Enfermedad de Rosai-Dorfman nasosinusal: actualización a propósito de un caso de obstrucción nasal progresiva / Nasosinusal Rosai-Dorfman disease: update on a case of progressive nasal obstruction

Resumen La histiocitosis sinusal con linfadenopatías masivas, conocida como enfermedad de Rosai-Dorfman (ERD), es una patología poco frecuente cuya presentación clásica consiste en el desarrollo de grandes adenopatías cervicales bilaterales indoloras. La manifestación extranodal puede involucrar compromiso cutáneo, del sistema nervioso central, hematológico, óseo, de la vía aérea, entre otros. Su diagnóstico es un desafío y requiere una evaluación completa del paciente incluyendo historia clínica, examen físico, exámenes de laboratorio, imágenes y estudio histopatológico que confirme el diagnóstico. El tratamiento debe ser individualizado para cada paciente. Las alternativas incluyen la observación, corticoides sistémicos, radioterapia, quimioterapia, inmunomoduladores y cirugía. Se presenta el caso de una paciente de 65 años con antecedente de enfermedad de Rosai-Dorfman localizada en glándulas lagrimales y linfoma no Hodgkin, que comienza con obstrucción nasal bilateral progresiva refractaria a tratamiento médico, por lo que se decide realizar cirugía, cuyo estudio histopatológico confirmó enfermedad de Rosai-Dorfman.

Abstract Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare pathology, with a classic clinical presentation of painless bilateral massive cervical lymphadenopathy. The extranodal manifestations may involve skin, central nervous system, hematological, bones, and airway compromise, among others. Its diagnosis is challenging and requires a complete evaluation of the patient including medical history, physical examination, laboratory testing, imaging and histopathological study to confirm the diagnosis. Treatment should be individualized for each patient, including follow-up, systemic corticosteroids, radiotherapy, chemotherapy, immunomodulators and surgery. We present the case of a 65-year-old patient with a history of RDD located in the lacrimal glands and lymphoma, which begins with progressive bilateral obstruction refractory to medical treatment, for which it is decided to perform surgery, whose histopathological study confirmed RDD.

Tertiary hospital sewage as reservoir of bacteria expressing MDR phenotype in Brazil / Esgoto de hospital terciário como reservatório de bactérias expressando o fenótipo MDR no Brasil

High doses of antibiotics used in hospitals can affect the microbial composition of sewers, selecting resistant bacteria. In this sense, we evaluated the antibiotic resistance profile and the multiresistant phenotype of bacteria isolated in sewage from a tertiary hospital in the interior São Paulo state, Brazil. For bacteria isolation, 10 µL of sewage samples were sown in selective culture media and the isolates were identified using VITEK-2 automatized system. The antibiotic sensitivity test was performed by disk diffusion. High percentages of resistance were found for amoxicillin, ampicillin, ceftazidime, clindamycin, vancomycin and the multidrug-resistant phenotype (MDR) was attributed to 60.7% of the isolates. Our results show bacteria classified as critical/high priority by WHO List of Priority Pathogens (Enterococcus and Staphylococcus aureus resistant to vancomycin and Enterobacteriaceae resistant to carbapenems) in hospital sewage. Therefore, the implementation of disinfection technologies for hospital sewage would reduce the bacterial load in the sewage that will reach urban wastewater treatment plants, minimizing superficial water contamination and bacterial resistance spread in the environment.

Altas doses de antibióticos utilizados em hospitais podem afetar a composição microbiana dos esgotos, selecionando bactérias resistentes. Nesse sentido, avaliamos o perfil de resistência a antibióticos e o fenótipo multirresistente de bactérias isoladas em esgoto de um hospital terciário no interior do estado de São Paulo, Brasil. Para o isolamento de bactérias, foram semeados 10 µL das amostras de esgoto em meios de cultura seletivos e os isolados foram identificados usando o sistema automatizado VITEK-2. O teste de sensibilidade aos antibióticos foi realizado por disco-difusão em ágar. Elevadas porcentagens de resistência foram encontradas para amoxicilina, ampicilina, ceftazidima, clindamicina, vancomicina e o fenótipo multirresistente (MDR) foi atribuído a 60,7% dos isolados. Nossos resultados mostram bactérias classificadas como prioridade crítica/alta pela Lista de Patógenos Prioritários da OMS (Enterococcus e Staphylococcus aureus resistentes à vancomicina e Enterobacteriaceae resistentes aos carbapenêmicos) no esgoto hospitalar. Sendo assim, implementação de tecnologias de desinfecção do esgoto hospitalar reduziriam a carga bacteriana no esgoto que chegará às estações de tratamento de esgoto urbanas, minimizando a contaminação dos ecossistemas hídricos receptores e a disseminação da resistência bacteriana no ambiente.

Tertiary hospital sewage as reservoir of bacteria expressing MDR phenotype in Brazil

Abstract High doses of antibiotics used in hospitals can affect the microbial composition of sewers, selecting resistant bacteria. In this sense, we evaluated the antibiotic resistance profile and the multiresistant phenotype of bacteria isolated in sewage from a tertiary hospital in the interior São Paulo state, Brazil. For bacteria isolation, 10 µL of sewage samples were sown in selective culture media and the isolates were identified using VITEK-2 automatized system. The antibiotic sensitivity test was performed by disk diffusion. High percentages of resistance were found for amoxicillin, ampicillin, ceftazidime, clindamycin, vancomycin and the multidrug-resistant phenotype (MDR) was attributed to 60.7% of the isolates. Our results show bacteria classified as critical/high priority by WHO List of Priority Pathogens (Enterococcus and Staphylococcus aureus resistant to vancomycin and Enterobacteriaceae resistant to carbapenems) in hospital sewage. Therefore, the implementation of disinfection technologies for hospital sewage would reduce the bacterial load in the sewage that will reach urban wastewater treatment plants, minimizing superficial water contamination and bacterial resistance spread in the environment.

