant recipients. Methods: From two hospitals in southern Brazil, we collected the following data on lung transplant recipients who developed pulmonary tuberculosis: gender; age; symptoms; the lung disease that led to transplantation; HRCT pattern; distribution of findings; time from transplantation to pulmonary tuberculosis; and mortality rate. The HRCT findings were classified as miliary nodules; cavitation and centrilobular nodules with a tree-in-bud pattern; ground-glass attenuation with consolidation; mediastinal lymph node enlargement; or pleural effusion. Results: We evaluated 402 lung transplant recipients, 19 of whom developed pulmonary tuberculosis after transplantation. Among those 19 patients, the most common HRCT patterns were ground-glass attenuation with consolidation (in 42%); cavitation and centrilobular nodules with a tree-in-bud pattern (in 31.5%); and mediastinal lymph node enlargement (in 15.7%). Among the patients with cavitation and centrilobular nodules with a tree-in-bud pattern, the distribution was within the upper lobes in 66.6%. No pleural effusion was observed. Despite treatment, one-year mortality was 47.3%. Conclusions: The predominant HRCT pattern was ground-glass attenuation with consolidation, followed by cavitation and centrilobular nodules with a tree-in-bud pattern. These findings are similar to those reported for immunocompetent patients with pulmonary tuberculosis and considerably different from those reported for AIDS patients with the same disease.

RESUMO Objetivo: As infecções respiratórias constituem a principal causa de morbidade e mortalidade em transplantados de órgãos sólidos. A incidência de tuberculose pulmonar é alta entre esses pacientes. Em exames de imagem, a tuberculose tem diferentes apresentações. Uma maior compreensão dessas apresentações poderia reduzir o impacto da doença ao facilitar o diagnóstico precoce. Portanto, buscamos descrever os padrões de tuberculose pulmonar na TCAR em transplantados de pulmão. Métodos: De dois hospitais no sul do Brasil, foram coletados os seguintes dados sobre transplantados de pulmão que desenvolveram tuberculose pulmonar: sexo; idade; sintomas; doença pulmonar que levou ao transplante; padrão na TCAR; distribuição dos achados; tempo entre transplante e tuberculose pulmonar; e taxa de mortalidade. Os achados na TCAR foram classificados como nódulos miliares; cavitação e nódulos centrolobulares com padrão de árvore em brotamento; atenuação em vidro fosco com consolidação; linfonodomegalia mediastinal; ou derrame pleural. Resultados: Foram avaliados 402 transplantados de pulmão, dos quais 19 desenvolveram tuberculose pulmonar após o transplante. Entre esses 19 pacientes, os padrões mais comuns na TCAR foram atenuação em vidro fosco com consolidação (em 42%); cavitação e nódulos centrolobulares com padrão de árvore em brotamento (em 31,5%); e linfonodomegalia mediastinal (em 15,7%). Entre os pacientes com cavitação e nódulos centrolobulares com padrão de árvore em brotamento, esses achados se distribuíam nos lobos superiores em 66,6%. Não se observou derrame pleural. Apesar do tratamento, a mortalidade em um ano foi de 47,3%. Conclusões: O padrão predominante na TCAR foi atenuação em vidro fosco com consolidação, seguido por cavitação e nódulos centrolobulares com padrão de árvore em brotamento. Esses achados são semelhantes aos relatados para pacientes imunocompetentes com tuberculose pulmonar e consideravelmente diferentes dos relatados para portadores de AIDS com a mesma doença.

Frecuencia de infecciones por Mycobacterium tuberculosis en el Hospital Luis Vernaza / Frequency of Mycobacterium tuberculosis infections in the Luis Vernaza Hospital

La tuberculosis (TB) es una enfermedad que representa un gran problema de salud pública en países en vías de desarrollo, como lo es el Ecuador, en el que, pese a una incidencia cada vez menor de casos reportados, sigue presente dentro de los grupos vulnerables de la población, como son los pacientes inmunodeprimidos, e incluso existen formas de difícil tratamiento como las multidrogorresistentes (TB-MDR). En este estudio presentamos la frecuencia de casos diagnosticados positivos a través del uso del kit Xpert MTB/RIF (GeneXpert®, Cepheid Innovation) y la frecuencia de casos resistentes a la rifampicina (Rifr). De este estudio, evidenciamos la aplicabilidad y utilidad del ensayo molecular para la detección de TB en muestras pulmonares y extrapulmonares, consiguiendo resultados de positividad del 13 %, y de ellos 7 % Rifr, resultados que superan los obtenidos con técnicas tradicionales de laboratorio.

