Providing Anti-Retroviral Therapy in the Context of Self-Perceived Stigma: a Mixed Methods Study from Tanzania

Adherence to anti-retroviral treatment (ART) has been a significant step towards improving quality of life among people living with HIV. However; stigma has been described to influence adherence to ART. A cross-sectional mixed methods study was conducted to explore factors related to stigma and perceived influence of stigma on adherence to treatment amongst ART-prescribed patients and health care providers; respectively in Tanzania. Stigma was assessed through interviewer administered survey among 295 patients. The results from patients showed that 279/295 (95) were satisfied with the services provided at the Care and Treatment Centres (CTCs). The set up of CTCs 107/295 (36); and queuing at the CTCs 88/295 (30) were associated with stigma (P0.001). The perceived influence of stigma on adherence to ART was assessed using focus group discussions (FGDs) of 33 health care providers (HCPs). Through FGDs; HCPs perceived the set up of CTCs as friendly yet violated confidentiality. The HCPs reported that ART-prescribed patients hide identifiable cards to avoid being recognised by other people. Some patients were reported to rush to avoid familiar faces; and due to the rush they picked wrong medicines. Also some patients were reported to throw away manufacturers' box with dosage instructions written on the box; resulting in use of doses contrary to the prescriptions. We conclude that despite the fact that most patients were satisfied with the services provided at the CTCs; it is important that HCPs provide dosage instructions on another piece of paper or use disposable bags. A common dispensing window for all patients regardless of the diagnosis may be useful to minimize stigma. Also HCPs may introduce appointment system to avoid long queue at the CTCs

Checklist das Spermatophyta do Estado de São Paulo, Brasil / Checklist of Spermatophyta of the São Paulo State, Brazil

O projeto Flora Fanerogâmica do Estado de São Paulo tem se dedicado a inventariar a flora paulistana há quase 20 anos. Conta com a atuação de mais de 200 colaboradores, a maioria do próprio estado, além de pesquisadores de outros estados e do exterior. Desde 2001, foram publicados sete volumes com as monografias de 151 famílias, contendo 3.237 espécies em 722 gêneros. Este projeto foi o ponto de partida para o conhecimento da diversidade das espécies de espermatófitas do estado de São Paulo. A apresentação do checklist neste momento é oportuna por constituir a produção de uma listagem das espécies com identificações certificadas pelos especialistas, além de conter a referência de uma coleção de herbário para a maior parte dos táxons (material-testemunho) ou referência à bibliografia em que a espécie é citada como ocorrente, de forma nativa ou subespontânea, no estado. Dessa forma, é aqui apresentada a listagem das espermatófitas do estado de São Paulo, com 7.305 espécies, distribuídas em 1.776 gêneros e em 197 famílias (segundo Cronquist 1981) ou então 195 (segundo o APG III). Em relação à flora do Brasil, com 31.728 espécies de espermatófitas, o estado São Paulo compartilha de 23% dessas espécies. As famílias mais representativas são Orchidaceae (797 espécies), Asteraceae (676 espécies), Fabaceae (513 espécies), Poaceae (500 espécies), Myrtaceae (304), Rubiaceae (265 espécies) e Melastomataceae (253 espécies) que, juntas, somam 3.308 espécies e constituem mais de 45% do total de espécies de espermatófitas do estado. Considerando a grande diversidade vegetal brasileira, parcialmente expressa em um estado, depreende-se a grande importância da continuidade dos estudos florísticos no Brasil, país provavelmente detentor da maior diversidade vegetal do planeta.

The Phanerogamic Flora of São Paulo State project has been dedicated to create an inventory of the flora for 20 years. More than 200 collaborators are involved, mostly from the State of São Paulo, with the contributions of researchers from other states and from abroad. Since 2001, seven books with monographs of 151 families were published, dealing with 3,237 species within 722 genera. This project was the starting-point of the gathering of information about the diversity of spermatophytes of the State of São Paulo. The current checklist, at this point, presents an updated and virtually complete list of species, all certified by specialists. It also contains references to scientific collections for most of the taxa (vouchers) or to bibliography referring to the natural or subspontaneous occurrence of the species in the State. The list now contains 7,305 species distributed in 1,776 genera and in 197 spermatophyte families (according to Cronquist 1981) or 195 (according to APG III). 23% of the 31,728 species of spermatophytes listed in the Flora of Brazil occur in São Paulo State. The most representative families are Orchidaceae (797 species), Asteraceae (676 species), Fabaceae (513 species), Poaceae (500 species), Myrtaceae (304), Rubiaceae (265 species) and Melastomataceae (253 species), which, altogether, accumulate 3,308 species and constitute 45% of total species of spermatophytes in the state. The wealth of the Brazilian plant diversity, partially expressed in São Paulo, shows how important is the continuity of floristic studies in a country that is very likely to hold the largest plant diversity in the planet.

