Revelar e ter com quem contar: infertilidade e apoio social / Revelar y tener con quien contar: infertilidade y apoyo social / To disclose and have someone to count on: infertility and social support

Infertile couples seeking treatment experience a social stigma that can lead to the need for privacy and, in turn, compromise their access to social support. This multiple case study, that involved the collection of sociodemographic and health data and interviews with four heterosexual couples accessed by convenience, aimed to examine the perception of the couples about the social support received after the disclosure of the condition of infertility and/or of the assisted reproductive technology treatment. The cases were analysed individually and comparatively. From the couples' statements, it is highlighted that all of them revealed something about infertility and/or treatment at some point in the process, although some considered not revealing it. Both support and lack of support were perceived from the revelations. The non-disclosure was motivated by self-preservation and by avoidance of social pressure. The findings indicate the importance of psychological intervention to expand the couples' social support.

Parejas infértiles que buscan tratamiento experimentan un estigma social que puede acarrear la necesidad de privacidad y, a su vez, comprometer el acceso al apoyo social. Ese estudio de múltiples casos, que involucró la recogida de datos sociodemográficos, de salud y entrevistas con cuatro parejas heterosexuales accedidas por conveniencia, buscó examinar la percepción de las parejas sobre el apoyo social después de la revelación de la condición de infertilidad y/o del tratamiento con técnicas de reproducción asistida. Los casos fueron analizados individual y comparativamente. De las declaraciones de las parejas, se destaca que todas revelaron algo sobre la infertilidad y/o el tratamiento en algún momento del proceso, aunque algunos consideraron no revelarlo. Se percibió tanto el apoyo como la falta de apoyo a partir de las revelaciones. La no revelación fue motivada por la autopreservación y por la evitación de presión social. Los hallazgos indican la importancia de la intervención psicológica para ampliar el apoyo social de las parejas.

Casais inférteis que buscam tratamento experimentam um estigma social que pode acarretar a necessidade de privacidade e, por sua vez, comprometer o acesso ao apoio social. Este estudo de casos múltiplos, que envolveu a coleta de dados sociodemográficos, de saúde e entrevistas com quatro casais heterossexuais acessados por conveniência, objetivou examinar a sua percepção sobre o apoio social recebido após a revelação da condição de infertilidade e/ou de tratamento com técnicas de reprodução assistida. Os casos foram analisados individualmente e comparativamente. A partir das falas, destaca-se que todos revelaram algo sobre a infertilidade e/ou o tratamento em algum momento do processo, ainda que alguns tenham considerado não revelar. Percebeu-se tanto apoio como falta de apoio diante das revelações. A não revelação foi motivada pela autopreservação e pela evitação de pressão social. Os achados indicam a importância da intervenção psicológica para ampliar o apoio social dos casais.

Dengue más allá del trópico: estudio de series temporales 2015-2016 versus 2019-2020 en un hospital pediátrico de la Ciudad de Buenos Aires / Dengue beyond the tropics: a time-series study comprising 2015-2016 versus 2019-2020 at a children's hospital in the City of Buenos Aires

Introducción. El dengue es un problema de salud pública a nivel mundial. Confinado en sus orígenes a las zonas tropicales y subtropicales, en la actualidad se presenta en otras regiones como Argentina. Desde el año 2008 se presenta con brotes epidémicos en la Ciudad Autónoma de Buenos Aires, con escasos reportes en niños. Objetivo. Analizar y comparar las características clínicas, epidemiológicas, de laboratorio y evolutivas de los dos últimos brotes de dengue fuera del área endémica. Población y métodos. Estudio de series temporales. Se incluyeron pacientes menores de 18 años con dengue probable o confirmado, evaluados en un hospital pediátrico de la Ciudad de Buenos Aires durante los períodos 2015-2016 y 2019-2020. Resultados. Se incluyeron 239 pacientes, 29 (12 %) con antecedente de viaje. La mediana de edad fue de 132 meses (rango intercuartílico: 102-156). Todos tuvieron fiebre. Otros síntomas fueron: cefalea en 170 (71 %), mialgias en 129 (54 %) y exantema en 122 (51 %). Cuarenta pacientes (17 %) tenían comorbilidades. Presentaron signos de alarma 79 pacientes (33 %) y 14 (6 %) tenían dengue grave. Requirieron internación 115 pacientes (45 %) y ninguno falleció. El serotipo DENV-1 fue el más frecuente. El antecedente de viaje y la necesidad de internación predominaron en el primer período; el dengue grave y la infección previa, en el segundo. Conclusiones. Ningún paciente falleció de dengue en los períodos estudiados. Se observaron diferencias estadísticamente significativas en la frecuencia de internación; el antecedente de viaje fue más frecuente en el período 2015-2016 y el dengue grave, en el 2019-2020.

