COVID-19 in the perioperative period of cardiovascular surgery: the brazilian experience

Abstract Introduction: We investigated the clinical course and outcomes of patients submitted to cardiovascular surgery in Brazil and who had developed symptoms/signs of coronavirus disease 2019 (COVID-19) in the perioperative period. Methods: A retrospective multicenter study including 104 patients who were allocated in three groups according to time of positive real time reverse transcriptase-polymerase chain reaction (RT-PCR) for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): group 1, patients who underwent cardiac surgery > 10 days after positive RT-PCR; group 2, patients with a positive RT-PCR within 10 days before or after surgery; group 3, patients who presented positive RT-PCR > 10 days after surgery. The primary outcome was mortality and secondary outcomes were postoperative complications, intensive care unit (ICU) length of stay, and postoperative days of hospitalization. Results: The three groups were similar with respect to age, the European System of Cardiac Operative Risk Evaluation score, and comorbidities, except hypertension. Postoperative complications and death were significantly higher in groups 2 and 3 than in group 1, and no significant difference between groups 2 and 3 was seen. Group 2 showed a high prevalence of surgery performed as an urgent procedure. Although no significant differences were observed in ICU length of stay, total postoperative hospitalization time was significantly higher in group 3 than in groups 1 and 2. Conclusion: COVID-19 affecting the postoperative period of patients who underwent cardiovascular surgery is associated with a higher rate of morbidity and mortality. Delaying procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.

Evaluation of actions of the official veterinary service to mitigate outbreaks of infectious laryngotracheitis and improve biosecurity on laying hen farms / Avaliação de ações do serviço veterinário oficial para bloqueio de foco de laringotraqueite infecciosa e melhoria da biosseguridade em granjas de postura

Infectious laryngotracheitis (ILT), caused by an Alphaherpesvirus (Gallid herpesvirus-1; GaHV-1), has been noticed in the region of the Terras Altas da Mantiqueira, Minas Gerais. From 2010 to 2018, the "Serviço Veterinário Oficial" (SVO) of the "Instituto Mineiro Agropecuário" (IMA), implemented measures to prevent spread of the virus to other regions and control the disease in the area. Due to the close proximity and consequent epidemiological link among farms, the region was considered a unique epidemiological unit. To check the efficiency of the ILT control measures, we carried out: (1) a seroepidemiological survey, (2) questionnaires for evaluating biosecurity measures; and (3) an evaluation of the influence of farm population density on the occurrence of ILT. In 2016, 2017, and 2018, ILT was investigated using epidemiological and clinicopathological methods, along with GaHV-1 molecular detection. Serological survey was carried out on 24 farms in the quarantined region and on 13 farms from other regions of the state. In 2010 and 2018, questionnaires were applied to collect data and determine indicators of biosecurity practices in all farms of the quarantined area. The differences were then assessed (Wilcoxon's p<0.05). The results indicated positive serology throughout the region, although only on four farms (16.6%) the chickens have clinical signs, macroscopic and histological lesions of ILT. The prevalence of viral infection increased from 2016 (27%) to 2017 (50%) and was higher in farms with a high stock density (p=0.033). No disease, virus or antibodies were detected in the farms outside of the quarantined area. Although the biosecurity indicators had improved on all farms in the quarantined area (p<0.05), the virus was active and circulating in the region. The contingency measures have contained the outbreak, but biosecurity practices are paramount in the control of new outbreaks. Official control will be maintained in the region, including surveillance of new cases and biosecurity procedures to mitigate the risk of the virus reaching other regions.(AU)

Laringotraqueíte infecciosa (LTI), causada por um alfaherpesvírus (herpesvírus Gallid-1; GaHV-1), foi observada na região das Terras Altas da Mantiqueira, Minas Gerais. De 2010 a 2018, o Serviço Veterinário Oficial (SVO) do Instituto Mineiro Agropecuário (IMA) implementou medidas para impedir a disseminação do vírus para outras regiões do estado e controlar a doença na região interditada. Devido à proximidade e consequente vínculo epidemiológico entre as granjas, a região foi considerada uma unidade epidemiológica única. Para verificar a eficiência das medidas de controle de LTI, foram realizados: (1) pesquisa soroepidemiológica, (2) questionários para avaliar medidas de biosseguridade; e (3) avaliação da influência da densidade populacional da granja na ocorrência de LTI. Em 2016, 2017 e 2018, a LTI foi investigada usando métodos epidemiológicos e clínico-patológicos, com a detecção molecular de GaHV-1. O levantamento sorológico foi realizado em 24 granjas da região interditada e em 13 granjas de outras regiões do estado. Em 2010 e 2018, foram aplicados questionários para coletar dados e determinar indicadores de medidas de biosseguridade em todas as granjas da área interditada. As diferenças foram avaliadas (p<0,05 de Wilcoxon). Os resultados indicaram sorologia positiva em toda a região, embora apenas em quatro granjas (16,6%) as galinhas apresentaram sinais clínicos, lesões macroscópicas e histológicas da LTI. A prevalência de infecção viral aumentou de 2016 (27%) para 2017 (50%) e foi maior em fazendas com alta densidade de alojamento (p=0,033). Presença da doença, vírus ou anticorpos foram detectados nas granjas fora da área interditada. Embora os indicadores de biosseguridade tenham melhorado em todas as fazendas da área interditada (p<0,05), o vírus está ativo e circulava na região. As medidas de contingência contiveram o surto, mas as práticas de biosseguridade são fundamentais para o controle de novos surtos. O controle oficial será mantido na região, incluindo a vigilância de novos casos e procedimentos de biosseguridade para mitigar o risco de transmissão do vírus para outras regiões.(AU)

Evaluation of actions of the official veterinary service to mitigate outbreaks of infectious laryngotracheitis and improve biosecurity on laying hen farms