Aspectos brioflorísticos e fitogeográficos de duas formações costeiras de Floresta Atlântica da Serra do Mar, Ubatuba/SP, Brasil / Bryophytic and phytogeographical aspects of two types of forest of the Serra do Mar State Park, Ubatuba/SP, Brazil

Bryophytes are indicators of climatic, environmental and ecology conditions and are useful in the characterization of the vegetation types. In this study, we analyzed the brioflora of 2-ha plots, one of Restinga Forest (RF) and the other of Lowland Ombrophilous Dense Forest (LF), located in the Núcleo Picinguaba, State Park of Serra do Mar (São Paulo state, Brazil) aiming to: a) compare the structure of these communities; b) compare the floristic composition between these areas and with other coastal vegetations of southeastern Brazil; c) verify if the bryophytes of the Atlantic Forest lowlands have phytogeographic patterns wider than those of the montane species. In each plot, the bryophytes samples were collected at ten randomized subplots (10 × 10 m). We found 152 species (87 liverworts, 64 mosses and one hornwort), of which 109 occur in RF (40 exclusives) and 112 in LF (43 exclusives). In terms of species richness and taxonomic diversity, LF was more diverse; however, the Simpson and Shannon index of diversity is higher in RF. The floristic composition, life form and ecological groups of light tolerance were significantly different between these two forests. Canopy opening (RF) and number of rocks (LF) were important environmental variables that influenced bryophyte distribution in the study areas. When evaluated in terms of landscape, the subplots of RF and LR form distinct floristic groups; however, at the regional level, the bryophytes of these two forest types have more similarities among themselves than with other Atlantic Forest areas. Bryophyte community observed in the Restinga Forest of Picinguaba shows more similarity with that of the neighbor Lowland Ombrophilous Dense Forest than with other Restinga or coastal formation, such as mangroves and caxetal. In both forests types studied, the majority of taxa (> 90 percent) is widely distributed in the world, presenting phytogeographic pattern equal to or wider than the Neotropical. Our results corroborate the idea that the RF of Picinguaba is a unique vegetation formation, presenting elements of ombrophilous and dryer forests. In addition, they reinforce the idea that, for the tropical bryophyte species, the phytogeographic patterns are wider in areas of lower altitudes.

Briófitas são bioindicadoras de condições climáticas, ambientais e ecológicas, sendo úteis na caracterização de tipos vegetacionais. Neste trabalho, foi analisada a brioflora de duas áreas de 1 ha, uma de Floresta de Restinga (FR) e outra de Floresta Ombrófila Densa de Terras Baixas (TB) do Núcleo Picinguaba, PE Serra do Mar (São Paulo, Brasil), com o objetivo de: a) comparar a estrutura dessas comunidades; b) entender as relações florísticas dessas áreas entre si e com outras formações litorâneas brasileiras; c) verificar se as briófitas de áreas de baixada apresentam padrões fitogeográficos mais amplos do que aquelas de áreas montanas. As briófitas foram coletadas em 10 subparcelas (10 × 10 m) distribuídas aleatoriamente em cada fitofisionomia. Variáveis ambientais foram quantificadas e correlacionadas com a distribuição da brioflora. Foram registradas 152 espécies (87 hepáticas, 64 musgos e 1 antócero), das quais 109 ocorrem na FR (40 exclusivas) e 112 em TB (43 exclusivas). Em termos de riqueza de espécies e diversidade taxonômica, TB foi mais diversa; contudo, os índices de diversidade de Simpson e Shannon foram maiores na FR. A composição florística, tipos de forma de vida e grupos ecológicos de tolerância à luz apresentaram diferenças significativas entre as duas fitofisionomias. A abertura do dossel (FR) e rochosidade (TB) são variáveis ambientais importantes que atuam sobre a distribuição das briófitas nas áreas estudadas. Quando avaliadas em termos de paisagem, as subparcelas da FR e TB formaram grupos florísticos distintos; entretanto, em nível regional, a brioflora dessas duas fitofisionomias apresenta mais afinidades entre si do que com outras áreas de Floresta Atlântica. Em termos florísticos, a FR de Picinguaba assemelha-se mais às Florestas Ombrófilas do que a outras Restingas ou outras formações costeiras (como mangue e caxetal). Nas duas fitofisionomias, a maioria dos táxons (> 90 por cento) é amplamente distribuída no mundo, apresentando padrão fitogeográfico igual ou maior do que o Neotropical. Nossos resultados corroboram a idéia de que a FR de Picinguaba é uma formação ímpar, apresentando em sua brioflora elementos de florestas ombrófilas entremeados àqueles de vegetações mais secas; além disso, reforçam a idéia de que, para as espécies de briófitas, os padrões fitogeográficos são mais amplos em locais de menores altitudes.