Introduction. Dengue is a public health problem worldwide. It was originally confined to tropical and subtropical areas, but it is now present in other regions, such as Argentina. Epidemic outbreaks have been observed in the City of Buenos Aires since 2008, with few reports in children. Objective. To analyze and compare the clinical, epidemiological, laboratory, and evolutionary characteristics of the latest 2 dengue outbreaks outside the endemic area. Population and methods. Time-series study. Patients under 18 years of age with probable or confirmed dengue and evaluated in a children's hospital of the City of Buenos Aires during the periods 2015-2016 and 2019-2020 were included. Results. A total of 239 patients were included; 29 (12%) had a history of travel. Their median age was 132 months (interquartile range: 102156). All had a fever. Other symptoms included headache in 170 (71%), myalgia in 129 (54%), and rash in 122 (51%). Forty patients (17%) had comorbidities. Warning signs were observed in 79 patients (33%); 14 (6%) developed severe dengue; 115 (45%) were hospitalized; none died. DENV-1 was the most common serotype. A history of travel and hospitalization prevailed in the first period; severe dengue and prior infection, in the second period. Conclusions. No patient died due to dengue in either study period. Statistically significant differences were observed in the frequency of hospitalization; a history of travel was more common in the 2015-2016 period and severe dengue, in the 2019-2020 period.

Doença de Crohn Metastática da Face ­ Relato de Caso / Metastatic Crohn's Disease of the Face - a Case Report

A Doença de Crohn Metastática é uma condição rara, não contígua ao trato gastrintestinal, que acomete, usualmente, pernas e braços, sendo face e genitais menos acometidos. Tem predileção feminina ­ 63% dos casos. As lesões se apresentam nas formas de nódulos, ulcerações ou placas eritematosas. O caso relatado é de uma mulher de 42 anos que possui a Doença de Crohn há 10 anos e, há 18 meses, convive com o surgimento de placa eritemato-descamativa infiltrada, associada a edema dos lábios em hemiface direita. Foram realizados testes para micobactéria e fungo, tendo resultados negativos. Ao exame anatomopatológico, apresentou-se dermatite granulomatosa associada a infiltrado linfocitário e plasmocitário, confirmando, assim, o diagnóstico de Doença de Crohn Metastática da face. A paciente já fazia uso de Certolizumabe em monoterapia, aumentando-se a dose. Associou-se Tacrolimo tópico, com melhora das lesões. É de suma importância a investigação minuciosa para o diagnóstico correto da doença, visto que pode ser confundida com manifestação orofacial da Doença de Crohn ou outra doença granulomatosa da face. O diagnóstico precoce auxilia no tratamento correto e na minimização do prejuízo estético e funcional causado pela doença, melhorando a qualidade de vida do paciente.

Metastatic Crohn's Disease is a rare condition, not contiguous to the gastrointestinal tract, which usually affects the legs and arms, with the face and genitals being less affected. It occurs predominantly in women - 63% of the cases. The lesions appear as nodules, ulcerations, or erythematous plaques. The case report is of a 42-year-old woman who has had Crohn's disease for 10 years and, for 18 months, has been living with the appearance of an infiltrated erythematous desquamative plaque associated with edema of the lips on the right hemiface. The patient underwent tests for mycobacteria and fungus, with negative results. The anatomopathological exam showed granulomatous dermatitis associated with lymphocytic and plasmacytic infiltrate, thus confirming the diagnosis of metastatic Crohn's disease of the face. The patient was already using Certolizumab in monotherapy, and the dose was increased. Topical Tacrolimus was associated with the treatment causing an improvement in the lesions. A thorough investigation is of utmost importance for the correct diagnosis of the disease since it can be mistaken for an orofacial manifestation of Crohn's Disease or another granulomatous disease of the face. Early diagnosis helps in the correct treatment and in minimizing the aesthetic and functional damage caused by the disease, improving the patient's quality of life.

Number of dentists in the neighborhood and incidence of dental caries in the children permanent dentition

Abstract This study aimed to evaluate the influence of the number of dentists in the neighborhood on the incidence of dental caries in the children permanent dentition. This cohort began in 2010 (T1) with a random sample of 639 children (1 to 5 years-old) followed for 7 years, in southern Brazil. The follow-up reassessment (T2) took place in 2017. Untreated dental caries was evaluated at T2 through the Decayed, Missing, and Filled surfaces index (DMF-S). The number of dentists in the neighborhood was obtained from the city's official database and used as a contextual variable. Socioeconomic, demographic, and oral health variables at the individual level were evaluated at T1. A multilevel Poisson regression was performed to evaluate the influence of the predictor variables in the incidence of untreated dental caries. From 639 children at T1, 449 were reassessed at T2 (a 70.3% retention rate). The mean of decayed surfaces at T2 was 0.92 (SE 0.01). The greater the number of dentists in the neighborhoods where the children lived, the lower the incidence of dental caries. Children with low socioeconomic status, who have not routinely visited the dentist in the last 6 months, who presented a experience of dental caries, and whose parents perceived their oral health as fair/poor showed a higher incidence of surfaces with untreated dental caries. As conclusion, children who live in neighborhoods with fewer dentists have a higher incidence of untreated dental caries in permanent dentition.