The tuberculosis (TB),is a major Public Health Issue in the Developing Countries, like Ecuador, in which, in spite of the low incidence of reported infections, TB still exist among the vulnerable population groups, like the immune compromised patients, and also as the multidrug-resistant TB (MDR-TB). In this study, we present the frequency of positive diagnosed cases, using the Xpert MTB/RIF Assay kit (GeneXpert®, Cepheid Innovation) and the frequency of Rifampicin-resistant cases (Rifr). From this study, we evidenced the applicability and utility of this assay in the TB detection in pulmonary and extra-pulmonary samples: 13% were TB positive and 7 % of them were Rifr. These results surpass those obtained through traditional laboratory techniques.

N-acetyl-cysteine inhibits liver oxidative stress markers in BALB/c mice infected with Leishmania amazonensis

BACKGROUND Leishmaniasis is a parasitosis caused by several species of the genus Leishmania. These parasites present high resistance against oxidative stress generated by inflammatory cells. OBJECTIVES To investigate oxidative stress and molecular inflammatory markers in BALB/c mice infected with L. amazonensis and the effect of antioxidant treatment on these parameters. METHODS Four months after infection, oxidative and inflammatory parameters of liver, kidneys, spleen, heart and lungs from BALB/c mice were assessed. FINDINGS In liver, L. amazonensis caused thiol oxidation and nitrotyrosine formation; SOD activity and SOD2 protein content were increased while SOD1 protein content decreased. The content of the cytokines IL-1β, IL-6, TNF-α, and the receptor of advanced glycation endproducts (RAGE) increased in liver. Treatment with the antioxidant N-acetyl-cysteine (20 mg/kg b.w) for five days inhibited oxidative stress parameters. MAIN CONCLUSIONS L. amazonensis induces significant alterations in the redox status of liver but not in other organs. Acute antioxidant treatment alleviates oxidative stress in liver, but it had no effect on pro-inflammatory markers. These results indicate that the pathobiology of leishmaniasis is not restricted to the cutaneous manifestations and open perspectives for the development of new therapeutic approaches to the disease, especially for liver function.

Litíase renal gigante: extração videolaparoscópica em paciente com pielolitotomia aberta prévia / Giant nephrolithiasis: videolaparoscopic extraction in a patient with prior conventional pielolitotomy

Introdução: Litíase é uma afecção comum de causas variáveis com uma clínica compreendendo desde indivíduos assintomáticos até cólicas incapacitantes e insuficiência renal. O tratamento envolve técnicas minimamente invasivas, porém em certas situações, modalidades convencionais são bastante utilizadas, em geral adaptadas para a videolaparoscópica. Caso clínico: homem 55 anos, queixa de lombalgia recente com história de pielolitotomia aberta em 2011 por cálculo pélvico à esquerda. Realizou uma tomografia que evidenciou cálculo coraliforme esquerdo de 57 mm, totalmente removido por pielolitotomia videolaparoscópica transperitoneal. Discussão: Cálculos renais são tratados por nefrolitotripsia percutânea associada a outras modalidades pouco invasivas, no entanto é caro e não disponível em todos os serviços. A videolaparoscopia é factível em casos selecionados, com resolutividade igual ou superior a nefrolitotripsia percutânea e índices de complicações tão baixos quanto.Conclusão: a pielolitotomia videolaparoscopica é eficaz e segura, mesmo naqueles com cirurgia renal prévia, sendo alternativa em pacientes com anatomia favorável

Introduction: Lithiasis is a common disorder of variable causes with a wide clinic range. The treatment involves minimally invasive techniques, but in certain situations, conventional modalities are widely used, usually adapted for videolaparoscopic. Case report: 55 year old male with recent low back pain and history of a pielolitotomy in 2011 due to left pelvic calculus. The patient underwent a CT scan, which showed a 57 mm left coraliform calculus, completely removed by transperitoneal videolaparoscopic pyelolithotomy. Discussion: Renal calculi are better treated by percutaneous nephrolithotripsy associated with other noninvasive modalities, however it is expensive and not available in all services. Videolaparoscopy is feasible in selected cases, with an equal or greater resolution than percutaneous nephrolithotripsy and rates of complications as low as the percutaneous technique. Conclusion: videolaparoscopic pielolitotomy is effective and safe, being an alternative in patients with favorable anatomy