Resumo Altas doses de antibióticos utilizados em hospitais podem afetar a composição microbiana dos esgotos, selecionando bactérias resistentes. Nesse sentido, avaliamos o perfil de resistência a antibióticos e o fenótipo multirresistente de bactérias isoladas em esgoto de um hospital terciário no interior do estado de São Paulo, Brasil. Para o isolamento de bactérias, foram semeados 10 µL das amostras de esgoto em meios de cultura seletivos e os isolados foram identificados usando o sistema automatizado VITEK-2. O teste de sensibilidade aos antibióticos foi realizado por disco-difusão em ágar. Elevadas porcentagens de resistência foram encontradas para amoxicilina, ampicilina, ceftazidima, clindamicina, vancomicina e o fenótipo multirresistente (MDR) foi atribuído a 60,7% dos isolados. Nossos resultados mostram bactérias classificadas como prioridade crítica/alta pela Lista de Patógenos Prioritários da OMS (Enterococcus e Staphylococcus aureus resistentes à vancomicina e Enterobacteriaceae resistentes aos carbapenêmicos) no esgoto hospitalar. Sendo assim, implementação de tecnologias de desinfecção do esgoto hospitalar reduziriam a carga bacteriana no esgoto que chegará às estações de tratamento de esgoto urbanas, minimizando a contaminação dos ecossistemas hídricos receptores e a disseminação da resistência bacteriana no ambiente.

Monitoring non-small cell lung cancer progression and treatment response through hyaluronic acid in sputum

We evaluated whether hyaluronan (HA) levels in the sputum could be used as a noninvasive tool to predict progressive disease and treatment response, as detected in a computed tomography scan in non-small cell lung cancer (NSCLC) patients. Sputum samples were collected from 84 patients with histological confirmation of NSCLC, 33 of which were in early-stage and 51 in advanced-stage disease. Patients received systemic chemotherapy (CT) after surgery (n=36), combined CT and immunotherapy (IO) (n=15), or targeted therapy for driver mutation and disease relapse (N=4). The primary end-point was to compare sputum HA levels in two different concentrations of hypertonic saline solution with overall survival (OS) and the secondary and exploratory end-points were radiologic responses to treatment and patient outcome. Higher concentrations of HA in the sputum were significantly associated to factors related to tumor stage, phenotype, response to treatment, and outcome. In the early stage, patients with lower sputum HA levels before treatment achieved a complete tumor response after systemic CT with better progression-free survival (PFS) than those with high HA levels. We also examined the importance of the sputum HA concentration and tumor response in the 51 patients who developed metastatic disease and received CT+IO. Patients with low levels of sputum HA showed a complete tumor response in the computed tomography scan and stable disease after CT+IO treatment, as well as a better PFS than those receiving CT alone. HA levels in sputum of NSCLC patients may serve as a candidate biomarker to detect progressive disease and monitor treatment response in computed tomography scans.

Tertiary hospital sewage as reservoir of bacteria expressing MDR phenotype in Brazil / Esgoto de hospital terciário como reservatório de bactérias expressando o fenótipo MDR no Brasil

High doses of antibiotics used in hospitals can affect the microbial composition of sewers, selecting resistant bacteria. In this sense, we evaluated the antibiotic resistance profile and the multiresistant phenotype of bacteria isolated in sewage from a tertiary hospital in the interior São Paulo state, Brazil. For bacteria isolation, 10 µL of sewage samples were sown in selective culture media and the isolates were identified using VITEK-2 automatized system. The antibiotic sensitivity test was performed by disk diffusion. High percentages of resistance were found for amoxicillin, ampicillin, ceftazidime, clindamycin, vancomycin and the multidrug-resistant phenotype (MDR) was attributed to 60.7% of the isolates. Our results show bacteria classified as critical/high priority by WHO List of Priority Pathogens (Enterococcus and Staphylococcus aureus resistant to vancomycin and Enterobacteriaceae resistant to carbapenems) in hospital sewage. Therefore, the implementation of disinfection technologies for hospital sewage would reduce the bacterial load in the sewage that will reach urban wastewater treatment plants, minimizing superficial water contamination and bacterial resistance spread in the environment.

Altas doses de antibióticos utilizados em hospitais podem afetar a composição microbiana dos esgotos, selecionando bactérias resistentes. Nesse sentido, avaliamos o perfil de resistência a antibióticos e o fenótipo multirresistente de bactérias isoladas em esgoto de um hospital terciário no interior do estado de São Paulo, Brasil. Para o isolamento de bactérias, foram semeados 10 µL das amostras de esgoto em meios de cultura seletivos e os isolados foram identificados usando o sistema automatizado VITEK-2. O teste de sensibilidade aos antibióticos foi realizado por disco-difusão em ágar. Elevadas porcentagens de resistência foram encontradas para amoxicilina, ampicilina, ceftazidima, clindamicina, vancomicina e o fenótipo multirresistente (MDR) foi atribuído a 60,7% dos isolados. Nossos resultados mostram bactérias classificadas como prioridade crítica/alta pela Lista de Patógenos Prioritários da OMS (Enterococcus e Staphylococcus aureus resistentes à vancomicina e Enterobacteriaceae resistentes aos carbapenêmicos) no esgoto hospitalar. Sendo assim, implementação de tecnologias de desinfecção do esgoto hospitalar reduziriam a carga bacteriana no esgoto que chegará às estações de tratamento de esgoto urbanas, minimizando a contaminação dos ecossistemas hídricos receptores e a disseminação da resistência bacteriana no ambiente.