Resumo Este estudo teve como objetivo avaliar a influência do número de cirurgiões-dentistas do bairro na incidência de cárie dentária na dentição permanente. Esta coorte teve início em 2010 (T1) com uma amostra aleatória de 639 crianças (1 a 5 anos) acompanhadas por 7 anos, no sul do Brasil. A reavaliação (T2) ocorreu em 2017. A cárie dentária não tratada foi avaliada no T2 por meio do índice de superfícies cariadas, perdidas e obturadas (CPO-S). O número de dentistas do bairro foi obtido no banco de dados oficial da cidade e usada como uma variável contextual. Variáveis socioeconômicas, demográficas e de saúde bucal no nível individual foram avaliadas no T1. Foi realizada uma análise de regressão de Poisson multinível para avaliar a influência das variáveis preditoras na incidência de cárie dentária não tratada. Das 639 crianças no T1, 449 foram reavaliadas no T2 (taxa de retenção de 70,3%). A média das superfícies cariadas no T2 foi de 0,92 (EP 0,01). Quanto maior o número de dentistas nos bairros em que as crianças residiam, menor era a incidência de cárie dentária. Crianças com baixo nível socioeconômico, que não consultaram rotineiramente o dentista nos últimos 6 meses, que apresentaram experiência de cárie dentária e cujos pais perceberam sua saúde bucal como regular/ruim apresentaram maior incidência de superfícies com cárie dentária não tratada. Como conclusão, crianças que moram em bairros com menos dentistas têm maior incidência de cárie não tratada na dentição permanente.

Doença de Crohn Metastática da Face - um Relato de Caso / Metastatic Crohn's Disease of the Face - a case report

A Doença de Crohn Metastática é uma condição rara, não contígua ao trato gastrintestinal, que acomete, usualmente, pernas e braços, sendo face e genitais menos acometidas. Tem predileção feminina ­ 63% dos casos. As lesões se apresentam nas formas de nódulos, ulcerações ou placas eritematosas. O caso relatado é de uma mulher de 42 anos que possui a Doença de Crohn há 10 anos e, há 18 meses, convive com o surgimento de placa eritemato-descamativa infiltrada associada a edema dos lábios em hemiface direita. Foram realizados testes para micobactéria e fungo, tendo resultados negativos. Ao exame anatomopatológico, apresentou-se dermatite granulomatosa associada a infiltrado linfocitário e plasmocitário, confirmando, assim, o diagnóstico de Doença de Crohn Metastática da face. A paciente já fazia uso de Certolizumabe em monoterapia, aumentando-se a dose. Associou-se Tacrolimo tópico, com melhora das lesões. É de suma importância a investigação minuciosa para o diagnóstico correto da doença, visto que pode ser confundida com manifestação orofacial da Doença de Crohn ou outra doença granulomatosa da face. O diagnóstico precoce auxilia no tratamento correto e na minimização do prejuízo estético e funcional causado pela doença, melhorando a qualidade de vida do paciente.

Metastatic Crohn's Disease is a rare condition, non-contiguous with the gastrointestinal tract, which usually affects the legs and arms, with the face and genitals being less affected. It has a female predilection ­ 63% of cases. Lesions present in the form of nodules, ulcerations, or erythematous plaques. The case reported is of a 42-year-old woman who has had Crohn's Disease for 10 years and, for 18 months, has been living with the appearance of an infiltrated erythematousscaly plaque associated with edema of the lips in the right hemiface. Tests for mycobacteria and fungus were carried out, with negative results. The pathological examination revealed granulomatous dermatitis associated with lymphocytic and plasma cell infiltrate, thus confirming the diagnosis of Metastatic Crohn's Disease of the face. The patient was already using Certolizumab in monotherapy, increasing the dose. Topical tacrolimus was combined, with improvement in the lesions. A thorough investigation is extremely important for the correct diagnosis of the disease, as it can be confused with an orofacial manifestation of Crohn's Disease or another granulomatous disease of the face. Early diagnosis helps in the correct treatment and in minimizing the aesthetic and functional damage caused by the disease, improving the patient's quality of life.

Programa alternativo de evaluación externa de calidad para serología de SARS-CoV-2: calidad en tiempos de pandemia / Alternative external quality assessment programme for SARS-CoV-2 serology: quality in pandemic times

Resumen Para el control de la pandemia por COVID-19 es indispensable contar con ensayos confiables para la detección de anticuerpos anti-síndrome respiratorio agudo severo por coronavirus 2 (SARS-CoV-2). Por este motivo el Laboratorio de Serología y la Residencia de Bioquímica Clínica del Hospital Garrahan desarrollaron el primer Programa Piloto Alternativo de evaluación externa de la calidad para serología de SARS-CoV-2 en la Argentina, destinado a evaluar comparativamente el desempeño de los métodos disponibles de los participantes con el fin de asegurar resultados confiables y clínicamente útiles. El esquema constó de 4 envíos con 5 muestras cada uno, con reactividad variable contra SARS-CoV-2 en las que se evaluaron anticuerpos totales, IgG e IgM. Participaron 21 laboratorios, tanto públicos como privados, de la Provincia y de la Ciudad de Buenos Aires de forma gratuita. Informaron metodología utilizada y resultados. Al finalizar cada entrega se enviaron los reportes individuales y se realizó un informe final global con los resultados totales del ciclo. El mismo se llevó a cabo a lo largo del segundo semestre de 2020. Se informó un total de 643 resultados, 239 de anti- SARS-CoV-2 IgM, 365 de IgG y 39 de anticuerpos totales. Se observó mayor concordancia en las metodologías anti-SARS-CoV-2 IgG que en las IgM. ELISA/ COVIDAR fue la metodología más utilizada para IgG y ELFA/bioMérieux para IgM. El espectro de metodologías fue amplio. El programa fue útil para asegurar la calidad de los resultados y brindó a los participantes el marco necesario para emitir resultados confiables y armonizados.