ABSTRACT: Infectious laryngotracheitis (ILT), caused by an Alphaherpesvirus (Gallid herpesvirus-1; GaHV-1), has been noticed in the region of the Terras Altas da Mantiqueira, Minas Gerais. From 2010 to 2018, the Serviço Veterinário Oficial (SVO) of the Instituto Mineiro Agropecuário (IMA), implemented measures to prevent spread of the virus to other regions and control the disease in the area. Due to the close proximity and consequent epidemiological link among farms, the region was considered a unique epidemiological unit. To check the efficiency of the ILT control measures, we carried out: (1) a seroepidemiological survey, (2) questionnaires for evaluating biosecurity measures; and (3) an evaluation of the influence of farm population density on the occurrence of ILT. In 2016, 2017, and 2018, ILT was investigated using epidemiological and clinicopathological methods, along with GaHV-1 molecular detection. Serological survey was carried out on 24 farms in the quarantined region and on 13 farms from other regions of the state. In 2010 and 2018, questionnaires were applied to collect data and determine indicators of biosecurity practices in all farms of the quarantined area. The differences were then assessed (Wilcoxons p 0.05). The results indicated positive serology throughout the region, although only on four farms (16.6%) the chickens have clinical signs, macroscopic and histological lesions of ILT. The prevalence of viral infection increased from 2016 (27%) to 2017 (50%) and was higher in farms with a high stock density (p=0.033). No disease, virus or antibodies were detected in the farms outside of the quarantined area. Although the biosecurity indicators had improved on all farms in the quarantined area (p 0.05), the virus was active and circulating in the region. The contingency measures have contained the outbreak, but biosecurity practices are paramount in the control of new outbreaks. Official control will be maintained in the region, including surveillance of new cases and biosecurity procedures to mitigate the risk of the virus reaching other regions.

RESUMO: Laringotraqueíte infecciosa (LTI), causada por um alfaherpesvírus (herpesvírus Gallid-1; GaHV-1), foi observada na região das Terras Altas da Mantiqueira, Minas Gerais. De 2010 a 2018, o Serviço Veterinário Oficial (SVO) do Instituto Mineiro Agropecuário (IMA) implementou medidas para impedir a disseminação do vírus para outras regiões do estado e controlar a doença na região interditada. Devido à proximidade e consequente vínculo epidemiológico entre as granjas, a região foi considerada uma unidade epidemiológica única. Para verificar a eficiência das medidas de controle de LTI, foram realizados: (1) pesquisa soroepidemiológica, (2) questionários para avaliar medidas de biosseguridade; e (3) avaliação da influência da densidade populacional da granja na ocorrência de LTI. Em 2016, 2017 e 2018, a LTI foi investigada usando métodos epidemiológicos e clínico-patológicos, com a detecção molecular de GaHV-1. O levantamento sorológico foi realizado em 24 granjas da região interditada e em 13 granjas de outras regiões do estado. Em 2010 e 2018, foram aplicados questionários para coletar dados e determinar indicadores de medidas de biosseguridade em todas as granjas da área interditada. As diferenças foram avaliadas (p 0,05 de Wilcoxon). Os resultados indicaram sorologia positiva em toda a região, embora apenas em quatro granjas (16,6%) as galinhas apresentaram sinais clínicos, lesões macroscópicas e histológicas da LTI. A prevalência de infecção viral aumentou de 2016 (27%) para 2017 (50%) e foi maior em fazendas com alta densidade de alojamento (p=0,033). Presença da doença, vírus ou anticorpos foram detectados nas granjas fora da área interditada. Embora os indicadores de biosseguridade tenham melhorado em todas as fazendas da área interditada (p 0,05), o vírus está ativo e circulava na região. As medidas de contingência contiveram o surto, mas as práticas de biosseguridade são fundamentais para o controle de novos surtos. O controle oficial será mantido na região, incluindo a vigilância de novos casos e procedimentos de biosseguridade para mitigar o risco de transmissão do vírus para outras regiões.

The Effects Of Smartphone Addiction On Childrens Cervical Posture And Range Of Motion

Background: This study examined the effects of smartphones addiction on cervical posture, and compared the cervical range of motion (ROM) between addicted and non-addicted boys and girls 8 to 13 years of age. Methods: Twenty-four boys and 26 girls were assigned to 2 groups; addicted group (score > 32, n=32) and non-addicted group (score ≤ to 32, n=18). Craniovertebral Angle (CVA) was assessed using side view photographs, forward head posture (FHP) was measured using ImageJ 64 software, and cervical ROM in each direction was measured using a cervical (CROM) device. Results: A forward multiple regression showed that addiction score and body mass index (BMI) were significant predictors of CVA (R2 =0.31, p<0.001). Twenty-three percent of the variability in CVA was related to addiction score. A forward logistic regression showed that addiction to smartphone use and BMI were significant predictors of having FHP, and participants who were addicted were more than four times as likely to have FHP than those who were not: Odds Ratio (OR) with 95 % confidence interval (CI)=4.5 (1.2, 10.7), p= 0.03. A significant reduction was found in mean cervical angle in addicted versus non-addicted boys (49.4±6.7 vs. 55.5±7.6,η2=0.5, p=0.03) and girls (47.3±6.3 vs. 52.9±6.1,η2=0.9, p=0.02). A significantly more limited cervical ROM found in most neck movements in addicted participants with FHP compared to participants without FHP. Conclusion: Children who are addicted to smartphones may develop faulty habitual posture due to constant neck flexion downward, which may place them at high risk of spine abnormalities.

