Antibacterial substances from leaves of Protium spruceanum (Burseraceae): in vitro and in silico evaluation

Due to the increase of bacterial resistance, the search for new antibiotics is necessary and the medicinal plants represent its most important source. The aim of this study was to evaluate the antibacterial property of extract and fractions from Protium spruceanum leaves, against pathogenic bacteria. By means of diffusion and microdilution assays, the crude extract was active against the nine bacteria tested being the hydromethanolic fraction the most active. During phytochemical procedures, procyanidin (1) and catechin (2) were identified as the main antibacterial constituents of this fraction. In silico results obtained using PASSonline tool indicated 1 and 2 as having good potential to interact with different targets of currently used antibiotics. These results no indicated potential to none DNA effect and indicated the cell wall as mainly target. Electrophoresis result supported that had no DNA damage. Cell wall damage was confirmed by propidium iodide test that showed increased membrane permeability and by cell surface deformations observed in scanning electronic microscopy. The in vitro assays together with the in silico prediction results establish the potential of P. spruceanum as source of antibacterial compounds that acts on important bacterial targets. These results contribute to the development of natural substances against pathogenic bacteria and to discovery of new antibiotics.

Qualidade de vida e percepção estética da cárie dentária / Quality of life and aesthetic perception of dental caries / Calidad de vida y la percepción estética de la caries dental

Objetivo: Relacionar a percepção estética e a qualidade de vida relacionada à saúde bucal na presença de cárie dentária em escolares. Métodos: Estudo transversal realizado em Araraquara, São Paulo, Brasil, entre outubro de 2014 e março de 2015, com 260 escolares, de 8 a 10 anos, divididos em grupos clínicos segundo a presença de cárie dentária. Utilizaram-se questionários "Child Perceptions Questionnaire" e "Child Questionnaire About Teeth Appearence" e avaliação clínica para detecção de dentes cariados, perdidos ou obturados em dentes permanentes e decíduos. Dados analisados através do teste qui-quadrado e Mann Whitney, p ≤ 0.05. Resultados: Dos 260 escolares, 130 (50%) apresentavam a doença cárie, com maior frequência (62,0%) na faixa etária 8 anos. Variáveis socioeconômicas, como menor renda familiar e menor escolaridade da mãe, estiveram associadas ao grupo com cárie (p<0,05 e p<0,01 respectivamente). No grupo com cárie, os domínios sintomas orais (4,9 vs 6,6), bem-estar emocional (3,0 vs 4,7) e bem-estar social (2,2 vs 3,5) foram maiores que no grupo sem cárie. Com relação à percepção estética, o domínio psicológico (0,94 vs 1,27) e a percepção geral de saúde bucal (2,26 vs 2,93) se apresentaram maiores no grupo com cárie. Na regressão linear, observou-se contribuição significativa dos números de dentes permanentes cariados e o índice ceo-d (dentes decíduos cariados, extraídos e obturados) na pior percepção de qualidade de vida. Conclusão: A cárie dentária afeta negativamente a percepção estética e a qualidade de vida em crianças de 8 a 10 anos.

Objetive: To relate the aesthetic perception and the oral health-related quality of life in the presence of dental caries in schoolchildren. Methods: Cross-sectional study carried out in Araraquara, São Paulo, Brazil, from October 2014 to March 2015, with 260 schoolchildren aged 8 to 10 years, divided into clinical groups according to the presence of dental caries. The Child Perceptions Questionnaire and the Child Questionnaire About Teeth Appearance were applied and a clinical evaluation of permanent and deciduous dentition was conducted for detection of decayed, missing or filled teeth. Data was analyzed using the chi-square test and Mann-Whitney's test, p ≤ 0.05. Results: Of the 260 students, 130 (50%) had caries disease, with the highest frequency (62.0%) in 8-year-olds. Socioeconomic variables, such as lower family income and lower maternal schooling, were associated with the dental caries group (p<0.05 and p<0.01, respectively). In the dental caries group, the domains oral symptoms (4.9 vs 6.6), emotional well-being (3.0 vs 4.7) and social well-being (2.2 vs 3.5) were higher than in the caries-free group. Regarding the aesthetic perception, the psychological domain (0.94 vs 1.27) and the overall perception of oral health (2.26 vs 2.93) were higher in the group with dental caries. In the linear regression, there was a significant contribution of the number of permanent decayed teeth and the dmft (decayed, missing and filled deciduous teeth) index to the worst perception of quality of life. Conclusion: Dental caries negatively affects aesthetic perception and quality of life in 8- to 10-year-old children.