Abstract For the control of COVID-19 pandemic it is essential to have reliable tests for the detection of antibodies against severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2). For this reason, the Serology Laboratory and the Residence of Clinical Biochemistry of Hospital Garrahan developed the first Alternative Pilot Programme for external quality assessment for SARS-CoV-2 serology in Argentina, aimed at comparatively evaluating the actuaperformance of the available methods of the participants using different anti-SARS-CoV tests in order to ensure reliable and clinically useful results. The scheme consisted of 4 deliveries with 5 samples each throughout the second semester of 2020, with variable reactivity against SARS-CoV-2 in which total antibodies, IgG and IgM were evaluated. Twenty one public and private laboratories participated in the Province and the City of Buenos Aires for free. The methodology applied and the results were informed. At the end of each delivery, individual reports were sent and a final global report was made with the total results of the cycle. A total of 643 results were reported, 239 for anti-SARS-CoV-2 IgM, 365 for IgG and 39 for total antibodies. There was greater agreement in the anti-SARS-CoV-2 IgG methodologies than in IgM. ELISA/COVIDAR was the most frequently used methodology for IgG and ELFA/bioMérieux for IgM. The spectrum of methodologies was wide. The programme was useful to ensure the quality of the results, providing the participants with the necessary framework to issue reliable and harmonised results.

Resumo Para o controle da pandemia de COVID-19, é imprescindível a existência de testes confiáveis para a detecção de anticorpos anti síndrome respiratória aguda grave por coronavírus 2 (SARS-CoV-2). Por esse motivo o Laboratório de Sorologia e a Residência de Bioquímica Clínica do Hospital Garrahan desenvolveram o primeiro Programa Piloto Alternativo de avaliação externa da qualidade para sorologia de SARS-CoV-2 na Argentina, com o objetivo de avaliar comparativamente o desempenho dos métodos disponíveis dos participantes para garantir resultados confiáveis e clinicamente úteis. O esquema consistiu em 4 remessas com 5 amostras cada uma, com reatividade variável contra SARS-CoV-2 em que foram avaliados anticorpos totais, IgG e IgM. Participaram 21 laboratórios públicos e privados da Província e da Cidade de Buenos Aires que participaram em forma gratuita. Eles relataram a metodologia utilizada e os resultados. Ao final de cada entrega, foram enviados relatórios individuais e foi feito um relatório final global com os resultados totais do ciclo. Ele foi realizado ao longo do segundo semestre de 2020. Um total de 643 resultados foram relatados, 239 de anti-SARS-CoV-2 IgM, 365 de IgG e 39 de anticorpos totais. Foi observada maior concordância nas metodologias anti-SARS-CoV-2 IgG do que nas IgM. ELISA/COVIDAR foi a metodologia mais utilizada para IgG e ELFA/bioMérieux para IgM. O espectro de metodologias foi amplo. O programa foi útil para garantir a qualidade dos resultados, proporcionando aos participantes o enquadramento necessário para a emissão de resultados confiáveis e harmonizados.

Secuelas físicas y emocionales en pacientes post hospitalización por COVID-19 / Physical and emotional sequelae after hospitalization for COVID-19

Background: Facing a severe life-threatening disease has physical and emotional consequences for patients. Aim: To evaluate the physical and emotional sequelae in patients who survived COVID-19 pneumonia. Material and Methods: This cross-sectional study collected data from post-COVID-19 pneumonia patients admitted to an outpatient follow-up program in a public hospital in Chile. One month after hospital discharge, the evaluation of physical capacity was carried out through the 1-minute sit-to-stand test (1STST). In addition, the Clinical Frailty Scale (CFS) and the Hospital Anxiety and Depression scale were applied. Results: We included 70 patients aged 63 ± 13 years (54% women). Eighty-five percent of the patients were able to execute the 1STST with an average of 20.6 ± 4.8 repetitions. Forty-eight percent of the patients had a performance below the 2.5th percentile according to the reference values and 28% of patients had exertional desaturation. The CFS classified as mildly vulnerable or with some degree of frailty to 33% of patients. Twenty-five percent of the patients presented symptoms of depression and 33% of anxiety. Conclusions: Patients who survived COVID-19 have a decrease in physical capacity and a significant proportion of depression and anxiety one month after hospital discharge.