Costs of acute otitis media in children in a city of the Colombian Caribbean coast / Costos de la otitis media aguda en niños de una ciudad de la costa caribe colombiana

Abstract Introduction: Acute otitis media is the main cause of consultation, antibiotic use, and ambulatory surgery in developed countries; besides, it is associated with an important economic burden. However, non-medical indirect costs of acute otitis media, which are relevant in this pathology, have been underestimated. Objective: To estimate the costs of acute otitis media in pediatric patients in Cartagena, Colombia. Materials and methods: We conducted a prospective study of micro-costing between 2014 and 2015. The direct and indirect costs of acute otitis media were determined through forms applied to parents or caregivers. Loss of productivity was estimated based on the monthly legal minimum wage of 2014 (COP $616.000) (USD $308). Results: A total of 62 episodes of acute otitis media occurred. The total economic costs attributed per episode was COP $358,954 (standard deviation: SD ± COP $254,903, i.e., USD $179). The total economic burden was COP $22,503,141 (USD $11,250), the indirect costs per episode were COP $101,402 (USD $51), and the average care time spent by parents was 3.7 days. Conclusion: The estimated costs of acute otitis media in this study were lower than the costs estimated in a review of high-income countries and similar to those of low-income countries such as Nigeria. Information on total costs (direct and indirect) of acute otitis media is necessary for public health decision-making and for full cost-effectiveness assessments.

Resumen Introducción. La otitis media aguda es la principal causa de consultas médicas, de uso de antibióticos y de cirugías ambulatorias en los países desarrollados. Está asociada con una significativa carga económica, pero sus costos indirectos no médicos, los cuales son relevantes en esta enfermedad, se han subestimado. Objetivo. Estimar los costos de la otitis media aguda en pacientes pediátricos en Cartagena, Colombia. Materiales y métodos: Se hizo un estudio prospectivo de microcosteo entre el 2014 y el 2015. Se determinaron los costos directos e indirectos de la otitis media aguda mediante encuestas a los padres o cuidadores. La pérdida de productividad se estimó con base en el salario mínimo legal vigente mensual del 2014(COP$616.000) (USD$308). Resultados. Se presentaron 62 episodios de otitis media aguda. Los costos económicos totales por episodio fueron de COP $358.954 (desviación estándar, DE: ± $254.903) (USD $179). La carga económica total fue de COP $22'503.141 (USD $11.250), los costos indirectos por episodio fueron de COP $101.402 (USD $51) y el tiempo promedio empleado por los padres en el cuidado fue de 3,7 días. Conclusiones. Los costos estimados de la otitis media aguda en el presente estudio fueron menores a los estimados en países con ingresos altos y similares a los de países con ingresos bajos como Nigeria, según una revisión bibliográfica. La información sobre los costos totales directos e indirectos de la otitis es necesaria para la adopción de decisiones en salud pública y para hacer evaluaciones económicas completas de costo-efectividad.

Viability Kinetic Profile, Morphological Structure, and Physicochemical Characterization of Candida albicans Biofilm on Latex Silicone Surfaces

Biofilm formed by Candida albicans on latex silicone surfaces was characterized by instrumental techniques such as fluorescence microscopy, scanning electron microscopy, and Fourier transform infrared spectroscopy. The growth and viability of C. albicans on the biofilm formed were described using different kinetic rate equations. C. albicans biofilm has a complex and heterogenous structure with hyphal elements and yeast cells entrenched within a polysaccharide matrix. Spectroscopic studies revealed specific stretching frequencies of O-H, C-O, and C=O which can be attributed to the presence of some functionalities in the biofilm formed by C. albicans. Viability of C. albicans behaved in accordance with the first-order kinetic equation on the first 48 h, then shifted to a second-order kinetic equation until the 72 h, and had a doubling time of 70 h. Information on model biofilms with emphasis on growth rates and morphogenesis, structural organization, and physicochemical characteristics can possibly explain resistance to some antifungal treatments and subsequent synthesis of newer generation drugs for fungal biofilm-related infections.

Adsorption Isotherm and Thermodynamic Profile of Hexavalent Chromium onto Lumbang (Aleurites moluccana) Activated Carbon Chitosan Composite Crosslinked with Epichlorohydrin

Adsorption isotherm and thermodynamic profile of hexavalent chromium onto lumbang (Aleurites moluccana) activated carbon chitosan composite crosslinked with epichlorohydrin were studied. The optimum conditions were identified at pH 3, contact time of 75 min, adsorbent dose of 3 g/L, initial concentration of 60 ppm, and 30ºC temperature resulted to a removal efficiency of 93%. The composite has a round and elliptical adsorption sites, contains –OH and –NH2 functional groups, and has increased stability with epichlorohydrin crosslinking. The adsorption process is best characterized by the Langmuir isotherm suggesting a monolayer adsorption nature of Cr(VI). The adsorption kinetics obeyed the pseudo-second order model and the adsorption process is exothermic. The investigated adsorption phenomenon described a chemisorption process, with 21.32 kJ mol-1 mean free energy, due to the functional groups identified and the high porosity of the adsorbent surfaces.

Investigação epidemiológica de estomatite vesicular por achados clínicos em bovinos e equinos no Estado do Maranhão / Stomatitis vesicular in cattle and horse in the Maranhão state

A Estomatite Vesicular (EV) é uma doença infecciosa que acomete equinos, bovinos, suínos, mamíferos silvestres e humanos. Por apresentar sinais clínicos semelhantes a outras doenças vesiculares, principalmente, febre aftosa, sua presença em determinadas regiões pode interferir no intercâmbio comercial internacional dos animais, seus produtos e subprodutos. Apesar de sua importância, a epidemiologia e a manutenção do vírus no ambiente não estão totalmente esclarecidas dificultando a aplicação de medidas de controle efetivas. A doença já foi diagnosticada em todas as regiões brasileiras. Bovinos com sialorréia, perda do epitélio lingual, lesões abertas com bordas amareladas nas gengivas, lábios, língua e mucosa oral e equinos com sialorréia e lesões abertas na mucosa oral e lábios foram observados e notificados ao Serviço Veterinário Oficial do Estado do Maranhão, Agência Estadual de Defesa Agropecuária do Maranhão (AGRD/MA). Amostras de soro de equinos e bovinos com sintomas de EV foram coletadas para investigação por ELISA e por neutralização viral, além do diagnóstico diferencial para Febre Aftosa (FA). Fragmentos epiteliais de bovinos com lesões na língua foram coletados para identificação molecular do agente. Todos os animais foram negativos para FA. Todos os bovinos e equinos foram reativos para EV nos testes sorológicos. A partir dos fragmentos epiteliais de bovinos enviados ao Instituto Biológico de São Paulo para PCR, foi possível caracterizar o agente como VesiculovirusIndiana III (Alagoas/VSAV).