Anorectal diseases in patients with Antiphospholipid syndrome: a cross-sectional study

Abstract Background: Hemorrhoid disease (HD) is one of the most common gastrointestinal complaints worldwide, affecting 4.4% of the general population in the United States. Since antiphospholipid syndrome (APS) may lead to intra-abdominal thrombosis, one may expect that this condition can impact the risk for HD development. Additionally, as APS patients are more prone to thrombosis and treatment with anticoagulants may increase risk of bleeding, one may also infer that rates of HD complications may be higher in this scenario. Nevertheless, no data in these regards have been published until now. The objective of the present study is to evaluate frequency of HD and describe its complications rates in antiphospholipid syndrome APS patients. Methods: We consecutively invited patients who fulfilled APS criteria to undergo proctological examination. After examination, patients were divided in two groups, based on the presence of HD, and compared regarding different clinical manifestations and antiphospholipid profile. We performed the analysis of the data, using chi-square and Mann Whitney U when applicable and considering a significance level of 0.05. Multivariate regression analysis included age and variables with p < 0.10 in the bivariate analysis. Results: Forty-one APS patients agreed to undergo proctological examination. All were female and overall median age was 43 (36-49). Seventeen (41.4%) patients were diagnosed with HD, with the following frequency distribution: 7 internal (41.2%), 4 external (23.5%) and 5 mixed hemorrhoids (29.4%). Of the internal hemorrhoids, 5 patients were classified as grade I (71.4%), 1 grade II (14.3%), and 1 grade IV (14.3%). Prior gestation ( p = 0.067) and constipation ( p = 0.067) correlated with a higher frequency of HD. In multivariate analysis, constipation remained as an important risk factor (OR 3.92,CI95% 1.03-14.2, p = 0.037). Five out of 17 patients (29.4%) reported anal bleeding, but it did not correlate with warfarin dose ( p = 0.949). Surgical treatment was indicated for 10 patients (58.8%). Other anorectal findings were anal fissure, plicoma, condyloma and one chlamydial retitis. Conclusion: We found an unexpected high frequency of hemorrhoids in APS patients, with a great proportion requiring surgical treatment.(AU)

Reacción granulomatosa a cuerpo extraño en punta y dorso nasal por materiales de relleno: presentación de un caso clínico y revisión de la literatura / Granulomatous foreign body reaction in tip and nasal dorsum due to filling materials: presentation of a clinical case and review of the literature

RESUMEN Paciente de 29 años con antecedente de tres rinomodelaciones en la punta nasal con ácido hialurónico hace cinco años, evaluada por deseo de mejora estética nasal y obstrucción nasal. Al examen visual se observó una leve giba osteocartilaginosa, punta bulbosa, narinas simétricas, sin laterorrinea, no se palparon masas ni nodulaciones. Posterior al manejo de su rinitis y previo consentimiento informado, al realizar rinoseptoplastía abierta se encontró gran cantidad de tejido granulatorio tipo cuerpo extraño en la punta y dorso nasal lo que obligó a cambiar el plan quirúrgico. La biopsia diferida confirmó granuloma por cuerpo extraño por biopolímero derivado de la silicona. Evolucionó satisfactoriamente estética y funcionalmente. La rinomodelación ha aumentado en los últimos años, aunque no existen rellenos faciales aprobados por la FDA para uso nasal. La correcta utilización de los rellenos nasales continúa siendo un tema controvertido. Los granulomas nasales por cuerpo extraño son complicaciones tardías que se han incrementado con el uso de biopolímeros con dosis y técnicas inadecuadas. El uso de ecotomografía ha contribuido a mejorar la planificación quirúrgica, así como el estudio histológico diferido ha permitido identificar el material utilizado en la mayoría de los casos convirtiéndose en el estándar de oro.

ABSTRACT A 29-year-old patient with a history of three nasal fillings in the nasal tip with hyaluronic acid five years ago, reason for consultation improvement nasal aesthetics and nasal obstruction. Physical examination showed a slight osteocartilaginous hump, bulbous tip, symmetrical nostrils, no deviation nasal pyramid, no masses or nodules were palpated. After the management of his rhinitis and previous informed consent, when performing open rhinoseptoplasty, a large amount of foreign body type granulation tissue was found in the tip and nasal dorsum, which forced the surgical plan to change. The post-surgical biopsy showed foreign body granuloma by biopolymer derived from silicone. Evolved satisfactorily aesthetically and functionally. The use of nasal fillers has increased in recent years, although there are no facial fillers approved by the FDA for nasal use. The correct use of nasal fillers is a controversial issue. Nasal granulomas by foreign body are late complications that have increased with the use of biopolymers with inadequate doses and techniques. The use of ecotomography has contributed to improve the surgical planning; the deferred histological study has allowed to identify the material used in most cases becoming the gold standard

The life cycle of Neotropical ground beetle, Abaris basistriata (Coleoptera: Carabidae) reared on different substrates / Ciclo de vida do besouro de solo Neotropical, Abaris basistriata (Coleoptera: Carabidae) criado em diferentes substratos

Abstract Carabids are recognized worldwide as biological control agents of agricultural pests. The objective was to compare the life cycle of Abaris basistriata Chaudoir (Coleoptera: Carabidae) on three substrates: soil, fine vermiculite, or paper napkins. The biological cycle of A. basistriata presented different durations in soil and paper. The viability of eggs and larvae survival of the first and second instars were similar on all three substrates, while the third instar and pupa in the soil presented higher survival when compared with vermiculite and paper. The soil substrate was more favorable for the longevity of the carabid beetle. Abaris basistriata showed a shorter pre-oviposition period and a higher oviposition and post-oviposition period in the soil. Fecundity and fertility were higher when A. basistriata was reared on soil. The soil was most favorable substrate for rearing of A. basistriata in the laboratory. This information may make this species useful for the biological control.

Resumo Os carabídeos são reconhecidos mundialmente como agentes de controle biológico de pragas agrícolas. O objetivo foi comparar o ciclo de vida de Abaris basistriata Chaudoir (Coleoptera: Carabidae) em três substratos: solo, vermiculita fina, ou guardanapos de papel. O ciclo biológico de A. basistriata apresentou diferentes durações no solo e no papel. A viabilidade dos ovos e a sobrevivência das larvas do primeiro e segundo instares foram semelhantes nos três substratos, enquanto que o terceiro instar e a pupa apresentaram maior sobrevivência no solo quando comparados com vermiculita e papel. O substrato solo foi mais favorável à longevidade do carabídeo. Abaris basistriata mostrou menor período de pré-oviposição e maior período de oviposição e pós-oviposição no solo. A fecundidade e a fertilidade foram maiores quando A. basistriata foi criado no solo. O solo foi o substrato mais favorável para a criação de A. basistriata no laboratório. Estas informações são importantes e podem tornar essa espécie útil para o controlo biológico.