Niños con deficiencia visual y sus actividades creadoras: contribuciones de la perspectiva histórico-cultural / Crianças com deficiência visual e suas atividades criadoras: contribuições da perspectiva histórico-cultural / Children with visual disabilities and their creative activities: contributions from the historical-cultural perspective

A Perspectiva Histórico-Cultural tem defendido a centralidade da imaginação para o desenvolvimento infantil e a necessidade de se entender a deficiência por uma via mais positiva, social e inclusiva. Neste trabalho teórico-argumentativo nosso objetivo foi problematizar como as atividades criadoras se desenvolvem em crianças com deficiência visual. Partindo do pressuposto de que essas crianças apresentam particularidades no modo de percepção e produção de imagens e configuram formas alternativas de organização da atividade criadora, realizou-se um levantamento bibliográfico sobre a produção científica de matriz Histórico-Cultural que envolve essas temáticas entre os anos de 2007-2017, nas bases de dados da Biblioteca Digital Brasileira de Teses e Dissertações, PROQUEST e B-ON (Portugal). Identificamos que os estudos sobre essas temáticas são reduzidos, mas avançam no sentido de defenderem que as situações de brincadeira, a atividade criadora e a autoria são espaços privilegiados para as crianças com deficiência visual interagirem com o ambiente, os objetos e os pares sociais.

La Perspectiva Histórico-Cultural ha defendido la centralidad de la imaginación para el desarrollo infantil y la necesidad de entenderse la deficiencia por un sendero más positivo, social e inclusiva. En ese estudio teórico-argumentativo nuestro objetivo fue problematizar cómo las actividades creadoras se desarrollan en niños con deficiencia visual. Partiéndose del presupuesto que esas presentan particularidades en el modo de percepción y producción de imágenes y configuran formas alternativas de organización de la actividad creadora, se realizó una recopilación bibliográfica sobre la producción científica de matriz Histórico-Cultural que abarcan esas temáticas entre los años de 2007-2017, en las bases de datos da Biblioteca Digital Brasileña de Tesis y Tesinas, PROQUEST y B-ON (Portugal). Identificamos que los estudios que abarcan esas temáticas son escasos, pero avanzan en el sentido de defender que las situaciones de juegos, la actividad creadora y la autoría son espacios privilegiados para los niños con deficiencia visual interactuar con el ambiente, los objetos y los pares sociales.

The Historical-Cultural Perspective has defended the centrality of imagination for child development and the need to understand disability in a more positive, social and inclusive way. In this theoretical-argumentative work, our objective was to problematize how creative activities are developed in children with visual impairment. Based on the assumption that these children have particularities in the way of perception and production of images and configure alternative forms of organization of creative activity, a bibliographic survey was carried out on the scientific production of the Historical-Cultural matrix that involves these themes between the years of 2007 -2017, in the databases of the Brazilian Digital Library of Theses and Dissertations, PROQUEST and B-ON (Portugal). We identified that the studies about these themes are reduced, but they move towards defending that situations of play, creative activity and authorship are privileged spaces for children with visual impairment to interact with the environment, objects and social peers.

Tomographic score (RAD-Covid Score) to assess the clinical severity of the novel coronavirus infection

ABSTRACT Objectives: The severity of pulmonary Covid-19 infection can be assessed by the pattern and extent of parenchymal involvement observed in computed tomography (CT), and it is important to standardize the analysis through objective, practical, and reproducible systems. We propose a method for stratifying the radiological severity of pulmonary disease, the Radiological Severity Score (RAD-Covid Score), in Covid-19 patients by quantifying infiltrate in chest CT, including assessment of its accuracy in predicting disease severity. Methods: This retrospective, single-center study analyzed patients with a confirmed diagnosis of Covid-19 infection by real-time reverse-transcriptase polymerase chain reaction, who underwent chest CT at hospital admission between March 6 and April 6, 2020. CT scans were classified as positive, negative, or equivocal, and a radiological severity score (RAD-Covid Score) was assigned. Clinical severity was also assessed upon hospital admission. Results: 658 patients were included. Agreement beyond chance (kappa statistic) for the RAD-Covid Score was almost perfect among observers (0.833), with an overall agreement of 89.5%. The RAD-Covid Score was positively correlated with clinical severity and death, i.e., the higher the RAD-Covid Score, the greater the clinical severity and mortality. This association proved independent of age and comorbidities. Accuracy of this score was 66.9%. Conclusions: The RAD-Covid Score showed good accuracy in predicting clinical severity at hospital admission and mortality in patients with confirmed Covid-19 infection and was an independent predictor of severity.