Vesicular stomatitis (VS) is an infectious viral disease that affects bovines, equines, swine, wild animals and humans. As it is indistinguishable from other vesicular diseases, mainly Foot and Mouth Disease (FMD), it causes restrictions in commercial livestock trade at national and international levels and also significant economic losses. As the epidemiology and maintenance of VS virus in nature are not clearly understood it is difficult to take effective control measures. VS was diagnosed in some regions of Brazil, such as Minas Gerais, Santa Catarina, São Paulo and Alagoas. Cattle and horses with clinical symptoms of drooling, shedding of the lingual epithelium, presence of vesicles on the oral mucosa were observed and reported to the National Animal Health Office health of Maranhão State, Brazil. Samples of serum of these animals were collected and sent to Laboratório Nacional de Agropecuaria for ELISA and virus neutralization and differential diagnosis for Foot and Mouth Disease (FMD). The results of ELISA confirmed the VS. In the differential diagnosis, the results were negative for FMD. Samples of bovine epithelial tissue for VS by PCR confirmation of diagnosis were collected and sent to Biological Institute of São Paulo. Molecular results confirmed the VesiculovirusIndiana III (Alagoas/VSAV) infection.

Seleção, caracterização e clonagem dos genes fljB e groEL agonistas dos receptores de reconhecimento de padrão do sistema imune inato das aves / Selection, characterization and cloning of the fljB and groEL genes agonists of the innate immune system pattern recognition receptors of birds

The recombinant production of innate immune system pattern recognition receptor agonists has provided a new tool for the production of immunostimulants for animals. The molecular pattern associated with the pathogen (PAMP), flagellin, coded by the fljB gene from Salmonella Typhimirium, and the molecular pattern associated to the damage (DAMP), HSP60, coded by the groEL gene from S. Typhimurium and S. Enteritidis, are recognized by pattern recognition receptors (PRRs) of the innate immune system of birds. In the present study, we performed the cloning of genetic fragments of the genes fljB, from S. Typhimurium, and groEL from S. Typhimurium and S. Enteritidis inserted in expression vector pET100/D-TOPO and transformed in E. coli TO10 cells. The clones were evaluated by colony PCR, plasmidial DNA PCR and genome sequencing in order to confirm the presence of these genes. In the colony PCR, we identified the presence of genes groEL (S. Enteritidis), groEL (S. Typhimurium) and fljB (S. Typhimurium) in 80%, 60% and 80% of the transformed colonies, respectively. The cloning system adopted allowed the production of HSP60 genetic fragment clones and flagellin of Salmonella strains, allowing the posterior use of these clones in gene expression trials, with the future potential of being used as non-specific immunostimulants for birds.

A produção recombinante de agonistas dos receptores do reconhecimento de padrão do sistema imune inato tem fornecido uma nova ferramenta para a produção de imunoestimulantes para animais. O padrão molecular associado ao patógeno (PAMP), flagelina, codificado pelo gene fljB de Salmonella Typhimurium e o padrão molecular associado ao dano (DAMP) HSP60, codificado pelo gene groEL da S. Typhimurium e S. Enteritidis, são reconhecidos por receptores de reconhecimento de padrões (RRPs) do sistema imune inato das aves. No presente estudo, foi feita a clonagem de fragmentos genéticos dos genes fljB de S. Typhimurium e groEL de S. Typhimurium e S. Enteritidis inseridos no vetor de expressão pET100/D-TOPO e transformados em células de E. coli TOP10. Os clones foram avaliados pela PCR de colônia, PCR de DNA plasmidial e sequenciamento genômico para a confirmação da presença desses genes. Na PCR de colônia, foram identificadas em 80%, 60% e 80% das colônias transformadas, a presença dos genes groEL (S. Enteritidis), groEL (S. Typhimurium) e fljB (S. Typhimurium) respectivamente. O sistema de clonagem adotado possibilitou a produção de clones dos fragmentos genéticos da HSP60 e flagelina das cepas de Salmonella, permitindo a utilização posterior desses clones em ensaios de expressão gênica, com potencial futuro de serem utilizados como imunoestimulante inespecífico das aves.

Outbreak of infectious laryngotracheitis in large multi-age egg layer chicken flocks in Minas Gerais, Brazil / Surto de laringotraqueíte infecciosa em granjas de galinhas poedeiras de múltiplas idades em Minas Gerais, Brasil