Entomopathogenic fungi associated with citrus blackfly (Aleurocanthus woglumi Ashby) in Southern Bahia / Fungos entomopatogênicos associados à mosca-negra-dos-citros (Aleurocanthus woglumi Ashby) na região Sul da Bahia

The Brazilian citrus industry is the world leading producer of concentrated orange juice. The presence of citrus blackfly Aleurocanthus woglumi Ashby (Hemiptera: Aleyrodidae) in Brazilian citrus orchards has led to agribusiness problems due to damages and inadequate control measures. Entomopathogenic fungi act as natural control in high precipitation regions, being important components of integrated management. The objective of this work was to identify entomopathogenic fungi associated with citrus blackfly in the southern region of the state of Bahia. Orange (Citrus sinensis L. Osbeck) and Tahiti lime (Citrus latifolia Tann.) leaves infested with citrus blackfly eggs, nymphs and pupae were collected in orchards in the municipalities of Ilhéus and Laje, Bahia, Brazil. Fragments of fungi colonies were disinfected with 70% alcohol and 2% sodium hypochlorite, and then washed with distilled water. After drying, the material was placed in Petri dishes with PDA and chloramphenicol, which were placed in bio-oxygen demand (BOD) incubators (27 ± 2 ºC, 12-hour photophase) until spore production. After isolation, the fungi were replaced in PDA Petri dishes and kept under continuous fluorescent light for 30 days to stimulate growth and spore production. The fungi isolates were preserved in test tubes containing PDA and mineral oil, and then stored at 18 ºC in a refrigerated incubator. Entomopathogenic fungi Aschersonia cf. aleyrodis Webber and Aegerita webberi Fawcett were associated with citrus blackfly in Southern Bahia.(AU)

A citricultura brasileira lidera mundialmente a produção de suco concentrado de laranja. A presença da mosca-negra-dos-citros Aleurocanthus woglumi Ashby (Hemiptera: Aleyrodidae) em pomares citrícolas brasileiros tem gerado problemas ao agronegócio, devido aos danos e medidas inadequadas de controle. O controle natural por ação de fungos entomopatogênicos é comum em regiões com alta precipitação, sendo esses agentes importantes componentes do manejo integrado. O objetivo deste trabalho foi identificar fungos entomopatogênicos associados à mosca-negra-dos-citros na região Sul do estado da Bahia. Foram coletadas folhas de laranjeira (Citrus sinensis L. Osbeck) e de lima-Tahiti (Citrus latifolia Tann.) infestadas com ovos, ninfas e pupários da mosca-negra-dos-citros em pomares nos municípios de Ilhéus e Laje, Bahia. Fragmentos de colônias dos fungos foram desinfetados com álcool 70% e hipoclorito de sódio a 2% e, posteriormente, com água destilada. Após secagem, o material foi colocado em placas de Petri com BDA e cloranfenicol, em seguida alocadas em câmaras climatizadas do tipo BOD (27 ± 2 ºC, 12 horas de fotofase) até a produção de esporos. Após o isolamento, os fungos foram recolocados em placas de Petri com BDA, as quais ficaram sob luz fluorescente contínua durante 30 dias para estimular o crescimento e a produção de esporos. Isolados dos fungos obtidos foram preservados em tubos de ensaio contendo BDA e óleo mineral, e armazenados a 18 ºC em câmara climatizada. Os fungos entomopatogênicos associados à mosca-negra-dos-citros na região Sul da Bahia foram Aschersonia cf. aleyrodis Webber e Aegerita webberi Fawcett.(AU)

Cutaneous mucormycosis in advanced HIV disease

ABSTRACT Angionvasive mucormycosis is an emerging fungal disease known to affect mainly diabetics or subjects with profound neutropenia. Infection usually occurs through the inhalation route, but cutaneous inoculation may occur after trauma or burns. However, mucormycosis remains unusual in HIV infection. We report a fatal case of cutaneous mucormycosis due to Rhizopus arrhizus involving the scalp following herpes zoster infection. The patient was a 42-year-old man with advanced AIDS failing on salvage antiretroviral therapy. The fungus was diagnosed on the basis of histopathology and culture. Our case emphasizes the need to consider mucormycosis in the differential diagnosis of necrotic cutaneous lesions in patients with late-stage HIV disease.