Fungal-host interactions: insights into microRNA in response to Paracoccidioides species

BACKGROUND Paracoccidioides spp. causes paracoccidioidomycosis (PCM), an important and frequent systemic mycosis that occurs in Latin America. The infectious process begins with contact between the fungus and lung cells, and the molecular pattern of this interaction is currently poorly understood. MicroRNAs (miRNAs) are small non-coding RNAs that regulate the gene expression in many biological processes, including in the infections. OBJECTIVE This study aimed to analyse the expression of miRNAs in lung cells as response to infection by Paracoccidioides spp. METHODS A quantitative real-time polymerase chain reaction (RT-qPCR) based screening was employed to verify differentially expressed miRNAs in human lung cells infected with three different species; Paracoccidioides lutzii, Paracoccidioides americana, and Paracoccidioides brasiliensis. Furthermore, the in silico predictions of target genes and pathways for miRNAs were obtained. FINDINGS The results showed that miRNAs identified in the lung cells were different according to the species studied. However, based on the predicted targets, the potential signaling pathways regulated by miRNAs are common and related to adhesion, actin cytoskeleton rearrangement, apoptosis, and immune response mediated by T cells and TGF-β. MAIN CONCLUSIONS In summary, this study showed the miRNAs pattern of epithelial cells in response to infection by Paracoccidioides species and the potential role of these molecules in the regulation of key pathogenesis mechanisms of PCM.

CO2 Fertilizer Effect on Growth, Polyphenols, and Endophytes in Two Baccharis Species

Abstract In a climate change context, the buildup of CO2 will affect plant communities worldwide. This study evaluated the effects of CO2 enrichment on the development and defense of two Cerrado native species Baccharis dracunculifolia and B. platypoda and their associated endophytic fungi richness. The study took place in Open-Top Chambers, two with ambient CO2 concentration (~400 ppm) and two in an enriched environment (~800 ppm). Baccharis platypoda developed 20% more leaves under enriched CO2 conditions, whereas B. dracunculifolia was 30% taller and showed 27% more leaves than those under ambient conditions. In both species, leaf polyphenol concentration did not differ between treatments. Nevertheless, polyphenol content had a positive correlation with plant height on both species' individuals grown under CO2 enriched conditions. Endophytic fungi richness and colonization rate on both plant species did not differ between ambient and enriched conditions. Our results show the positive effect of CO2 fertilizer in at least one of the measured growth parameters. An important new finding was a synergistic increase in growth and chemical defense in both studied species under enriched CO2 conditions, suggesting higher carbon assimilation and accumulation. This study suggests that the effects on primary productivity and secondary metabolites of Baccharis species will potentially reflect on the diversity and distribution of Cerrado plants and their associated animal communities.

Sífilis congénita tardía: a propósito de un caso / Late congenital syphilis: case report

La sífilis presenta un marcado aumento de su prevalencia en Argentina y en el mundo. La Organización Mundial de la Salud estima que, por año, hay 12 millones de personas infectadas mundialmente, y 270 000 corresponden a recién nacidos con sífilis congènita. Se presenta a una niña de 8 años de edad con mononucleosis por virus de Epstein-Barr, que mostró como hallazgo diagnóstico sífilis confirmada por dos pruebas treponémicas positivas; se interpretó el cuadro como compatible con sífilis congènita latente tardía asintomática.

Syphilis shows marked increase in its prevalence in Argentina and the world. The World Health Organization estimates that annually there are 12 million people infected in the world, 270,000 corresponding to newborns with congenital syphilis. We describe an 8-year-old girl who was undergoing mononucleosis due to Epstein-Barr virus and presented syphilis as a diagnostic finding, confirmed by two different positive treponemal tests, assuming a compatible picture of late latent congenital asymptomatic syphilis.

Perfil Epidemiológico de Pacientes Notificados com Hanseníase, em uma Cidade do Norte de Minas no Período de 2009-2013 / Epidemiological Profile of Patients Notified With Leprosy in a City in the North of Minas in the Period of 2009-2013

Objetivo: Descrever o perfil epidemiológico dos pacientes notificados com hanseníase no Município de Montes Claros, no período de 2009-2013, disponibilizados no Sistema de Informação de Agravos e Notificação-SINAN. Metodologia: Realizou-se um estudo epidemiológico observacional retrospectivo, que envolveu uma amostra de 225 casos confirmados de hanseníase. Critério de inclusão correspondeu aos hansenianos diagnosticados, residentes em Montes Claros e notificados no Sistema de Informação de Agravos de Notificação (SINAN). Resultados: As variáveis do estudo foram divididas em sete categorias de análise: ano; sexo; faixa etária mais acometida; classificação operacional; forma clínica; avaliação do grau de incapacidade física no diagnóstico e esquema terapêutico. Foram realizadas análises descritivas dos dados, em que se verificou os seguintes dados: No período de 2009-2013 foram notificados 225 novos casos de hanseníase, sendo o ano de 2009 o de maior índice de infecção chegando a 73 casos, correspondendo a 32,44% destes, acometendo, principalmente, homens (56%). A faixa etária prevalente foi 20 a 39 anos e 40 a 59 anos. O grau zero de incapacidade foi o mais encontrado (76%). A forma clínica prevalente foi a dimorfa (44,89%), a classe operacional foi a multibacilar (87,11%), com poliquimioterapiamultibacilar (85,78%). Conclusão:Após a análise dos dados estudados chegou-se à conclusão que o número de casos de hanseníase diagnosticados em Montes Claros-MG apresentou uma redução. A forma multibacilar ainda foi a predominante. Embora o número de casos de hanseníase tenha evidenciado uma redução, a doença ainda é preocupante. (AU)