Objetivo: Relacionar la percepción estética y la calidad de vida relacionada con la salud bucal de escolares con caries dental. Métodos: Estudio transversal realizado en Araraquara, São Paulo, Brasil, entre octubre de 2014 y marzo de 2015 con 260 escolares entre 8 y 10 años que fueron divididos en grupos clínicos según la presencia de caries dental. Se utilizaron los cuestionarios "Child Perceptions Questionnaire" y "Child Questionnaire About Teeth Appearence" y la evaluación clínica para detectar los dientes con caries, los perdidos u con obturaciones en dientes permanentes y deciduos. Los datos fueron analizados a través de las pruebas Chi-cuadrado y Mann Whitney con p ≤ 0,05. Resultados: Entre los 260 escolares, 130 (50%) tenían caries con más frecuencia en la franja de edad de 8 años (62,0%). Las variables socioeconómicas como la menor renta familiar y menor escolaridad de la madre se asociaron con el grupo que tenía caries (p<0,05 y p<0,01 respectivamente). Los dominios síntomas orales (4,9 vs 6,6), el bien estar emocional (3,0 vs 4,7) y el bien estar social (2,2 vs 3,5) fueron mayores en el grupo con caries que el grupo sin caries. Respecto la percepción estética, el dominio psicológico (0,94 vs 1,27) y la percepción general de salud bucal (2,26 vs 2,93) se presentaron mayores en el grupo con caries. A partir de la regresión linear se observó la contribución significativa de los números de dientes permanentes con caries y el índice ceo-d (dientes deciduos con caries, extraídos y con obturación) para la peor percepción de calidad de vida. Conclusión: La caries dental afecta de manera negativa la percepción de la estética y la calidad de vida de niños entre 8 y 10 años.

The B-blocker carvedilol and the benznidazole modulate the cardiac immune response in the acute infection induced by Colombian strain of the Trypanosoma cruzi

BACKGROUND The infection led by Trypanosoma cruzi persists in mammalian tissues causing an inflammatory imbalance. Carvedilol (Cv), a non-selective beta blocker drug indicated to treat heart failure and antihypertensive has shown to promote antioxidant and immunomodulatory properties which might improve the inflammation induced by T. cruzi. OBJECTIVES Evaluate the role of Cv on the inflammatory response of C57BL/6 mice acutely infected with the Colombian strain of T. cruzi. METHODS Animals were infected with the Colombian strain of T. cruzi and treated with Cv (25 mg/kg/day), benznidazole (Bz) (100 mg/kg/day) or their combination. On the 28th day of infection and 23 days of treatment, the euthanasia occurred, and the heart preserved for histopathological, oxidative stress (SOD, catalase, TBARs, carbonylated proteins) and plasma (CCL2, CCL5, TNF, IL-10) analyses. Parasitaemia and survival were assessed along the infection. FINDINGS Cv decreased TBARs, but increased the mortality rate, the parasitaemia and the levels of CCL2, CCL5, catalase and the inflammatory infiltrate in the cardiac tissue. Bz led the reduction of the inflammatory infiltrate and circulating levels of oxidative stress and inflammatory mediators in the infected mice. MAIN CONCLUSIONS Our data suggest that Cv, in this experimental model using the Colombian strain of T. cruzi, caused damage to the host.

The TcI and TcII Trypanosoma cruzi experimental infections induce distinct immune responses and cardiac fibrosis in dogs

Trypanosoma cruzi infection may be caused by different strains with distinct discrete typing units (DTUs) that can result in variable clinical forms of chronic Chagas disease. The present study evaluates the immune response and cardiac lesions in dogs experimentally infected with different T. cruzi strains with distinct DTUs, namely, the Colombian (Col) and Y strains of TcI and TcII DTU, respectively. During infection with the Col strain, increased levels of alanine aminotransferase, erythrocytes, haematocrit and haemoglobin were observed. In addition, CD8+ T-lymphocytes isolated from the peripheral blood produced higher levels of interleukin (IL)-4. The latter suggests that during the acute phase, infection with the Col strain may remain unnoticed by circulating mononuclear cells. In the chronic phase, a significant increase in the number of inflammatory cells was detected in the right atrium. Conversely, infection with the Y strain led to leucopoenia, thrombopoenia, inversion of the ratio of CD4+/CD8+ T-lymphocytes and alterations in monocyte number. The Y strain stimulated the production of interferon-γ by CD4+ and CD8+ T-lymphocytes and IL-4 by CD8+ T-cells. In the chronic phase, significant heart inflammation and fibrosis were observed, demonstrating that strains of different DTUs interact differently with the host.