Rinoseptoplastía: experiencia de 3 años en la Pontificia Universidad Católica de Chile / Rhinoseptoplasty: three-year experience at the Pontificia Universidad Católica de Chile

RESUMEN Introducción: La rinoseptoplastía es una cirugía compleja y desafiante. Permite resolver problemas estéticos y funcionales de la nariz. Objetivo: Describir la experiencia en rinoseptoplastías realizadas en el Comité de Nariz en nuestro centro. Material y método: Estudio descriptivo de pacientes sometidos a rinoseptoplastía entre 2013 y 2015. Resultados: Se operaron 265 pacientes en 3 años, 164 (61,8%) fueron mujeres y la edad promedio fue de 29 años (rango 13-73). Las cirugías fueron principalmente primarias (secundarias: 2,6%). El abordaje más utilizado fue abierto (92,5%). Se realizó trabajo de punta nasal en 253 (95,5%) pacientes; resección del dorso osteocartilaginoso en 252 (95,1%), y aumento de éste en sólo 5 (1,9%). Las osteotomías fueron frecuentes: paramedianas en 229 (86,4%), percutánea lateral bilateral en 217 (81,9%) y percutánea lateral unilateral en 17 (6,4%). El vástago columelar fue el injerto de punta más frecuentemente utilizado, en 241 (90,9%) pacientes, seguido del escudo en 69 (26,0%). En el dorso, se utilizaron autoespaciadores en 124 (46,7%) pacientes, y espaciadores en 109 (41,1%). Conclusiones: El abordaje abierto fue el más frecuente, demostrando ser favorable en nuestro centro por la exposición y aprendizaje de nuestros residentes. Se constató 2,6% de cirugías secundarias. Se destaca el uso de vástago columelar para otorgar soporte a la punta nasal dada la alta prevalencia de nariz hispana en nuestro centro.

ABSTRACT Introduction: Rhinoseptoplasty is a complex and challenging surgery. It addresses nasal aesthetics and functionality. Aim: To describe the experience in rhinoseptoplasty performed by the Nose Committee at our medical center. Material and method: Descriptive study, of the all rhinoseptoplasties performed by the Nose Committee between 2013 and 2015. Results: 265 patients underwent surgery in the 3-year period; 164 (61.8%) were women and the mean age was 29 years (range 13-73). Most were primary surgeries (secondary: 2.6%). An external approach was most commonly used (92.5%). Nasal tip surgery was performed in 253 (95.5%) patients; osteocartilaginous dorsum reduction in 252 (95,1%), and augmentation in only 5 (1,9%). Osteotomies were frequent: paramedian in 229 (86.4%), bilateral percutaneous lateral osteotomies in 217 (81.9%) and unilateral percutaneous lateral in 17 (6.4%). Regarding nasal tip grafts, columellar strut was most often used, in 241 (90,9%) patients, followed by the shield graft in 69 (26,0%). For the dorsum, autospreaders were used in 124 (46.7%), and spreader grafts in 109 (41.1%). Conclusions: Open rhinoseptoplasty was the most commonly used approach. This has shown favorable for residents due to better exposition of nasal anatomy. Only 2.6% were secondary rhinoseptoplasties. We emphasize the use of the columellar strut for nasal tip support as we frequently encounter hispanic noses at our center.

Parâmetros citológicos e bioquímicos do líquido cefalorraquidiano coletado de bovinos sadios em dois momentos, com intervalo de 96 horas / Cerebrospinal fluid cytological and biochemical values of healthy cattle in two sampling times with an interval of 96 hours

A análise do líquido cefalorraquidiano (LCR) é uma importante ferramenta no diagnóstico das doenças neurológicas dos bovinos. A coleta do LCR em diferentes momentos facilita o monitoramento do quadro clínico e/ou a avaliação da eficácia de tratamentos estabelecidos. Todavia, os efeitos de coletas consecutivas sobre os parâmetros citológicos e bioquímicos do LCR de bovinos saudáveis ainda não foram analisados. Dessa forma, o objetivo do presente estudo foi avaliar potenciais diferenças citológicas e bioquímicas no LCR de bovinos sadios, obtidos em dois momentos, com intervalo de 96 horas. O LCR foi submetido à análise citológica e à determinação do teor de proteína total. Na segunda coleta, verificou-se aumento significativo da celularidade, porém ainda dentro do intervalo de referência para a espécie, diminuição de linfócitos e elevação de células mononucleares em relação à primeira coleta. No entanto, os números de hemácias (/µL), células nucleadas (/µL), neutrófilos (%), eosinófilos (%) e a concentração da proteína total (mg/dL) continuaram dentro dos valores de referência 96 horas após a realização da primeira punção. Conclui-se que os procedimentos de coleta de LCR consecutivos não provocaram inflamação local detectável 96 horas após a primeira punção, o que sugere que, quando necessário, coletas de LCR seriadas, por si só, não interfeririam nos resultados do exame.(AU)

The analysis of cerebrospinal fluid (CSF) is important for the diagnosis of neurological diseases in cattle. However, the effect of consecutive collections on the cytological and biochemical parameters of the CSF has not been evaluated yet. The objective of the present study was to evaluate potential differences on the cytological and biochemical analysis of CSF obtained from healthy cattle at two sampling times with 96 hours of interval in between. Total and differential cell counts, and total protein concentration were analyzed in the CSF. Increased cellularity and significant reduction of lymphocyte and elevated numbers of mononuclear cells were observed on the second collection. However, erythrocyte count (/µl), total leukocyte count (/µl), neutrophils (%), eosinophils (%) and total protein concentration (mg/dl) remained within the reference range 96 hours after the completion of the first puncture. In conclusion, consecutive CSF collections cause no detectable local inflammation 96 hours after the first puncture suggesting that repeated collections do not interfere in the CSF results.(AU)

Economic valuation of the ecosystem services provided by a protected area in the Brazilian Cerrado: application of the contingent valuation method / Valoração econômica de serviços ecossistêmicos fornecidos por uma área protegida no Cerrado brasileiro: aplicação do método de valoração contingente