Terpinen-4-ol, tyrosol, and ß-lapachone as potential antifungals against dimorphic fungi

Abstract This study aimed to evaluate the in vitro antifungal activity of terpinen-4-ol, tyrosol, and β-lapachone against strains of Coccidioides posadasii in filamentous phase (n = 22) and Histoplasma capsulatum in both filamentous (n = 40) and yeast phases (n = 13), using the broth dilution methods as described by the Clinical and Laboratory Standards Institute, to determine the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of these compounds. The mechanisms of action of these compounds were also investigated by analyzing their effect on cell membrane permeability and ergosterol synthesis. The MIC and MFCf these compounds against C. posadasii, mycelial H. capsulatum, and yeast-like H. capsulatum, were in the following ranges: 350-5720 µg/mL, 20-2860 µg/mL, and 40-1420 µg/mL, respectively for terpinen-4-ol; 250-4000 µg/mL, 30-2000 µg/mL, and 10-1000 µg/mL, respectively, for tyrosol; and 0.48-7.8 µg/mL, 0.25-16 µg/mL, and 0.125-4 µg/mL, respectively for β-lapachone. These compounds showed a decrease in MIC when the samples were subjected to osmotic stress, suggesting that the compounds acted on the fungal membrane. All the compounds were able to reduce the ergosterol content of the fungal strains. Finally, tyrosol was able to cause a leakage of intracellular molecules.

Azole resistance in Candida spp. isolated from Catú Lake, Ceará, Brazil: an efflux-pump-mediated mechanism

Abstract Since, there is no study reporting the mechanism of azole resistance among yeasts isolated from aquatic environments; the present study aims to investigate the occurrence of antifungal resistance among yeasts isolated from an aquatic environment, and assess the efflux-pump activity of the azole-resistant strains to better understand the mechanism of resistance for this group of drugs. For this purpose, monthly water and sediment samples were collected from Catú Lake, Ceará, Brazil, from March 2011 to February 2012. The obtained yeasts were identified based on morphological and biochemical characteristics. Of the 46 isolates, 37 were Candida spp., 4 were Trichosporon asahii, 3 were Cryptococcus laurentii, 1 Rhodotorula mucilaginosa, and 1 was Kodamaea ohmeri. These isolates were subjected to broth microdilution assay with amphotericin B, itraconazole, and fluconazole, according to the methodology standardized by the Clinical and Laboratory Standards Institute (CLSI). The minimum inhibitory concentrations (MICs) of amphotericin B, itraconazole, and fluconazole were 0.03125–2 µg/mL, 0.0625 to ≥16 µg/mL, and 0.5 to ≥64 µg/mL, respectively, and 13 resistant azole-resistant Candida isolates were detected. A reduction in the azole MICs leading to the phenotypical reversal of the azole resistance was observed upon addition of efflux-pump inhibitors. These findings suggest that the azole resistance among environmental Candida spp. is most likely associated with the overexpression of efflux-pumps.

Histomorphometric analysis of the Achilles tendon of Wistar rats treated with laser therapy and eccentric exercise / Análise histomorfométrica do tendão calcanear comum de ratos Wistar tratado com laserterapia e exercício excêntrico