Características termorreguladoras no início da gestação e índices reprodutivos de matrizes suínas de diferentes ordens de parto / Thermoregulatory characteristics in early pregnancy and reproductive efficiency of sows of different parity orders

Neste estudo objetivou-se avaliar algumas características termorreguladoras no início da gestação, bem como obter alguns índices reprodutivos de matrizes suínas de diferentes ordens de parto. Matrizes de 0 a 11ª ordem de parto (98) foram divididas em nulíparas, primíparas, de segundo ao sexto parto e do sétimo ao décimo primeiro para quantificar a frequência respiratória, temperatura retal e temperatura da pele em três momentos da gestação: no dia da primeira inseminação artificial, do segundo ao quarto dia de gestação e do décimo ao décimo terceiro dia. Também calcularam-se os gradientes térmicos entre temperaturas retal e da pele (TR-TP), temperaturas retal e do ar (TR-TA) e temperaturas da pele e do ar (TP-TA). Outras 164 matrizes de 1ª a 12ª ordens de parto: primíparas, de segundo parto, do terceiro ao sétimo e do oitavo ao décimo segundo parto foram utilizadas para obter o período de gestação e número de leitões nascidos vivos. Os diferentes momentos da gestação e ordem de parto não influenciaram as médias da frequência respiratória e da temperatura da pele. Matrizes de 7ª a 11ª ordem de parto apresentaram menor média de temperatura retal que as demais ordens. Em relação aos momentos da gestação, foi observada menor temperatura retal do segundo ao quarto dia de gestação comparado ao dia da primeira inseminação e do décimo ao décimo terceiro dia de gestação. O gradiente TR-TP de leitoas foi maior em comparação às demais ordens de parto. Matrizes de 7ª a 11ª ordem de parto apresentaram valores dos gradientes TR-TA e TP-TA maiores em relação às demais ordens de parto. O gradiente TR-TP aumentou conforme se distanciou do dia da inseminação artificial e os gradientes TR-TA e TP-TA, diminuíram. Matrizes de 8ª a 12ª ordem de parto apresentaram maior período de gestação (114,87±1,55 dias) comparada aos demais grupos de ordem de parto (113,28±1,43 para primíparas; 113,09±1,77 para 2º parto e 113,83±1,33 dias para 3º ao 7º). O número de leitões nascidos vivos não diferiu entre as diferentes ordens de parto. Momentos da gestação até o 13º dia e a ordem de parto não influenciam a temperatura da pele medida pela manhã e a frequência respiratória avaliada às 14 horas. Entretanto, matrizes suínas mais velhas (7ª a 11ª ordem de parto) apresentam menor temperatura retal pela manhã e maior período de gestação. A ordem de parto não interfere no número de nascidos vivos na linhagem comercial PenArlan.

The aim of this study was to evaluate some of the thermoregulation characteristics during early pregnancy, and obtain reproductive parameters of sows of different birth orders. Sows 0-11 the parity orders (98) were divided into groups consisting of nulliparous; primiparous; sows from the second to sixth; and sows from the seventh to eleventh birth, in order to quantify the respiratory rate, rectal temperature and skin temperature at three time intervals of pregnancy: the day of first artificial insemination, the second to the fourth day of gestation and the tenth to the thirteenth day. The thermal gradients between rectal and skin temperatures (RT-ST), rectal temperatures and air (RT-AT) and skin temperatures and air (ST-AT) were also calculated. Another 164 sows from 1st to 12th parity orders were grouped as follows: primiparous, second parity, the third to the seventh, and the eighth to twelfth parity orders were used to obtain data on gestation period and number of piglets born alive. The different stages of gestation and parity orders did not influence the average respiratory rate and skin temperature. Sows of 7th to 11th parity orders showed lower mean rectal temperature than the other orders. As regards gestation times, lower rectal temperature was observed on second to fourth day of gestation compared with the first day of insemination and the tenth to the thirteenth day of gestation. The RT-ST gradient of gilts was higher compared with that of other parity orders. Sows of groups from 7th to 11th parity orders showed higher values of gradients RT-AT and ST-AT compared with other parity orders. The RT-ST gradient increased as time passed after the day of insemination, and RT-AT and ST-AT gradients decreased. Sows from 8th to 12th parity orders showed longer gestation period (114.87 ± 1.55 days) compared with the other groups of parity order (113.28 ± 1.43 for primiparous; 113.09 ± 1.77 to 2nd parity orders and 113.83 ± 1.33 days for the group from 3rd to 7th parity orders. The number of piglets born alive did not differ between the different parity orders. Time intervals of pregnancy until the 13th day and the parity orders did not influence the skin temperature measured in the morning, and respiratory rate measured at 14 hours. However, older sows (7th to 11th parity order) had a lower rectal temperature in the morning and longer gestation period. The parity order did not interfere in the number of live births in the commercial line PenArlan.