A recent (November 2010) outbreak of infectious laryngotracheitis (ILT) in a multi-age laying hen facility in Minas Gerais state, Brazil, is described. Previous ILT outbreak in laying hens was only notified in São Paulo state, Brazil, in 2002. In the outbreak described here, the affected population was approximately eight million hens, with flock sizes ranging from 100,000 to 2,900,000 chickens. The average mortality ranged from 1 to 6%, and morbidity was around 90% (most of the twenty seven farms of the area were positive for ILT virus). Three multi-age laying farms from one company were selected for this report. Clinical signs included prostration, dyspnea, conjunctivitis, occasional swelling of the paranasal sinuses and bloody mucous nasal discharge. Severely affected chickens presented with dyspnea, gasping and became cyanotic before death. At necropsy, these chickens had fibrinous exudate blocking the larynx and the lumen of cranial part of the trachea. In addition, conjunctivitis with intense hyperemia, edema and sinuses with caseous exudate were present. On histopathology, there were marked necrosis and desquamation of respiratory ephitelium and conjunctiva with numerous syncytial cells formation and fibrinous exudate. Moderate to marked non suppurative (especially lymphocytes and plasma cells) infiltration in the lamina propria also was observed. Sixteen out of 20 examined chickens, eosinophilic intranuclear inclusion bodies were observed in the syncytial cells. The DNA extracted from larynx and trachea produced positive PCR results for ILT virus (ILTV) DNA using formalin-fixed, paraffin embedded (FFPE) samples. Amplicons from a small region of ICP4 gene were submitted to sequencing and showed 100% identity with ILTV EU104910.1 (USA strain), 99% with ILTV JN596963.1 (Australian strain) and 91% with ILTV JN580316.1 (Gallid herpesvirus 1 CEO vaccine strain) and JN580315.1 (Gallid herpesvirus 1 TCO vaccine strain).

Um surto recente (Novembro de 2010) de laringotraqueite infecciosa (LTI) em granjas de postura de múltiplas idades em Minas Gerais, Brasil, é descrito. Um surto de LTI em galinhas de postura havia sido previamente relatado apenas no Estado de São Paulo em 2002. No surto aqui descrito, a população afetada foi de aproximadamente oito milhões de galinhas, com lotes variando de 100.000 a 2.900.000 galinhas. A mortalidade média variou de 1 a 6% e a morbidade atingiu cerca de 90% (a maioria das 27 granjas foram positivas para o virus da LTI). Três granjas com aves de múltiplas idades pertencentes a uma empresa foram selecionadas para o presente relato. Os sinais clinicos incluíram prostração, dispneia, conjuntivite, edema ocasional dos seios paranasais e secreção nasal mucosa e/ou sanguinolenta. As aves severamente afetadas apresentaram acentuada dispneia, aparente engasgo e tornaram-se cianóticas antes da morte. Nestas aves, exsudato fibrinoso denso obstruindo o lúmen da laringe e parte cranial da traqueia foi observado na necropsia. Havia também, conjuntivite com hiperemia intensa e edema, além de sinusite com exsudato caseoso. Na histopatologia, observaram-se necrose e descamação acentuada do epitélio respiratório e da conjuntiva com formação de numerosos sincícios e exsudato fibrinoso. Além disso, infiltrado inflamatório mononuclear (especialmente linfócitos e plasmócitos) moderado a acentuado na lâmina própria foi observado. Corpúsculos de inclusão intranucleares nas células sinciciais foram observados em 16 das 20 aves examinadas. Resultados positivos pela PCR para o virus da LTI foram obtidos de DNA extraído das laringes e traqueias utilizando amostras fixadas em formol e incluidas na parafina. O produto amplificado de uma região pequena do gen ICP4 foi submetido ao sequenciamento e quando comparado com outras sequências depositadas no Genbank mostrou os seguintes resultados: 100% de identidade com uma estirpe do virus de LTI dos Estados Unidos (JN596963.1), 99% de identidade com uma estirpe Australiana e 91% com a estirpe vacinal CEO (JN580316.1) e TCO (JN580315.1).

Relação entre vitamina D e doenças alérgicas / Vitamin D and allergic diseases

Objetivo: A vitamina D (VD) tem sido tema de diversos estudos com objetivo de determinar sua influência nos mecanismos imunológicos, incluindo os alérgicos. Esta revisão pretende apresentar o conhecimento atual, sobre a relação dos níveis séricos de vitamina D e doenças alérgicas. Fonte de dados: Artigos originais, artigos de revisão e consensos obtidos à partir da pesquisa dos termos vitamin D, allergy, asthma, rhinitis, food allergy, atopic dermatitis, no banco de dados Pubmed®, publicados nos últimos 10 anos. Os artigos mais relevantes, de acordo com o objetivo do artigo, foram utilizados. Sintese dos dados: Vários mecanismos de ação da VD sobre o sistema imunológico foram propostos. O momento em que ocorre a exposição à VD durante a vida pode ser ter efeito protetor quanto ao desenvolvimento de asma e outras doenças respiratórias. Como exemplo, filhos de mães suplementadas com VD na gestação tem menor incidência de sibilância recorrente. A VD tem participação na síntese de catelecidinas, e níveis altos destas estão relacionados à menor persistência dos sintomas de dermatite atópica. A menor exposição solar está inversamente relacionada à frequência de prescrição de adrenalina para reações anafiláticas. A VD também pode ter efeito potencializador da imunoterapia. Algumas observações, contrariando a corrente maior, demonstram que em comunidades isoladas, onde não se faz suplementação de VD, existe menor incidência de alergia alimentar. Conclusão: Evidencias epidemiológicas e experimentais demonstram a relação da VD e alergia. Estudos sobre a suplementação de VD, tanto para a prevenção primaria de alergias, quanto para a modificação da doença existente são necessários e ajudarão a melhor compreender as doenças alérgicas.

Objective: Vitamin D (VD) has been the subject of several studies aiming to determine their influence on immunological mechanisms, including allergic. This review aims to present the current knowledge on the relationship of serum vitamin D levels and allergic diseases. Data source: Original articles, review articles and consensus obtained from the search terms of vitamin D, allergy, asthma, rhinitis, food allergy, atopic dermatitis, the database Pubmed®, published in the last 10 years. The most relevant articles in accordance with the purpose of this paper were used. Data synthesis: Multiple mechanisms of action of VD on the imune system have been proposed. The moment of exposure to VD, during life, may have a protective effect on the development of asthma and other respiratory diseases. As an example, children of mothers who received supplemental RV during pregnancy have a lower incidence of recurrent wheezing. VD participates in the synthesis of cathelicidins, and high VD levels are related to the lower persistence of atopic dermatitis symptoms. The less sunlight exposure is inversely related to frequency of adrenaline prescription for anaphylactic reactions. VD may also have a potentiating effect on immunotherapy. Some contradictory observations show that in isolated communities, where there is no supplementation of VD, lower incidence of food allergy is reported. Conclusion: Epidemiological and experimental evidences demonstrate the relationship between the VD and allergy. Studies on VD supplementation, as much for allergy primary prevention, as for modification of existing disease are needed and will help the better understanding of allergic diseases.