Abstract Considering that the economic valuation of ecosystem services is a useful approach to support the conservation of natural areas, we aimed to estimate the monetary value of the benefits provided by a protected area in southeast Brazil, the Serra do Cipó National Park. We calculated the visitor's willingness to pay to conserve the ecosystems of the protected area using the contingent valuation method. Located in a region under intense anthropogenic pressure, the Serra do Cipó National Park is mostly composed of rupestrian grassland ecosystems, in addition to other Cerrado physiognomies. We conducted a survey consisting of 514 interviews with visitors of the region and found that the mean willingness to pay was R$ 7.16 year-1, which corresponds to a total of approximately R$ 716,000.00 year-1. We detected that per capita income, the household size, the level of interest in environmental issues and the place of origin influenced the likelihood that individuals are willing to contribute to the conservation of the park, as well as the value of the stated willingness to pay. This study conveys the importance of conserving rupestrian grassland and other Cerrado physiognomies to decision makers and society.

Resumo Dado que a valoração econômica de serviços ecossistêmicos é uma abordagem útil para incentivar a conservação de áreas naturais, tivemos como objetivo estimar o valor monetário dos benefícios fornecidos por uma área protegida no sudeste do Brasil, o Parque Nacional da Serra do Cipó. Calculamos a disposição a pagar dos visitantes pela conservação dos ecossistemas abrangidos pela área protegida, usando o método da valoração contingente. Localizado em uma região que sofre intensa pressão antrópica, o Parque Nacional da Serra do Cipó é composto majoritariamente por campos rupestres, além de outras fitofisionomias do Cerrado. Realizamos 514 entrevistas com os visitantes da região e encontramos uma disposição a pagar média de R$ 7,16 ano-1, o que corresponde ao total de aproximadamente R$ 716.000,00 ano-1. Detectamos que renda per capita, número de dependentes, nível de interesse por temas relacionados ao meio ambiente e local de origem influenciam a probabilidade de o indivíduo estar disposto a contribuir para a conservação do parque, assim como o valor da disposição a pagar declarada. Este estudo atrai atenção dos tomadores de decisão e da sociedade para a importância de se conservar os campos rupestres e outras fitofisionomias do Cerrado.

Retrospective study of Bovine herpesvirus 5 meningoencephalitis in cattle from São Paulo State, Brazil / Estudo retrospectivo de meningoencefalite por herpesvírus bovino-5 em bovinos do estado de São Paulo, Brasil

Meningoencephalitis caused by Bovine herpesvirus 5 (BoHV-5) is an important neurological disease that affects Brazilian cattle herds. The present study investigated the presence of BoHV-5 DNA in cattle diagnosed with meningoencephalitis at Faculdade de Medicina Veterinária e Zootecnia, UNESP - Univ Estadual Paulista from 1980 to 2009. The records obtained from the Large Animal Internal Medicine Service and the Animal Pathology Service were reviewed to identify clinical and epidemiological data from cattle with neurological signs. Excluding rabies cases, we found 115 cases of cattle with neurological signs that had been necropsied. Non-suppurative meningoencephalitis was diagnosed in 28 animals of the 115 initially selected based on histopathological examination of brain tissues. Of these 28 animals, 15 (54%) were positive for BoHV-5 DNA by polymerase chain reaction (PCR) of formalin-fixed paraffin-embedded (FFPE) brain samples. PCR target was 159-bp fragment from the BoHV-5 glycoprotein C gene. The oldest case identified in the present study was from 1988. PCR was a good tool for the diagnosis of BoHV-5 DNA extracted from FFPE tissues, allowing retrospective studies of samples stored for more than 20 years.(AU)

A meningoencefalite por herpesvírus bovino-5 (BoHV-5) é uma doença neurológica importante no rebanho bovino brasileiro. Este estudo tem por objetivo verificar a presença do DNA de BoHV-5 em bovinos diagnosticados com meningoencefalite na Faculdade de Medicina Veterinária e Zootecnia da Universidade Estadual Paulista, entre os anos de 1980 e 2009. Foram revisados os arquivos do Serviço de Clínica de Grandes Animais e da Patologia Animal em busca dos dados clínicos e epidemiológicos de bovinos com sinais neurológicos. Excluídos os casos de raiva, foram encontrados 115 casos de bovinos com sinais neurológicos, que foram necropsiados. O exame histopatológico realizado nos tecidos encefálicos desses animais constatou lesões de meningoencefalite não supurativa em 28 animais. Destes, em 15 (54%) casos foi identificada a presença do DNA de BoHV-5 por meio de PCR realizada em amostras de tecido encefálico fixadas em formalina e incluídas em parafina (FFPE). O alvo da PCR foi um fragmento de 159 pb do gene da glicoproteína C do BoHV-5. O caso mais antigo identificado neste estudo foi de 1988. A PCR apresentou-se como boa ferramenta para o diagnóstico do DNA de BoHV-5 extraído de tecidos FFPE, possibilitando estudos retrospectivos e diagnóstico de amostras com mais de 20 anos de armazenamento.(AU)

The life cycle of Neotropical ground beetle, Abaris basistriata (Coleoptera: Carabidae) reared on different substrates

Abstract Carabids are recognized worldwide as biological control agents of agricultural pests. The objective was to compare the life cycle of Abaris basistriata Chaudoir (Coleoptera: Carabidae) on three substrates: soil, fine vermiculite, or paper napkins. The biological cycle of A. basistriata presented different durations in soil and paper. The viability of eggs and larvae survival of the first and second instars were similar on all three substrates, while the third instar and pupa in the soil presented higher survival when compared with vermiculite and paper. The soil substrate was more favorable for the longevity of the carabid beetle. Abaris basistriata showed a shorter pre-oviposition period and a higher oviposition and post-oviposition period in the soil. Fecundity and fertility were higher when A. basistriata was reared on soil. The soil was most favorable substrate for rearing of A. basistriata in the laboratory. This information may make this species useful for the biological control.