Myenteric plexus is differentially affected by infection with distinct Trypanosoma cruzi strains in Beagle dogs

Chagasic megaoesophagus and megacolon are characterised by motor abnormalities related to enteric nervous system lesions and their development seems to be related to geographic distribution of distinct Trypanosoma cruzi subpopulations. Beagle dogs were infected with Y or Berenice-78 (Be-78) T. cruzi strains and necropsied during the acute or chronic phase of experimental disease for post mortem histopathological evaluation of the oesophagus and colon. Both strains infected the oesophagus and colon and caused an inflammatory response during the acute phase. In the chronic phase, inflammatory process was observed exclusively in the Be-78 infected animals, possibly due to a parasitism persistent only in this group. Myenteric denervation occurred during the acute phase of infection for both strains, but persisted chronically only in Be-78 infected animals. Glial cell involvement occurred earlier in animals infected with the Y strain, while animals infected with the Be-78 strain showed reduced glial fibrillary acidic protein immunoreactive area of enteric glial cells in the chronic phase. These results suggest that although both strains cause lesions in the digestive tract, the Y strain is associated with early control of the lesion, while the Be-78 strain results in progressive gut lesions in this model.

Síndrome de Mayer-Rokitansky-Kuster-Hauser (SMRKH): relato de caso / Syndrome Mayer-Rokitansky-Kuster-Hauser (SMRKH): case report

Relata-se o caso clínico de paciente feminino, 46 anos de idade, que procurou, há 21 anos, atendimento médico, após várias tentativas frustradas de engravidar. Não havia levado em consideração que sua menarca não tinha acontecido, o que ocorreu talvez à sua pouca informação. Trata-se da síndrome de Mayer-Rokitansky-Kuster-Hauser. A obtenção do diagnóstico exigiu intensa propedêutica, como ultrassonografia abdominal total e pélvica endovaginal, laparotomia exploradora e urografia excretora. Não há consenso quanto ao melhor acesso terapêutico. A paciente não foi submetida a qualquer das formas terapêuticas.

We report a case of female patient, 46 years old, who began to seek medical attention at age 25, after several failed attempts to become pregnant. Still did not take into account that her menarche had not occurred. This fact is perhaps due to little information about the patient. This is the syndrome of Mayer-Rokitansky-Kuster- Hauser. Obtaining the required extensive diagnostic workup, as USG total abdominal + pelvic endovaginal, laparotomy and intravenous urography. Currently there is no consensus on the best therapeutic access. The patient was not subjected to any form of treatment.

Fatores associados ao consumo de medicamentos sem receita médicapor pessoas com Diabetes mellitus e/ou Hipertensão arterialatendidas por equipes da estratégia saúde da família / Medication use without prescription among people with diabetes mellitus and/or hypertension assisted by family health strategy teams