Spectral domain optical coherence tomography findings of acute branch retinal artery occlusion from calcific embolus.

An 82-year-old female presented with sudden painless decrease in vision in the right eye after awakening. She could see the “superior half” of her vision from the right eye only. On examination, best-corrected vision was 20/300 in the right eye and 20/30 in the left eye. The fundus in the right eye revealed recent superotemporal branch retinal artery occlusion (BRAO) with calcified plaque at the disc. Spectral domain optical coherence tomography (OCT) (OTI Ophthalmic Technologies, Inc.), revealed hyperreflectivity and increased thickness of the inner retinal layers of the superior compared to the inferior retina. Imaging at the optic disc revealed the blocked artery containing a highly reflective material. The high reflectivity of the material and underlying optical shadowing could be characterized as calcific emboli.

Biotransformation of sucrose into 5-hydroxy-2-hydroxymethyl-γ-pirone by Aspergillus flavus

The sucrose hydrolysis and the preference of consumption of glucose instead of fructose were investigated for the production of 5-hydroxy-2-hydroxymethyl-γ-pyrone (HHMP) in the presence of Aspergillus flavus IOC 3974 cultivated in liquid Czapeck medium. Standardized 0.5g of pellets were transferred as inoculum into twelve conical flasks of 250 ml containing 100 ml of medium with different sucrose concentration, which was kept at 120 rpm and 28"C for 16 days without pH adjustment. Aliquots of 500μl of the broth culture were withdrawn at 24 h intervals and analyzed. The major yield of HHMP was 26g l-1 in 120g l-1 of sucrose. At these conditions, A. flavus produced an invertase capable of hydrolyzing 65 percent of total sucrose concentration in 24h, and an isomerase capable of converting fructose into glucose. In this work, it focused the preference for glucose and, then, of fructose by A. flavus and the strategy used to produce HHMP.

Foram investigadas a hidrólise da sacarose e a preferência pela glicose frente à frutose no processo de produção do 5-hidroxi-2-hidroximetil-γ-pirona (HHMP) na presença de Aspergillus flavus IOC 3974 cultivado em meio líquido Czapeck. Quantidades de 0,5g de pelletes foram utilizadas como inóculo. Doze frascos cônicos de 250 ml contendo 100 ml de meio de culturacom diferentes concentrações de sacarose foram utilizados.Os microrganismos foram cultivados a 120 rpm e 28"C por 16 dias sem ajuste do pH. O maior rendimento do HHMP foi 26g l-1em 120g l-1de sacarose. Nestas condições, A. flavus, foi capaz de produzir uma invertase possibilitando a hidrólise de 65 por cento da concentração total de sacarose em 24 horas, conjuntamente com a produção de uma isomerase que foi capaz de converter a frutose em glicose. Este trabalho está focalizado preferencialmente no consumo da glicose frente à frutose por A. flavus e na estratégia de produção do HHMP.

Produtividade de genótipos de soja sob infestação da lagarta-da-soja e de percevejos / Yield of soybean genotypes under infestation of the velvetbean caterpillar and stink bugs

Three soybean experiments, one for each maturation group (early, semi-early, and medium), were installed in the field in Assis, State of São Paulo, during the 2003/2004 growing season to evaluate damage caused by Anticarsia gemmatalis (Hubn.) and by the soybean stink bug complex, Euschistus heros (F.), Piezodorus guildinii (West.), and Nezara viridula (L.). The experiments were installed again in 2004/2005, with the exception of the early cycle group. Defoliation caused by A. gemmatalis was evaluated by the percentage estimate of leaf area cut in the first year only, due to low caterpillar infestations in 2004/2005. All three stink bug species were present in both growing seasons. In 2003/2004, E. heros was predominant over the other two; in the following year, all three species occurred in similar numbers. The productivity criterion was adopted to evaluate stink bug damage. Based on both growing seasons and mainly considering productivity, a few lines could be selected within each maturation group for new field studies or for hybridizations in breeding programs. Among the early germplasm varieties, lines IAC 98-4540, IAC 98-4576, and IAC 98-3123 can be highlighted as promising; the latter also showed little defoliation by A. gemmatalis; in the semi-early group, IAC 98-4017, IAC 98-2663, and IAC 98-4250 were prominent, with steady productivity in both years; in the medium group, IAC 98-4136, the most productive, as well as IAC 98-4140 and IAC 98-4133, all with little defoliation, can be pointed out as promising.

Cardiomyopathy and secondary mitral insufficiency: Surgical possibilities in the end-stage phase / Cardiomiopatia e insuficiência mitral secundária: Possibilidades cirúrgicas na fase avançada / Miocardiopatía e insuficiencia mitral secundaria: Posibilidades quirúrgicas en la etapa final

Background. Secondary mitral insufficiency is a strong risk factor for death in end stage cardiomyopathies. The possible correction of mitral regurgitation is now been accepted as an alternative to cardiac transplantation in a special subset of patients. We proposed a surgical approach that consists of implantation of a mitral prosthesis smaller than the annulus and preservation and traction of the papillary muscles to reduce sphericity of the left ventricle. Methods. Between December 1995 and March 2008, 132 cardiomyopathies were operated on including the following etiologies: ischemic (78), idiopathic (49), Chaga's disease (3), viral (1), and postpartum (1). The patients were analyzed according to clinical criteria, echocardiographic findings and morphology of left ventricle. Results. All patients were in an end-stage phase, requiring >2 hospital admissions over the past 3 months, despite receiving full medication. Furthermore, 8 were in intensive care unit receiving intravenous drugs or intra-aortic balloon counterpulsation, and one was in cardiogenic shock. Hospital mortality was 14.4% (19/132) yet midterm follow-up showed a relatively flat late survival curve, with evidence of improved clinical status, better echocardiographic parameters, and reduction ventricular sphericity. Conclusions. The high early mortality rate is related to other clinical conditions at the time of surgery. However, the resultant flat survival after this early interval offers a promising long-term therapeutic alternative for the treatment of patients in refractory heart failure with cardiomyopathy that is associated to moderate or severe secondary mitral regurgitation.