Low-level laser therapy is recommended for the treatment of tendinopathies despite the contradictory results related to the ideal dose of energy, wavelength and time of application. This study aimed to assess the effects of laser therapy and eccentric exercise on tendinopathy of the Achilles tendon of Wistar rats. Forty-eight adult male rats were randomly distributed into four groups (L= laser; E= eccentric exercise; LE = laser and eccentric exercise; and R= rest). Laser therapy (904nm/3J/cm2) and/or eccentric exercise (downhill walking; 15o incline treadmill; 12m/min; 50min/day) was started 24h after induction of unilateral tendinopathy and remained for 20 days. At 3, 7, 14 and 21 days after lesion induction, three rats from each group were euthanized and the tendons were collected for histological and morphometric analyses. There was no difference among groups or among times for the characteristics hemorrhage (p=0.4154), fibrinous adhesion formation (p=0.0712), and organization of collagen fibers (p=0.2583) and of the connective tissue (p=0.1046). For these groups, regardless of the time, eccentric exercise led to epitenon thickening (p=0.0204), which was lower in the group treated with laser therapy. Histological analysis revealed differences (p=0.0032) in the number of inflammatory cells over time. They were more numerous in the group that only exercised. This result was confirmed by morphometric analysis, which showed a significant interaction (groups x time) for this characteristic. Eccentric exercise increased (p=0.0014) the inflammatory infiltrate over time (3 and 21 days). However, association with laser therapy reduced inflammatory reaction. On the other hand, the combination of the treatments increased angiogenesis in morphometric (p=0.0000) and histological (p=0.0006) analyses compared with the other groups, while the isolated application of low-level laser reduced this characteristic over time. Animals maintained at rest presented the lowest amount (p=0.0000) of fibroblasts, according to the morphometric analysis. However, histological evaluation showed a significant group x time interaction (p=0.0024). Greater amounts of fibroblasts were observed in groups E, L and LE on the 7th, 14th and 21st days, respectively. The animals that received laser therapy and were exercised showed a greater (p=0.0000) amount of collagen fibers over time. Laser therapy at a dose of 3J and at a wavelength of 904nm, starting 24h after surgical induction of tendinopathy in Wistar rats, is suitable for angiogenesis and prevention of tendon thickening, which can be associated with the intensity of inflammatory process. When associated with eccentric exercise, the therapy has the advantage of increasing the amount of collagen fibers, reducing fibrinous adhesions and inflammatory infiltrate, despite prolonging angiogenesis. Therefore, eccentric exercise performed concomitantly with laser therapy improves the histological properties of the injured tendon.(AU)

O laser de baixa potência é recomendado para o tratamento das tendinopatias apesar dos resultados contraditórios no que se refere a dose de energia ideal, comprimento de onda e tempo de aplicação. O objetivo desse estudo foi avaliar os efeitos da laserterapia e do exercício excêntrico na tendinopatia do tendão calcanear comum de ratos Wistar. Foram utilizados 48 ratos machos adultos. Os animais foram distribuídos aleatoriamente em quatro grupos (L=laser; E=exercício excêntrico; LE=laser e exercício excêntrico, e R=repouso). Após 24h da indução de tendinopatia unilateral, foi iniciada laserterapia (904nm/3J/cm2) e/ou exercício excêntrico (caminhada em declive; esteira com 15o de inclinação; 12m/min; 50min/dia) que permaneceu por 20 dias. Aos 3, 7, 14 e 21 dias após indução da lesão, três ratos de cada grupo foram submetidos à eutanásia, e os tendões foram obtidos para análises histológica e morfométrica. Não houve diferença entre grupos nem entre tempos nas características hemorragia (p=0,4154), formação de aderência fibrinosa (p=0,0712) e organização das fibras colágenas (p=0,2583) e do tecido conjuntivo (p=0,1046). Considerando os grupos, independentemente do tempo, foi observado que o exercício excêntrico ocasionou espessamento do epitendão (p=0,0204), que foi menor no grupo submetido à laserterapia. A análise histológica revelou diferença (p=0,0032) na quantidade de células inflamatórias ao longo do tempo, sendo observado em maior quantidade no grupo apenas exercitado. Esse resultado foi confirmado pela análise morfométrica, que demonstrou haver interação significativa (grupos x tempo) nessa característica, na qual o exercício excêntrico aumentou (p=0,0014) o infiltrado inflamatório ao longo do tempo (3 e 21 dias), porém, quando associado à laserterapia, ocorreu redução da reação inflamatória. Por outro lado, a associação dos tratamentos ocasionou maior angiogênese observada nas análises morfométrica (p=0,0000) e histológica (p=0,0006), quando comparada com os demais grupos, enquanto a aplicação isolada do laser de baixa potência reduziu essa característica ao longo do tempo. Os animais mantidos em repouso foram os que apresentaram menor (p=0,0000) quantidade de fibroblastos, na análise morfométrica, porém na avaliação histológica foi observada interação significativa entre grupo e tempo (p=0,0024). Maior quantidade de fibroblastos foi observada nos grupos E, L e LE, no 7o, 14o e 21o dias, respectivamente. Os animais que receberam laserterapia e foram exercitados apresentaram maior (p=0,0000) quantidade de fibras colágenas ao longo do tempo. A laserterapia na dose de 3J e comprimento de onda de 904nm, iniciada 24h após indução cirúrgica de tendinopatia em ratos Wistar é adequada para angiogênese e para evitar o espessamento do tendão, que pode estar relacionado com a intensidade do processo inflamatório. Quando associada ao exercício excêntrico, a terapia apresenta a vantagem de aumentar a quantidade de fibras colágenas, reduzir a aderência fibrinosa e infiltrado inflamatório, apesar de prolongar a angiogênese. Portanto, o exercício excêntrico realizado concomitantemente com a laserterapia melhora as propriedades histológicas do tendão lesionado.(AU)