Introdução: A receita médica se caracteriza como meio para prover as informações necessárias ao paciente referentes à sua terapia medicamentosa. Objetivo: identificar os fatores associados ao consumo de medicamentos sem receita médica em pessoas com Diabetes Mellitus e/ou Hipertensão arterial sistêmica, moradores das áreas de abrangência das Estratégias de Saúde da Família (ESFs) de Blumenau - SC.Métodos: foi realizado um estudo epidemiológico observacional do tipo seccional, corte temporal transversal, tendo como unidade amostral pessoas com HAS e/ou DM tipo2 de 10 unidades de ESF entrevistados, no domicílio comquestionário com variáveis sociodemográficas, assistenciais e sobre a utilização de medicamentos. A variável dependentefoi uso de medicamentos sem receita. Utilizou-se estatística descritiva e testes t de Student e Qui-quadrado paraassociação com p-valor < 0,05. Resultados: Participaram doestudo 716 pessoas, das quais 488 (62,2%) eram mulheres.Foram utilizadas 2932 especialidades farmacêuticas dasquais 881 (29,9%) sem a presença da receita médica. O subgrupomais utilizado foi os Inibidores da enzima conversorade angiotensina (359; 12,3%), o medicamento mais comumfoi a Hidroclorotiazida (268, 9,1%) e a classe mais utilizadasem a presença da receita foi a dos Psicotrópicos (45,9%).Mostram-se associados ao consumo de medicamentos sema presença da receita as pessoas de maior escolaridade,tabagistas, sedentárias, que utilizavam menor quantidadede medicamentos, que não foram informadas sobre cuidadose reações adversas ao remédio e que abandonaram o tratamento. Conclusão: os resultados sugerem que o maior consumo de medicamentos sem a presença da receita está associado àquelas pessoas que cuidam menos de sua saúdee que recebem menos informação do profissional de saúdesobre seu tratamento.

Introduction: The medical prescription is a means to provide patients with information necessary to their drug therapy. Objectives: identify the factors associated with the use of drugs without a medical prescription, by patients with diabetes mellitus (DM) or systemic arterial hypertension (SAH), living in the catchment area of the Family Health Strategy (FHS) of Blumenau-SC. Methods: epidemiologic, observational, cross-sectional study, with a sample composed of type 2 DM and/or SAH patients from 10 FHS units. The participants were interviewed in their households, with a questionnaire consisting of sociodemographic, care-related and drug use variables. The dependent variable was the use of drugs without prescription. We used descriptive statistics with Student's t and chi-squared tests for association with p-value < 0.05. Results: There were 716 participants, of whom 488 (62.2%) were women. 2932 pharmaceutical preparations were used, of which 881 (29.9%) were used without medical prescription. The drug subgroup most often used was that of angiotensin-converting enzyme inhibitors (359; 12.3%). The most frequent drug was hydrochlorothiazide (268, 9,1%), and the class most frequently used without a prescription was that of the psychotropics (45.9%). The following factors were associated with the use of drugs without a medical prescription: higher schooling, smoking, sedentarism, lower amount of drug use, no information about precautions and side-effects related to drug use, and treatment drop-out. Conclusion: the results suggest that higher drug use without a medical prescription is associated with those who care less about their health, and who receive less professional information about their treatment.

Extrusão acidental de hipoclorito durante tratamento endodôntico de dente com raiz fraturada / Accidental extrusian oi hypachlarite during endadantic treatment oi tooth with freatured roat

Os autores fazem uma revisão da literatura sobre fraturas radiculares, acidentes com hipoclorito de sódio durante o tratamento endodôntico e o uso de clorexidina gel a 2% como substância auxiliar na limpeza e modelagem dos canais radiculares. Apresentam um caso clínico em que, durante um tratamento endodôntico de um dente com fratura radicular transversal no terço médio, ocorreu extrusão involuntária de hipoclorito de sódio a 1% no ligamento periodontal através da linha de fratura, provocando grande edema no tecido gengival e no lábio superior da paciente. Foi administrada medicação sistêmica e tratamento fisioterápico de urgência, e, posteriormente, foi feita uma contenção da unidade com sucessivas camadas de tiras de poliéster e resina, limpeza e modelagem do canal com o Sistema Rotatório NiTi, utilizando-se clorexidina gel a 2% como substância auxiliar da instrumentação, irrigação com soro fisiológico e colocação de hidróxido de cálcio por 30 dias. Após este período, o canal radicular foi obturado utilizando-se a técnica da Termoplastificação da Guta Percha com um termocampactador de McSpadden e cimento AHPlus. A contenção foi removida com noventa dias. O exame clínico radiográfico de proservação foi realizado após seis meses, sugerindo reparação tecidual do caso.

The authors make a revision of the literature over root fractures, accidents with sodium hypochlorite during endodontic treatment and the use of 2% gel chlorhexidine as a auxiliary substance in the cleaning and shaping to the root canais. Presents a clinical case under, during a endodontic treatment of a tooth with a transversal freatured root in the medium third, occur involuntary extrusion of sodium hypochlorite at 1% in the periodontalligament across the fre- acture line, provoking great edema in the gingival tissue and in the superior lip of the patient. Administrated systemic medication and urgency physioterapic treatment and after time maked a splinting of the tooth with successives stratuns of poliester bands and resins, cleaning and shaping of the root canal with the NiTi Rotary System, using 2% gel chlorexidine how auxi- liary substance of the instrumentation, irrigation with physiological serum and place calcium hydroxide at 30 days. After this time the root canal was obtured used the guta percha termo- plastification technique used a McSpadden guta condensor and AHPus sealer. The splinting was removed with 90 days. The clinical and radiographic follow up was maked after six months, suggest tissue reparation.