Resumo Os carabídeos são reconhecidos mundialmente como agentes de controle biológico de pragas agrícolas. O objetivo foi comparar o ciclo de vida de Abaris basistriata Chaudoir (Coleoptera: Carabidae) em três substratos: solo, vermiculita fina, ou guardanapos de papel. O ciclo biológico de A. basistriata apresentou diferentes durações no solo e no papel. A viabilidade dos ovos e a sobrevivência das larvas do primeiro e segundo instares foram semelhantes nos três substratos, enquanto que o terceiro instar e a pupa apresentaram maior sobrevivência no solo quando comparados com vermiculita e papel. O substrato solo foi mais favorável à longevidade do carabídeo. Abaris basistriata mostrou menor período de pré-oviposição e maior período de oviposição e pós-oviposição no solo. A fecundidade e a fertilidade foram maiores quando A. basistriata foi criado no solo. O solo foi o substrato mais favorável para a criação de A. basistriata no laboratório. Estas informações são importantes e podem tornar essa espécie útil para o controlo biológico.

Prebiótico, probiótico e simbiótico para larvas de Trichogaster leeri (Bleeker, 1852, Perciformes, Osphronemidae) / Prebiotic, probiotic and symbiotic for Trichogaster leeri larvae (Bleeker, 1852, Perciformes, Osphronemidae)

Avaliou-se a suplementação de prebiótico (mananoligossacarídeo - 2g/kg), probiótico (Bacillus subtilis, Cohn, 1872, Bacillales, Bacillaceae - 2g/kg) e simbiótico (mananoligossacarídeo - 2g/kg + B. subtilis - 2g/kg), em rações para larvas de Trichogaster leeri (Bleeker, 1852, Perciformes, Osphronemidae), durante a transição alimentar, sobre o crescimento, a sobrevivência, a morfometria intestinal e a resistência ao estresse por exposição aérea. Para isso, 420 larvas (0,45±0,05mg) foram distribuídas em 20 aquários (3,5L), em delineamento inteiramente ao acaso, com cinco tratamentos e quatro repetições, durante 28 dias, a saber: 12 dias de alimento vivo (AV) + oito dias de coalimentação (AV + ração controle) + oito dias de ração controle; 12 dias de AV + oito dias de coalimentação (AV + ração prebiótico) + oito dias de ração prebiótico; 12 dias de AV + oito dias de coalimentação (AV + ração probiótico) + oito dias de ração probiótico; 12 dias de AV + oito dias de coalimentação (AV + ração simbiótico) + oito dias de ração simbiótico; 28 dias de AV. Larvas que receberam apenas AV apresentaram resultados de desempenho zootécnico significativamente superiores às larvas dos demais tratamentos, exceto para taxa de crescimento específico em comprimento e sobrevivência, que foram semelhantes aos resultados obtidos por larvas que receberam rações suplementadas com simbiótico. Larvas que receberam a ração controle apresentaram resultados significativamente inferiores para altura das vilosidades intestinais e taxa de resistência ao estresse comparando-se aos demais tratamentos. Os resultados deste estudo indicam que a suplementação com prebiótico, probiótico e simbiótico exerce efeito positivo sobre a sobrevivência, a morfometria intestinal e a resistência ao estresse em larvas de T. leeri, no entanto somente a suplementação com simbiótico resulta em melhora no crescimento.(AU)

The prebiotic (mannan oligosaccharide - 2g/kg), probiotic (Bacillus subtilis Cohn, 1872, Bacillales, Bacillaceae - 2g/kg) and symbiotic (mannan oligosaccharide - 2g/kg + Bacillus subtilis - 2g/kg) supplementation in diets during food transition in Trichogaster leeri (Bleeker, 1852, Perciformes, Osphronemidae) larvae on growth, survival, intestinal morphology and stress resistance to air exposure was evaluated. For this, 420 larvae (0.45±0.05mg) were distributed in 20 aquaria (3.5L) in a completely randomized design with five treatments and four replications for 28 days, namely: 12 days of live food (LF) + eight days of co-feeding (LF + control diet) + eight days of control diet; 12 days of LF + eight days of co-feeding (LF + prebiotic feed) + eight days of prebiotic feed; 12 days of LF + eight days of co-feeding (LF + probiotic feed) + eight days of probiotic feed; 12 days of LF + eight days of co-feeding (LF + symbiotic feed) + eight days symbiotic feed; 28 days of LF. Larvae fed only LF showed growth performance significantly higher than the larvae of other treatments, except for specific growth rate in length and survival that were similar to the results obtained by larvae fed diets symbiotically supplemented. Larvae fed the control diet showed significantly lower results for height of intestinal villi and stress resistance rate comparing to other treatments. The results of this study indicate that prebiotic, probiotic and symbiotic supplementation has a positive effect on survival, intestinal morphology and resistance to stress in larvae of T. leeri, however, only symbiotic supplementation results in improved growth.(AU)

Laringitis fúngica en pacientes inmunocompetentes / Fungal laryngitis in immunocompetent patients

Introducción: La laringitis fúngica es una patología poco planteada en pacientes inmunocompetentes, sin embargo se debería tener en consideración en el diagnóstico diferencial de leucoplaquias en estos pacientes, más aún con factores predisponentes como reflujo faringolaríngeo, tabaquismo crónico y/o uso de corticoides. Objetivo: Presentar una serie de casos de pacientes inmunocompetentes con diagnóstico clínico de laringitis fúngica y tratamiento antimicótico empírico. Describir la asociación con factores predisponentes claves. Material y método: Estudio retrospectivo que incluyó a 11 pacientes con diagnóstico clínico de laringitis fúngica por correlación de la clínica, factores predisponentes y hallazgos en la videoestroboscopía laríngea (leucoplaquias múltiples en los pliegues vocales) sumado a la respuesta a tratamiento empírico con fluconazol oral. Se realizó además una revisión de la literatura disponible hasta el año 2015. Resultados: Todos los diagnósticos fueron clínicos correlacionando síntomas con hallazgo de leucoplaquias características en la laringe. El principal factor asociado fue el reflujo faringolaríngeo (91%) seguido por uso de corticoides (55%). Todos los pacientes fueron tratados con un esquema empírico de fluconazol oral por 14-21 días. El 100% de los pacientes respondió de forma exitosa al uso de este fármaco con remisión de los síntomas y de las lesiones laríngeas. Conclusión: El diagnóstico clínico y tratamiento con fluconazol oral como tratamiento de primera línea generarían buena tasa de respuesta, siempre que se correlacionen los síntomas y signos del paciente con los hallazgos encontrados en la laringe.