Objective: To describe the epidemiological profile of the patients notified with leprosy in the municipality of Montes Claros, in the period of 2009-2013, available in the SINAN Notification and Injury Information System. Methodology: This was a retrospective observational epidemiological study involving a sample of 225 confirmed cases of leprosy. Inclusion criterion corresponded to the diagnosed hansenians, living in Montes Claros and notified in the Notification of Injury Information System (SINAN). Results: The study variables were divided into seven categories of analysis: year; sex; Age group; Operational classification; Clinical form; Evaluation of the degree of physical incapacity in the diagnosis and therapeutic scheme. Descriptive analysis of the data were carried out, in which the following data were verified: In the 2009-2013 period, 225 new cases of leprosy were reported, 2009 being the one with the highest infection rate, reaching 73 cases corresponding to 32.44% of these; Affecting mainly men (56%). The prevalent age range was 20 to 39 years and 40 to 59 years. The zero degree of disability was mostly found (76%). The prevalent clinical form was dimorphic (44.89%), the operational class was multibacillary (87.11%), with polyquimioterapia multibacilar (85.78%). Conclusion: After analyzing the data, we conclude that the number of leprosy cases diagnosed in Montes Claros-MG reduced. The multibacillary form is still predominant, although the number of cases of reduced leprosy is still worrying.(AU)

Mycoplasma pneumoniae: manifestaciones neurológicas y controversias diagnósticas. A propósito de un caso / Mycoplasma pneumoniae: neurologic manifestations and diagnostic controversies. A case report

Mycoplasma pneumoniae (Mp) es el agente causal de un 30% de las manifestaciones respiratorias de la población general. La neumonía ocupa el primer lugar dentro de este grupo. Las manifestaciones neurológicas representan las formas más frecuentes de presentación clínica extrapulmonar (40%). Las encefalitis y meningoencefalitis son las formas más habituales de sintomatología neurológica asociada a infección por Mp. La presentación de más de una variante clínica en un mismo paciente asociada a primoinfección por Mp es posible. El diagnóstico serológico plantea, habitualmente, controversias en su interpretación. A partir del caso de una niña de 7 años con inyección conjuntival, adenopatía cervical, rash descamativo y fotofobia con "pseudoedema de papila bilateral", que desarrolla durante su evolución parálisis facial periférica y meningitis aséptica, se analizarán las controversias que se plantean en relación con la interpretación diagnóstica asociada al compromiso neurológico por Mp.

Mycoplasma pneumoniae (Mp) is responsible for 30% of the respiratory manifestations of the general population. Pneumonia occupies the first place within this group. Among the extra-respiratory forms (40%), the neurological ones are the most frequent. Meningoencephalitis and aseptic meningitis are the most common. The presentation of more than one clinical variant in the same patient associated with primoinfection by Mp is possible. In relation to the serological diagnosis, controversies in interpretation sometimes occur. This is a 7-year-old girl with conjunctival injection, cervical adenopathy, photophobia with bilateral papilla pseudoedema, and scaly rash that develops peripheral facial paralysis and aseptic meningitis. We will discuss diagnostic controversies.

Aneurisma de veia poplítea: relato de dois casos / Popliteal vein aneurysm: report of two cases

Os aneurismas venosos são raros, sendo na maioria das vezes diagnosticados de forma incidental. Os aneurismas de veia poplítea são os mais comuns entre os aneurismas venosos e apresentam uma forte associação com a ocorrência de trombose venosa profunda e embolia pulmonar recorrente. O presente estudo descreve dois casos de aneurisma de veia poplítea associados a trombose venosa profunda.

Venous aneurysms are rare and often diagnosed incidentally. Popliteal vein aneurysms are the most common type of venous aneurysms and have a strong association with the occurrence of deep vein thrombosis and recurrent pulmonary embolism. This article reports two cases of popliteal vein aneurysms associated with deep vein thrombosis.

Adenocarcinoma de uraco: presentación de dos casos / Urachal adenocarcinoma: report of two cases

OBJETIVOS: Revisión de la literatura del Adenocarcinoma de uraco y presentación de dos casos MÉTODOS/RESULTADOS: Analizamos las características epidemiológicas, clínicas y terapéuticas del Adenocarcinoma de uraco y presentamos dos casos diagnosticados y tratados en nuestro centro CONCLUSIONES: El Adenocarcinoma de uraco es una neoplasia rara, con mal pronóstico y cuyo tratamiento generalmente es la cistectomía parcial o radical con resección en bloque del uraco y el ombligo. Debido a su gravedad, debería tenerse en cuenta a la hora del diagnóstico.AU

OBJECTIVE: Literature review of Urachus adenocarcinoma and report of two cases. METHODS/RESULTS: We analyze epidemiological, clinical and therapeutic features of the Urachus adenocarcinoma and we report two cases diagnosed and treated in our institution. CONCLUSIONS: The Urachus adenocarcinoma is a rare cancer, with poor prognosis and treatment of which usually is radical or partial cystectomy with umbilicotomy and removal of the urachus in bloc. Due to its gravity, you should keep it in mind when you make a diagnosis.AU