Tratamento da doença arterial coronariana em renais crônicos em diálise do Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP / Coronary artery disease treatment in dialysis patients at the Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP

FUNDAMENTO: O tratamento intervencionista da insuficiência coronariana é subempregado nos pacientes em diálise, pois há poucos estudos comprovando sua eficácia. OBJETIVO: Avaliar os resultados do tratamento intervencionista da doença arterial coronariana em pacientes tratados por diálise no HC da FMB. MÉTODOS: Foram avaliados 34 pacientes em diálise submetidos à angiografia coronariana entre set/95 e out/04, divididos de acordo com a presença ou ausência de lesão coronariana, tipo de tratamento e presença ou ausência de diabetes. Os grupos foram comparados de acordo com suas características clínicas e sobrevida. A sobrevida dos pacientes submetidos a tratamento intervencionista foi comparada à sobrevida geral dos 146 pacientes em diálise na instituição no mesmo período. O tratamento intervencionista foi indicado nas mesmas situações clínicas que na população geral. RESULTADOS: Os 13 pacientes que realizaram coronariografia e não exibiam lesões coronarianas apresentaram sobrevida de 100 por cento em 48 meses, contra 35 por cento dos 21 coronarianos no mesmo período. Os diabéticos coronarianos apresentaram sobrevida inferior aos não-diabéticos. A angioplastia exibiu pior prognóstico quando comparada à cirurgia; entretanto 80 por cento dos submetidos a angioplastia eram diabéticos. Os 17 pacientes submetidos a procedimentos de revascularização coronariana apresentaram sobrevida semelhante aos 146 pacientes gerais do serviço. CONCLUSÃO: Esta pequena casuística mostra que a revascularização miocárdica, quando indicada, pode ser realizada em pacientes em diálise. Esta conclusão é corroborada pelo índice de mortalidade semelhante nos dois extratos de pacientes: coronarianos revascularizados e pacientes em diálise de maneira geral.

BACKGROUND: Interventional treatment of coronary insufficiency is underemployed among dialysis patients. Studies confirming its efficacy in this set of patients are scarce. OBJECTIVE: To assess the results of interventional treatment of coronary artery disease in patients undergoing dialysis. METHODS: A total of 34 dialysis patients submitted to coronary angiography between September 1995 and October 2004 were divided according to presence or absence of coronary lesion, type of treatment and presence or absence of diabetes mellitus. The groups were compared according to their clinical and survival characteristics. Survival of patients undergoing interventional treatment was compared to overall survival of 146 dialysis patients at the institution in the same period. Interventional treatment was indicated to the same clinical conditions in the general population. RESULTS: Thirteen patients with no angiography coronary lesions presented a survival rate of 100 percent in 48 months as compared to 35 percent of 21 patients with coronary artery disease. Diabetic patients had a lower survival rate compared with non-diabetics. Angioplasty had a worse prognosis compared to surgery; however, 80 percent of patients undergoing angioplasty were diabetic. Seventeen patients submitted to interventional procedures presented a survival rate similar to that of the others 146 hemodialysis patients without clinical evidence of coronary disease. CONCLUSION: This small series shows that myocardial revascularization, whenever indicated, can be performed in dialysis patients. This conclusion is corroborated by similar mortality rates in two groups of patients: coronary patients submitted to revascularization and overall dialysis patients.

Enxertos e retalhos: conceitos e indicações na cirurgia plástica / Grafts and flaps: concepts and recommendations in the plastic surgery

Os autores fazem uma revisão dos principais tipos de enxertos e retalhos utilizados na cirurgia plástica, descrevendo-os e enfatizando suas aplicações tanto na cirurgia reconstrutiva como na cirurgia estética

Tumores da Papila (Ampola) de Vater / Ampulla of Vater Neoplasms

Os autores fazem uma revisão bibliográfica sobre os tumores da Papila de Vater, sua classificação, apresentação clínica, diagnóstico e estadiamento, assim como as alternativas de procedimentos cirúrgicos