Uma revisão da distribuição de Ocotea curucutuensis J.B. Baitello na região sudeste do Brasil / A revised distribution for Ocotea curucutuensis J.B. Baitello in southeastern Brazil

Este trabalho apresenta uma revisão da distribuição de Ocotea curucutuensis J.B. Baitello, na Região Sudeste do Brasil, ampliando substancialmente a extensão conhecida da sua ocorrência. Pela semelhança com Ocotea spixiana (Nees) Mez, essa espécie permaneceu confundida com esta e desconhecida por mais de cem anos, desde a primeira coleta por A. F. M. Glaziou, em 1888. Com base em novos registros para a Serra do Mar e para a Serra da Mantiqueira, sua distribuição foi revisada e ampliada. O. curucutuensis apresenta uma ampla distribuição nas florestas das partes altas da Serra do Mar e da Serra da Mantiqueira, nos Estados de São Paulo e Rio de Janeiro, no sudeste do Brasil, enquanto O. spixiana possui uma distribuição mais ao norte do País.

This analysis presents a revised distribution for Ocotea curucutuensis J.B. Baitello in southeastern Brazil. Because of its strong similarity with Ocotea spixiana (Nees) Mez this species remained unrecognized for over a hundred years after the first collection by A. F. M. Glaziou in 1888, but it was recently shown to be a distinct species. Although the species was originally described from material from the Serra do Mar in São Paulo, subsequent new collections and a wider investigation of herbarium material have shown that it is, in fact, quite widespread, especially in the Serra do Mar and Serra da Mantiqueira and that it is necessary to revise and enlarge the known distribution. O. curucutuensis has a wide distribution in forests in the higher parts of the Serra do Mar and Serra da Mantiqueira, in the states of Rio de Janeiro and São Paulo, in the southeast of Brazil, while O. spixiana has a more northerly distribution.

O primeiro registro de Sinningia gigantifolia Chautems (Gesneriaceae) no estado de São Paulo / Sinningia gigantifolia Chautems (Gesneriaceae) first record in the São Paulo State

Sinningia gigantifolia Chautems é uma espécie rupícola restrita à Serra da Mantiqueira e partes altas da Serra do Mar, que ocorre principalmente em formações florestais. O presente trabalho apresenta o primeiro registro desta espécie para o Estado de São Paulo, na Serra do Baú, em São Bento do Sapucaí. Uma descrição completa da espécie, uma análise da sua distribuição e uma alteração na chave de identificação do gênero Sinningia da Flora Fanerogâmica do Estado de São Paulo são fornecidas.

Sinningia gigantifolia Chautems is a rupicolous species restricted to the Serra da Mantiqueira and higher parts of the Serra do Mar in SE Brazil, ocurring mainly in forest formations. This note presents the first record of this species for São Paulo State, from the Serra do Baú, in São Bento do Sapucaí. A full species description, an analysis of its distribution and a revised key to the genus Sinningia for the Flora Fanerogâmica do Estado de São Paulo are provided.

An unusual scrotal lump

Polyorchidism is a rare anomaly of the genital tract in which supernumerary testes are present, usually within the scrotum. Less than 100 cases have been reported in the literature. We present a case of polyorchidism in which the diagnosis was made on ultrasonography and as there was no evidence of an associated pathology on clinical examination or imaging, surgical exploration was therefore not considered necessary

Primary carcinoid tumour of the testis

A left radical orchidectomy was performed on a 32-year-old man presenting with a testicular mass. Histology revealed a tumour comprising of cells with monotonous nuclei and granular cytoplasm arranged in an insular pattern. Immunohistochemical expression for NSE, synaptophysin and chromogranin A were positive. No teratomatous elements were seen. Postoperatively, a staging CT and an octreotide scan were normal. Urinary 5-HIAA levels were not elevated. Based on these investigations the tumour was diagnosed as a pure primary carcinoid tumour of the testis. The patient has been followed up for 3 years with no evidence of recurrence

Removal and insertion of pollinia in flowers of Oxypetalum (Asclepiadaceae) in southeastern Brazil

Pollinarium removal and pollinium insertion of seven Oxypetalum species (O. alpinum var. alpinum, O. appendiculatum, O. banksii subsp. banksii, O. jacobinae, O. mexiae, O. pachyglossum and O. subriparium) were recorded in Viçosa. Minas Gerais. They presented a tendency of one or two pollinarium removals and one pollinium insertion (single insertion), except O. appendiculatum. In this species, mainly, two pollinia of the same pollinarium were inserted per stigmatic chamber (double insertion), resulting exceptionally in 6-10 inserted pollinia in a flower, an unusual occurrence among the Asclepiadaceae. No association between removal and insertion was found, e.g., O. subriparium and O. banksii subsp. banksii had the highest pollinarium removal (1.78 and 1.45, respectively) and one of the lowest pollinium insertions (0.02 in both species), per flower. Oxypetalum mexiae showed the lowest pollinarium removal and pollinium insertion per flower (0.09 and 0.01, respectively) among the studied species and other Asclepiadaceae. Oxypetalum subriparium, O. banksii subsp. banksii and O. mexiae might be having reproductive limitations. Pollinarium removal and pollinium insertion per flower of the studied species varied from site to site, similarly to what was recorded for other Asclepiadaceae.