Introduction: The fungal laryngitis is an unusual disease in immunocompetent patients, however should take into consideration in the differential diagnosis of leukoplakias, especially in patients with predisposing factors such as pharyngolaryngeal reflux, use of inhaled, oral or intravenous corticosteroids. Aim: Describe a series of cases of fungal laryngitis in immunocompetent patients with clinical diagnosis and empirical antifungal treatment. In addition, finding the association with predisposing factors keys. Material and method: Retrospective study of 11 patients with diagnosis of fungal laryngitis according to clinical presentation, predisposing factors and findings in the laryngeal videostroboscopy (vocal folds leukoplakias) joined the response to empirical treatment with oral fluconazole. Also an extensive literature review was conducted until 2015. Results: The main predisposing factor was the pharyngolaryngeal reflux (91%) followed by use of corticosteroids (55%). All patients were treated empirically with fluconazole for 14-21 days. 100% of patients responded successfully, with remission of symptoms and laryngeal lesions. Conclusion: Clinical diagnosis and treatment with fluconazole as first-line treatment generate good response rate, provided that the patient's symptoms and signs with the findings in the larynx are correlated.

Mites occurrence on Pachira aquatica Aubl. including aspects of external mouthpart morphology of Brachytydeus formosa (Acari: Tydeidae) / Ocorrência de ácaros em Paquira aquatica Aubl. incluindo aspectos morfológicos do aparato bucal de Brachytydeus formosa (Acari: Tydeidae)

Abstract Pachira aquatica Aubl. is commonly used as an ornamental plant in urban areas of Brazil. The objective of the study was to investigate the occurrence of mites on P. aquatica, with emphasis on Brachytydeus formosa (Cooreman), and to describe aspects the external features of its mouthpart. The study was conducted in 2012 in Jaboticabal, State of São Paulo, Brazil. Ten trees of P. aquatica were selected for the experiment. Approximately 130 leaflets were collected from each tree, which were located in different quadrants (north, south, east, and west) and strata (upper, middle, and lower). The leaflets were placed in paper bags and transported to the laboratory. The mites were prepared on optical microscope slides. A total of eleven species of mites were found, belonging to eight different families. The species and genera of the organisms included B. formosa, Eutetranychus banksi (McGregor), Agistemus sp., Tyrophagus putrescentiae (Schrank, 1781), Brevipalpus phoenicis (Geijskes), Brevipalpus sp., Cheletogenes sp., Iphiseiodes zuluagai Denmark & Muma, Euseius sp., Neoseiulus sp., and only one specimen from the Bdellidae family. The predominant species was B. formosa, with 8,142 mites equally distributed among the four quadrants and mostly in the middle and upper strata of the plant. B. formosa mites from leaflets of P. aquatica were separated for the study of the external mouthpart morphology by scanning electron microscopy (SEM).

Resumo Pachira aquatica Aubl. é frequentemente utilizada como planta ornamental em áreas urbanas no Brasil. O objetivo do trabalho foi conhecer os ácaros associados a P. aquatica com ênfase em Brachytydeus formosa (Cooreman), bem como descrever alguns aspectos morfológicos do seu aparato bucal. O estudo foi realizado em 2012, em Jaboticabal, estado de São Paulo, Brasil. Foram selecionadas dez árvores de P. aquatica para realização do experimento. Cerca de 130 folíolos foram coletados de cada árvore localizados em diferentes quadrantes (norte, sul, leste e oeste) e estratos (superior, médio e inferior). Os folíolos foram colocados em sacos de papel e transportados para o laboratório. Os ácaros foram preparados em lâminas de microscopia óptica. No total foram encontradas onze espécies de ácaros, pertencentes a oito famílias. As espécies encontradas foram B. formosa, Eutetranychus banksi (McGregor), Agistemus sp., Tyrophagus putrescentiae (Schrank, 1781), Brevipalpus phoenicis (Geijskes), Brevipalpus sp., Cheletogenes sp., Iphiseiodes zuluagai Denmark & Muma, Euseius sp., Neoseiulus sp., e apenas um exemplar da família Bdellidae. A espécie predominante foi B. formosa, com 8.142 ácaros igualmente distribuídos nos quatro quadrantes e principalmente nos estratos médio e superior da planta. Ácaros de B. formosa dos folíolos de P. aquatica foram separados para o estudo da morfologia externa do aparato bucal utilizando-se microscopia eletrônica de varredura (SEM).

Fibroma osificante juvenil, presentación de un caso clínico y revisión de la literatura / Juvenil ossifying fibroma, case report and review of the literature

Se presenta el caso de una paciente de seis años, de sexo femenino sin antecedentes mórbidos ni familiares de importancia, quien consulta por proptosis izquierda en abril de 2011. Se realiza resonancia magnética de cerebro evidenciándose un tumor de seno etmoidal con compromiso de órbita izquierda que ocasiona exoftalmo. La biopsia endoscópica nasal fue compatible con fibroma osificante juvenil. Posteriormente se realiza antrostomía con etmoidectomía en dos tiempos, con resultados satisfactorios para la paciente. Aunque el fibroma osificante juvenil es un tipo de lesión benigna poco frecuente, puede llegar a ser muy agresiva y con una alta tasa de recidiva en ciertas ocasiones, por lo que se debe tener en cuenta para realizar un diagnóstico y tratamiento precoz, con un seguimiento programado a largo plazo.