Hidatidosis en niños: experiencia en un hospital de alta complejidad fuera del área endémica / Echinococcosis in children: Experience in a tertiary care hospital outside the endemic area

La hidatidosis es una zoonosis con una amplia distribución en Argentina y en el mundo. Se adquiere en la infancia, pero se presenta, más frecuentemente, en la edad adulta. La población pediátrica representa el 10%-20% del total de los casos. Se presentan 47 niños con diagnóstico de hidatidosis durante un período de 20 años. La mediana de edad fue de 8 años (rango: 3-17) y, en su mayoría, tenían algún antecedente epidemiológico orientador, como la procedencia de un área endémica, rural y/o la tenencia de perros alimentados con visceras. El 85% fueron quistes únicos localizados en un solo parénquima. Las localizaciones quísticas pulmonares y hepáticas fueron las más frecuentemente encontradas. El tratamiento fue médico-quirúrgico en 45 pacientes (96%). Trece (28%) presentaron alguna complicación posterior, que fue más frecuente en aquellos con localización pulmonar. Tres (6%) recayeron entre el mes y los 24 meses, y requirieron una nueva cirugía. Ninguno falleció a causa de la enfermedad parasitaria.

Echinococcosis is a zoonotic disease that is widely spread across Argentina and worldwide. It is acquired during childhood but it is more common during adulthood. The pediatric population accounts for 10-20% of all cases. This study included 47 children diagnosed with echinococcosis over a 20-year period. Their median age was 8 years old (range: 3-17); most patients had some epidemiological history, such as having lived or living in an endemic or rural area and/or having dogs that are fed with viscera. Findings included 85% of single cysts in only one parenchyma. Cysts were most commonly located in the liver and lungs. Medical/surgical treatment was carried out in 45 patients (96%). Subsequent complications were observed in 13 patients (28%), which were more common in those with lung cysts. Three patients (6%) relapsed 1-24 months later and required a new surgery. No patient died as a result of the parasitic disease.

Sala de espera: diálogo entre extensão universitária e educação alimentar e nutricional com pacientes pré e pós-transplante hepático / Waiting room: dialogue between university extension and food and nutritional education with patients pre- and post-liver transplantation

Introdução: A Educação Alimentar e Nutricional (EAN) deve estar inserida em diversos setores públicos, dentre esses a Sala de Espera, que consiste em área física com pessoas que aguardam atendimento profissional. Esse espaço pode ser utilizado para ajudar pacientes e familiares, em situações que exijam maior atenção de cuidados de saúde, incluindo a nutrição. Pacientes candidatos ou já submetidos ao transplante hepático são grupo vulnerável que deve compreender o tratamento e aprender a manejar os cuidados necessários por toda a vida, especialmente os dietéticos. Método: Estudo descritivo com abordagem quanti-qualitativa, cujas atividades desenvolvidas consistiram em oficinas com diferentes temáticas. O público-alvo foi de pacientes candidatos ou já submetidos ao transplante hepático e que aguardavam atendimento médico na Sala de Espera. A efetividade das oficinas foi avaliada por meio de testes de conhecimento pré e pós-oficina, utilizando-se o teste t Student para verificar a média de acertos obtidos antes e após as oficinas, considerando-se 5% como valor de significância. Ademais, foram analisados comentários e sugestões deixadas pelos participantes de forma a avaliar as representações dos pacientes em relação às oficinas. Resultados: A amostra foi composta por 62 pacientes (23 pré-transplante e 39 pós-transplante hepático). A idade média foi 45,7 anos, sendo 32 pacientes do sexo masculino e 30 do sexo feminino. Verificou-se que, após as oficinas, os participantes, tanto pré como póstransplante, tiveram melhor desempenho nos testes de conhecimento (p<0,05). Conclusões: A Sala de Espera revelou-se como espaço de construção de conhecimento, compartilhamento de experiências, sentimentos, dúvidas e socialização dos saberes técnico-científico e popular.

Introduction: The Food and Nutrition Education must be inserted in various public sectors, among others, the Waiting Room, consisting of physical area with people waiting for a professional service. This space can be used to help patients and families, in situations that require greater attention to health care, including nutrition. Patient candidates or already undergoing liver transplantation are vulnerable group that should understand the treatment and learn how to handle the necessary care for life, especially dietary. Methods: A descriptive study with quantitative and qualitative approach developed whose activities consisted of workshops with different themes. The audience was patient candidates or already undergoing liver transplantation and waiting for medical care in the Waiting Room. The effectiveness of the workshops was assessed by pre-and post-workshop knowledge tests, using the student t test to verify the mean score obtained before and after the workshops, considering 5% significance level. In addition, we analyzed comments and suggestions left by participants to assess the representations of patients in relation to the workshops. Results: The sample consisted of 62 patients (23 pre-transplant and 39 post-liver transplantation). The mean age was 45.7 years, 32 male and 30 females. It was found that after the workshops, participants from both pre-and post-transplant showed better performance in the knowledge tests (p<0.05). Conclusions: The Waiting Room proved as a space to build knowledge, share experiences, feelings, doubts, and socialization of scientific-technical and popular knowledge.