Introdução. A insuficiência mitral secundária é um importante fator de risco de morte na fase inicial de cardiomiopatias. A possibilidade de correção do refluxo mitral é aceito na atualidade como uma alternativa cirúrgica ao transplante em um grupo especial de pacientes. Propomos uma abordagem cirúrgica que consiste na implantação de uma prótese valvular, menor que o anel e a preservação e tração dos músculos papilares para reduzir a esfericidade do ventrículo esquerdo. Método. Entre dezembro de 1995 até março de 2008, 132 cardiomiopatias foram operadas incluindo as seguintes etiologias: isquêmicas (78), idiopática (49), Chaga's (3), viral (1) e pós-parto (1). Os pacientes foram analisados de acordo com critérios clínicos, ecocardiográficos e morfologia do ventrículo esquerdo. Resultados. Todos os pacientes estavam em fase final de insuficiência cardíaca, exigindo 2 admissões hospitalares nos últimos 3 meses a despeito de medicação plena. Ainda, 8 estavam em uso de drogas vasoativas em UTI ou sob auxilio do balão intra-aórtico. Um paciente se apresentava em choque cardiogênico. A mortalidade hospitalar foi de 14,4% (19/132). No seguimento a médio prazo a curva de sobrevivência se mostrou estável com evidencias de melhora clínica, melhores parâmetros ecocardiográficos e redução da esfericidade do ventrículo esquerdo. Conclusões. A alta mortalidade hospitalar esteve relacionada com precárias condições clínicas pré-operatórias, no entanto a estabilidade da curva de sobrevivência oferece uma expectativa boa neste grupo de pacientes com insuficiência mitral secundária nas miocardiopatias em fase final.

Introducción. La insuficiencia mitral secundaria es un fuerte factor de riesgo de muerte en la etapa final de las miocardiopatías. La posible corrección de la regurgitación mitral es actualmente aceptada como una alternativa al trasplante cardíaco en un subconjunto especial de pacientes. Propusimos un enfoque quirúrgico que consiste en la implantación de una prótesis mitral más pequeña que el anillo valvular, y la preservación y tracción de los músculos papilares para reducir la esfericidad del ventrículo izquierdo. Métodos. Entre Diciembre de 1995 y Marzo de 2008, se operaron 132 miocardiopatías que incluían las siguientes etiologías: isquémica (78), idiopática (49), chagásica (3), viral (1) y postparto (1). Se analizaron a los pacientes de acuerdo a los criterios clínicos, resultados ecocardiográficos y morfología del ventrículo izquierdo. Resultados. Todos los pacientes se encontraban en la etapa final de la enfermedad, y requirieron más de 2 hospitalizaciones en los 3 últimos meses, a pesar de recibir medicación completa. Además, 8 se encontraban en la unidad de cuidados intensivos, recibiendo drogas intravenosas o balón de contrapulsación intraaórtico, y uno estaba en shock cardiogénico. La mortalidad hospitalaria fue del 14,4% (19/132) y el seguimiento a mediano plazo (trimestral) mostró una curva de sobrevida tardía relativamente aceptable, con evidencia de un estado clínico mejorado, mejores parámetros ecocardiográficos, y reducción de la esfericidad ventricular. Conclusiones. La alta tasa de mortalidad temprana está relacionada a otras condiciones clínicas a la hora de la cirugía. De todas maneras, la sobrevida resultante luego de este temprano intervalo, ofrece una prometedora alternativa terapéutica a largo plazo para el tratamiento de pacientes en insuficiencia cardíaca refractaria con miocardiopatía asociada a regurgitación mitral secundaria moderada o severa.

Penetrating ureteral trauma

OBJECTIVE: The purpose of this series is to report our experience in managing ureteral trauma, focusing on the importance of early diagnosis, correct treatment, and the impact of associated injuries on the management and morbid-mortality. MATERIALS AND METHODS: From January 1994 to December 2002, 1487 laparotomies for abdominal trauma were performed and 20 patients with ureteral lesions were identified, all of them secondary to penetrating injury. Medical charts were analyzed as well as information about trauma mechanisms, diagnostic routine, treatment and outcome. RESULTS: All patients were men. Mean age was 27 years. The mechanisms of injury were gunshot wounds in 18 cases (90 percent) and stab wounds in two (10 percent). All penetrating abdominal injuries had primary indication of laparotomy, and neither excretory urography nor computed tomography were used in any case before surgery. The diagnosis of ureteric injury was made intra-operatively in 17 cases (85 percent). Two ureteral injuries (10 percent) were initially missed. All patients had associated injuries. The treatment was dictated by the location, extension and time necessary to identify the injury. The overall incidence of complications was 55 percent. The presence of shock on admission, delayed diagnosis, Abdominal Trauma Index > 25, Injury Severity Score > 25 and colon injuries were associated to a high complication rate, however, there was no statistically significant difference. There were no mortalities in this group. CONCLUSIONS: A high index of suspicion is required for diagnosis of ureteral injuries. A thorough exploration of all retroperitoneal hematoma after penetrating trauma should be an accurate method of diagnosis; even though it failed in 10 percent of our cases.