647 casos de neoplasia maligna de mama do Instituto da Mama de Ubá / 647 cases of breast malignancy of Breast Institute of Ubá

Objetivo: Verificar o perfil da apresentação e o tratamento cirúrgico realizado em um serviço do Estado de Minas Gerais, Brasil. Métodos: Estudo descritivo de série de casos, prospectivo, realizado com base em casos tratados pela mesma equipe no período de março de 2001 a dezembro de 2014, arquivando informações pré-definidas e com análise dos dados pelos programas R e SPSS PC. Resultados: Foram operadas no serviço 647 casos com idade média de 57±14,2 anos (variando de 24 a 92 anos), sendo as pacientes oriundas de 33 cidades diferentes, predominando Ubá (MG) (34%). O Carcinoma Ductal Infiltrante foi o tipo histopatológico da maioria dos casos (64%). Predominou os estadiamentos iniciais, com 34% das pacientes no estádio clínico I e 31% no IIa. A abordagem cirúrgica foi conservadora na maioria dos casos (67%), oferecendo linfonodo sentinela em 160 casos e 143 cirurgias com técnica oncoplástica. No seguimento após tratamento, houve 17% de óbitos. Conclusão: Observou-se um predomínio de pacientes com tumores iniciais, o que possibilitou alta taxa de tratamento com conservação mamária e com expectativa futura de redução da mortalidade pela doença.

Objective: To verify the presentation profile and the surgical treatment in hospital in the state of Minas Gerais in Brazil. Methods: Descriptive, prospective study of a series of cases which was performed based on cases treated by the same team in the Mastology outpatient in Instituto de Mama de Ubá, in the period of March 2001 and December 2014, filing pre-defined information and with analysis of the data of the programme R and SPSS PC. Results: A total of 647 cases, with a mean age of 57±14.2 years old (the ages varied from 24 to 92), underwent surgery. The patients came from 37 different cities, mostly from Ubá (MG) (34%). The infiltrating ductal carcinoma was the main histological type (64%). The initial stages prevailed, with 34% of the patients on the clinical stage I and 31% on stage II a. The surgical approach was breast-conserving therapy in 67% of the cases. The sentinel node biopsy was performed in 160 cases. Operations including oncoplastic technique were performed in 143 patients. There were 17% of death in the post-treatment follow-up. Conclusion: It was noted that there was a prevalence of patients with early stages tumor, this enabled high rates of treatment with breast preservation and with prospect of reducing the disease mortality rate in the future.

Componentes Determinantes na Escolha da Especialização em Novos Profissionais Médicos / Decisive Factors in the Career Choices of New Medical Professionals

Na edição de volume 38, número 2, versão online desta revista, Corsi e colaboradores apresentaram um texto muito elegante sobre os fatores que influenciam os alunos na escolha da especialidade médica. Este tema vem sendo abordado com grande frequência nas discussões do nosso Curso de Prática Educativa em Medicina, da Universidade Federal do Rio Grande do Sul, coordenado pelos professores Manfroi e Machado. A respeito deste assunto, temos algumas considerações sobre a nova geração de profissionais médicos e sua relação com o autodesenvolvimento profissional.

In volume 38, number 2, of the online version of this magazine, Corsi et al. presented a very elegant piece about the factors that influence students in their choice of medical specialty. This issue has been frequently addressed in discussions on our Course in Education Practice in Medicine at the Federal University of Rio Grande do Sul, coordinated by professors Manfroi and Machado. Regarding this matter we have some thoughts on the new generation of medical professionals and their relationship with professional self-development.