This paper presents the case of a patient of six years old female without background or important morbidly in her family, who consults for left-sided proptosis in April of 2011. It performs brain magnetic resonancebeing demonstrated a tumor of theethmoid sinus with commitment to the left orbit that causes exophthalmus. Nasal endoscopic biopsy was compatible with juvenile ossifying fibroma. It was subsequently performed ananthrostomy whitethmoidectomy in two times, with satisfactory results for the patient. Although the Juvenile ossifying fibroma is a rare type of benign lesion, can be very aggressive and have a high recurrence rate in certain occasions, by what should be taken into account to make an early diagnosis and treatment, with a scheduled follow up in the long term.

Atresia de coanas, revisión y una mirada desde la evidencia / Choanal atresia, review and a look from the evidence

La atresia de coanas es la anomalía congénita nasal más común. Cuando es bilateral, se presenta con dificultad respiratoria desde el nacimiento. La atresia unilateral se manifiesta con insuficiencia ventilatoria y rinorrea unilateral, pudiendo pasar inadvertida. El diagnóstico se sospecha ante la ausencia de paso de aire en las fosas nasales y la imposibilidad de hacer progresar una sonda nasogástrica. Se confirma mediante examen endoscópico y tomografía computarizada. El tratamiento definitivo es quirúrgico, existiendo diferentes técnicas y vías de abordaje. Se presenta una revisión de la literatura, con especial énfasis en el tratamiento pos-quirúrgico con stents y mitomicina-C a través de una mirada desde la evidencia.

Choanal atresia is the most common congenital nasal anomaly. When bilateral, it presents with respiratory distress at birth. Unilateral atresia is manifested by respiratory failure and unilateral rhinorrhea, and may go along unnoticed. Diagnosis is suspected in the absence of airflow in the nasal cavity and for the inability to advance a nasogastric tube. Diagnosis is confirmed by endoscopic examination and computed tomography. The definitive treatment is surgical, and there are different techniques and surgical approaches. A review of the literatureis presented, with special emphasis onthepost-surgical treatmentwithstents and Mitomycin-Cview from the evidence.

Síndrome de Lemierre, secundario a otitis media aguda: revisión a partir de un caso / Lemierre syndrome secondary to acute otitis media: review from a case

El síndrome de Lemierre (SL), una grave complicación, generalmente de las infecciones orofaríngeas. Se caracteriza por una inflamación agresiva del espacio parafaríngeo lateral, aparición de tromboflebitis de la vena yugular interna y el desarrollo de émbolos sépticos a distancia. Con un diagnóstico clínico y radiológico para su confirmación y posterior seguimiento, debe ser tratado con antibioterapia precoz y parenteral, además de debridación, drenaje quirúrgico de las posibles colecciones purulentas que presente y eventual anticoagulació. En el siguiente trabajo, reportamos el caso de un paciente con esta rara, pero nuevamente emergente entidad, en donde se profundiza su estudio y se resume la literatura.

Lemierre's syndrome (SL), generally, a serious complication of the oropharyngeal infections.Its characterized by an aggressive inflammation of the lateral parapharyngeal space, thrombophlebitis of the yugular internal vein and metastasic abscesses in different organs. With a clinical and radiological diagnosis for his confirmation and later follow-up, it must be treatedwith iv antibiotics and surgical drainage of the possible purulent collections that he presentsand eventual anticoagulation. In the following work, we bring the case of a patient with this rare, but again emergent entity, where his study is deepened and the literature is summarized.

Estratégia de coalimentação na sobrevivência e no crescimento de larvas de Betta splendens durante a transição alimentar / Co-feeding strategy on survival and growth of Betta splendens larvae during weaning

Conduziu-se um experimento com o objetivo de avaliar a influência do período de coalimentação na sobrevivência e no crescimento de larvas de Betta splendens. As larvas foram alimentadas com náuplios de Artemia durante sete dias e, posteriormente, submetidas aos seguintes tratamentos: jejum contínuo; ração contínua; quatro dias de coalimentação + 14 dias de ração; oito dias de coalimentação + 10 dias de ração; 12 dias de coalimentação + seis dias de ração; náuplios de Artemia durante todo o período experimental. Os valores das variáveis de desempenho das larvas do tratamento 12 dias de coalimentação + seis dias de ração e do tratamento náuplios de Artemia foram superiores aos demais tratamentos, exceto para sobrevivência, em que não houve diferença significativa com o tratamento oito dias de coalimentação + 10 dias de ração. Considerando-se apenas o tempo de oferta de Artemia (em dias), obteve-se a equação de regressão para as variáveis analisadas. A sobrevivência e a taxa de crescimento específico (TCE) apresentaram efeito quadrático, e as demais variáveis apresentaram efeito linear. O ponto de máxima para sobrevivência foi de 21,7 dias (88,92%) e para TCE foi de 26,2 dias (23,47% dia-1). O período de co-feeding influencia no crescimento e na sobrevivência de larvas de Betta splendens. Após o período de 19 dias de oferta de alimento vivo, com 12 dias de coalimentação, as larvas estão aptas a aproveitar de maneira eficiente o alimento inerte sem prejuízos ao crescimento e à sobrevivência.

An experiment was carried out to evaluate the influence of the period of co-feeding on survival and growth of Betta splendens larvae. The following strategies for co-feeding were used: continuous fasting, 18 days of inert diet, 4 days of co-feeding + 14 days of inert diet; 8 days of co-feeding + 10 days of inert diet; 12 days of co-feeding + 6 days of inert diet, nauplii of Artemia throughout the experiment period. The values of performance variables for larvae with 12 days of treatment for co-feeding + 6 days of inert diet and the nauplii treatment with Artemia were higher than the other treatments, except for survival, which did not differ significantly from the treatment with 8 days of co-feeding + 10 days of inert diet. Considering only the supply time for Artemia (in days) the regression equation was obtained for the variables analyzed. The survival and specific growth rate (SGR) showed a quadratic effect and other variables showed a linear effect. The point of maximum survival was 21.7 days (88.92%) and for SGR it was 26.2 days (23.47 % day-1). The co-feeding period influences the survival and growth of the Betta splendens larvae. After the period of 19 days of supply of live food, with 12 days of co-feeding, larvae can be fed exclusively on inert diet, without negative effects on growth and survival.