Polymorphism in 1908STR1934 locus of the 3. UTR of the Nramp1 bovine gene in eight cattle breeds

The Nramp1 gene has been associated with natural resistance to intracellular microorganisms in several species including bovine. Recent evidence suggests an association between polymorphism in the 3. untranslated region (3. UTR) of this gene with resistance/susceptibility (R/S) to Brucella abortus as determined in vivo and in vitro. In this study we tested for the variability of the short tandem repeat (STR) within the 3. UTR of Nramp1 in six breeds of Colombian creole cattle (CCC) and compared the genotypes with those of Holstein and Brahman, which were recently introduced into this country. In CCC as well as in Holstein we found the allele 175 fixed in all populations. In Brahman, 175 allele was also present with a frequency of 0.467 but additionally, in this breed there appeared five other alleles and among them two previously unreported: 183 y 185; also was found the allele 189 in the Colombian creole Harton del Valle cattle, which is not previously reported. Together these results suggest that the 175 allele in the 3. UTR Nramp1 may be an ancestral allele in cattle and if this is true the association previously reported with the R/S trait requires further evaluation.

Transplante cardíaco e neoplasias: experiência na Escola Paulista de Medicina da Universidade Federal de São Paulo / Cardiac transplantation and neoplasms: experiences at Escola Paulista de Medicina of the Federal University of São Paulo

OBJETIVOS: Analisar ocorrência e tipos de neoplasias que se desenvolveram em pacientes submetidos a transplante cardíaco ortotópico, no Programa de Transplante Cardíaco da Escola de Paulista de Medicina da Universidade Federal de São Paulo. MÉTODOS: O presente estudo apresenta uma análise observacional de 106 pacientes submetidos a transplante cardíaco ortotópico, no período de novembro de 1986 a setembro de 2002, que sobreviveram por período superior a trinta dias após o procedimento. O regime de imunossupressão consistiu de terapia tríplice com ciclosporina A, azatioprina e corticosteróide. Apenas dois pacientes receberam, além da terapia tríplice, a adição de ortoclone OKT-3. O período médio de acompanhamento foi de 61,4 meses. (variação de dois meses a 192 meses). RESULTADOS: Vinte e três pacientes (21,3 por cento) desenvolveram neoplasias, dos quais 56,5 por cento apresentaram neoplasia de pele, 30,1 por cento apresentaram tumores sólidos e 13,4 por cento, doença linfoproliferativa pós-transplante (DLPT). O intervalo médio entre o transplante e o diagnóstico de neoplasia foi: pele - 54,9 meses, tumores sólidos - 24,8 meses e DLPT - 70,3 meses. CONCLUSÕES: A ocorrência de neoplasias malignas foi relativamente comum na população analisada. O câncer de pele prevaleceu em relação às demais neoplasias e os tumores sólidos foram mais diagnosticados do que as doenças linfoproliferativas nessa série de pacientes.

Concurrent validity, internal consistency and responsiveness of the portuguese version of the king's health questionnaire (KHQ) in women after stress urinary incontinence surgery

OBJECTIVE: To evaluate the concurrent validity, internal consistency and responsiveness of King's Health Questionnaire (KHQ) in patients who underwent sling procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: We performed a prospective open label multicenter study in 4 tertiary referral centers. Sixty-eight female patients were enrolled with urodynamically diagnosed urinary stress incontinence. Patients were treated using surgical procedures, mostly (73 percent) with the synthetic sling procedure, which has been considered one of the gold standard methods for the treatment of urinary incontinence. The patients were assessed before and after one month of postoperative follow up, using the KHQ in its validated Portuguese version. Patients also underwent preoperative urodynamic test, Stamey incontinence grading, pad usage and the assessment of number of pads used per day. After surgery, patients underwent stress test, Stamey incontinence grading pad usage and the assessment of number of pads used per day. RESULTS: The concurrent validity showed good correlations in some domains of KHQ to clinical parameters. The internal consistency was higher after treatment compared to preoperative values. Objective parameters, such as pad usage and the assessment of number of pads used per day, had significant correlation with changes in post-treatment scores on KHQ. The responsiveness expressed in terms of standardized effect size (SES) and standardized response mean (SRM) was large. CONCLUSION: The results showed moderate concurrent validity, strong internal consistency and high responsiveness for KHQ, indicating that it is suitable for measuring outcomes in clinical trials among female patients with stress urinary incontinence.

Safyreã: a readjustable minimally invasive sling for female urinary stress incontinence

INTRODUCTION: SAFIRE TM is a readjustable and minimally invasive sling for the treatment of stress urinary incontinence (SUI). It is as a pubovaginal sling placed in the medial third of the urethra. The initial experience is described. MATERIALS AND METHODS: Forty-five patients (mean age = 59 years) underwent a SAFYRE TM implant to treat SUI. Physical examination and urodynamic study were performed before surgery. All patients presented symptoms of SUI and 20 percent also reported mild urgency. Approximately 60 percent of this group had a previously failed anti-incontinence procedure. Urethral hypermobility was diagnosed in 40 percent of the patients and intrinsic sphincter deficiency (ISD) in 60 percent of the cases. RESULTS: The average follow up period was 10 months. The mean operative time was 20 minutes. Dystopia repair was performed whenever necessary, during the same procedure. The average hospital stay was 24 hours. In 11 percent of the implants, bladder perforation occurred. During the postoperative period, 9 patients (20 percent) developed transient urgency symptoms. During the initial follow up period, 90 percent were found to be continent, 3 percent reported an improvement and 7 percent were unchanged. CONCLUSION: SAFYRE TM is a safe and quick procedure that allows postoperative readjustment. This technique may be an attractive alternative in the management of SUI, should the good result obtained so far prove to be long lasting.