Predatory capacity and intraguild interaction between aphidophagous predators in the control of rose bush aphids

ABSTRACT Chrysoperla externa (Hagen) and Hippodamia convergens (Guérin-Meneville) are voracious generalist predators, and important aphid control agents. In an environment containing a complex of species, the occurrence of intraguild interactions can interfere in the predator behavior and consumption. The aim of this work was to know the number of nymphs of Rhodobium porosum (Sanderson) and Macrosiphum rosae (Linnaeus) consumed by larvae of C. externa and H. convergens, and the interaction between these predators when confined together. First, second and third instar nymphs of R. porosum and M. rosae were provided in Petri dishes containing rose leaflets and second instar larvae of the predators. Intraguild interaction was studied in Petri dishes containing first instar nymphs of both aphid species and a second instar larva of C. externa plus one of H. convergens. A third treatment consisted of dishes containing a second instar larva of both predators maintained in the absence of prey. The evaluations took place throughout the entire instar of the predators. C. externa consumed a greater number of R. porosum nymphs and H. convergens a greater number of M. rosae nymphs. For both species of prey, the highest consumption was verified on the last day of evaluation. There was a positive interaction when the predator's larvae were confined in the presence of aphid nymphs, with no mortality observed for any of them. In the absence of prey, there was 70% mortality of H. convergens larvae due to intraguild predation.

Compatibility between the predators Cryptolaemus montrouzieri (Coleoptera: Coccinellidae) and Chrysoperla externa (Neuroptera: Chrysopidae) in the control of Planococcus citri (Hemiptera: Pseudococcidae) associated with rose crop

ABSTRACT Rose crops are attacked by many pests, including mealybugs. Although Planoccocus citri is not registered as a main pest of roses in Brazil, it is an increasing problem on roses inside greenhouses. Chrysoperla externa and Cryptolaemus montrouzieri are options against P. citri and other pests on roses, however using two predators in biological control programs may face problems like intraguild predation. This work aimed to assess the consumption of 1st instar nymphs and adult females of P. citri by adults of C. montrouzieri and 3rd instar larvae of C. externa, as well as the interaction between these predators when confined together. The following treatments were performed with ten replications in a completely randomized design: 1 - C. externa + 200 nymphs of P. citri; 2 - C. externa + 10 adults of P. citri; 3 - C. montrouzieri + 500 nymphs of P. citri; 4 - C. montrouzieri + 15 adults of P. citri. Each replication was set on rose leaflets inside a Petri dish (9cm Ø). Intraguild interaction was assessed by releasing both predators inside dishes containing 700 nymphs of P. citri. Before the releases, predators stayed 24 hours without food. We evaluated the prey consumption and intraguild predation for three hours. C. externa consumed significantly less (85,4±2,99) nymphs than did C. montrouzieri (387,0±3,02). There was no difference in adult mealybugs consumed, with an average of 1,85±0,19. No intraguild predation was observed, and an increase of 11,8% in consumption was observed when predators were released together compared to the scenario of no competition.

Representação Espacial das Doenças Negligenciadas no Estado do Tocantins / Spatial Representation of Neglected Diseases in Tocantins State

As doenças negligenciadas consistem em agravos prevalentes em toda a população, mas com maior incidência em indivíduos em situação de vulnerabilidade social. O georreferenciamento surge neste momento como estratégia de orientação da ESF no controle de agravos, atuando como instrumento de reconhecimento, análise, definição de prioridades e intervenção, através da inter-relação entre os princípios da atenção básica e da vigilância em saúde. Este estudo teve como objetivo entender o comportamento dos agravos hanseníase, leishmaniose tegumentar americana, leishmaniose visceral e tuberculose, consideradas moléstias negligenciadas, encontradas no Estado do Tocantins, sob perspectiva da análise espacial, no período de 2013 a 2017, e justificadas por meio de análise bibliográfica complementar. A metodologia empregada amparou-se no princípio metodológico ecológico observacional descritivo, que possibilitou o discernimento sobre tais doenças, a partir de dados secundários colhidos no Sistema de Informática do Sistema Único de Saúde (DATASUS) com posterior espacialização e representação cartográfica, através da elaboração de mapas temáticos que melhor caracterizasse as variáveis estudadas por meio do software QGIS. Como resultado, foi possível analisar a distribuição dos agravos em estudo no estado do Tocantins, trazendo as possíveis causas relacionadas à dificuldade de controle destas moléstias neste território. Concluiu-se que apesar das doenças negligenciadas serem possíveis de controle, infelizmente, a gestão de saúde não tem conseguido aplicar estratégias suficientes para a redução do índice de morbidade, e o georreferenciamento mostrou-se como um forte instrumento de suporte para a adoção de táticas pontuais para o manejo de doenças.

Lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis

OBJECTIVES: To assess the prevalence and interrelationship between lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis (MS). METHODS: In a cross-sectional study, we evaluated 41 men (mean age 41.1±9.9 years) with MS from February 2011 to March 2013, who were invited to participate irrespective of the presence of lower urinary tract symptoms or sexual dysfunction. Neurological impairment was assessed with the Expanded Disability Status Scale; lower urinary tract symptoms were evaluated with the International Continence Society male short-form questionnaire, and sexual dysfunction was evaluated with the International Index of Erectile Function. All patients underwent transabdominal urinary tract sonography and urine culture. RESULTS: The mean disease duration was 10.5±7.3 years. Neurological evaluation showed a median Expanded Disability Status Scale score of 3 [2-6]. The median International Continence Society male short-form questionnaire score was 17 [10-25]. The median International Index of Erectile Function score was 29 [15-46]. Twenty-nine patients (74.4%) had sexual dysfunction as defined by an International Index of Erectile Function score <45. Voiding dysfunction and sexual dysfunction increased with the degree of neurological impairment (r=0.02 [0.02 to 0.36] p=0.03 and r=-0.41 [-0.65 to -0.11] p=0.008, respectively). Lower urinary tract symptoms and sexual dysfunction also displayed a significant correlation (r=-0.31 [-0.56 to -0.01] p=0.04). CONCLUSIONS: Most male patients with MS have lower urinary tract symptoms and sexual dysfunction. The severity of the neurological disease is a predictive factor for the occurrence of voiding and sexual dysfunctions.

Evaluation of urodynamic parameters after sling surgery in men with post-prostatectomy urinary incontinence

ABSTRACT Objective: To evaluate urodynamic alterations after sub-urethral sling surgery (SSU) in patients with post-prostatectomy urinary incontinence (PPUI). Materials and Methods: We evaluated data of 22 patients submitted to radical prosta- tectomy (RP) or transurethral resection of prostate (TURP) that presented post-surgical urinary incontinence and were treated with SSU implant in a pilot study previously performed in our institution. Methods: Those patients with PPUI were evaluated by urodynamic exam (UD) before and after surgery, and the parameters were compared, including uroflow, cystometry and micturition study. Exclusion criteria included patients without pre-operatory urodynamic study, those with urethral stenosis, those not healed of prostate cancer, pa- tients without clinical conditions to be submitted to urodynamic study and those with severe neurological diseases or that refused to sign the consent form. Results were analyzed statistically by Fisher, Wilcoxon or Mann-Whitney tests. Results: During free uroflow, none parameters showed any statistical significant differ- ences. During cystometry, there were also no statistical differences and the same was observed at pressure versus flow study; the exception was at maximal flow detrusor pressure (PdetQmax), that was lower at post-operatory (p=0.028). In relation to the presence of urinary dysfunctions associated to PPUI, we observed a significant reduc- tion of detrusor overactivity (p=0.035) in relation to pre-operatory period. Conclusion: SSU surgery significantly reduced detrusor overactivity and PdetQMax; however, there were no alterations of other evaluated urodynamic parameters.

Comparative evaluation of healing response between colo-colic invagination anastomosis and single-layer running suture. Experimental study in dogs / Avaliação comparativa da resposta cicatricial entre anastomose colocólica por invaginação e sutura contínua em plano único. Estudo experimental em cães

Abstract Objective Evaluate healing response of colo-colic anastomosis by invagination vs. single-layer suture. Methods Sixty dogs were randomly distributed in two groups and anastomosed with single-layer suture (G-I, control) or by invagination and cardinal sutures (G-II, study). In the end, the animals were euthanized (10 from each group on POD7 and 20 on POD21) and the anastomosed segment was retrieved for histology and immunohistochemistry. Parameters included body weight, adhesions, edema, vasoproliferation, type I and III collagen, myeloperoxidase and nitric oxide. Findings were analyzed with Student's t test and the Mann–Whitney test. Results No animal died prior to euthanasia. The groups were similar with regard to all parameters: median weight 10.86 kg (G-I) and 9.98 kg (G-II) on POD7 (p = 0.41) and 11.86 kg (G-I) and 11.55 kg (G-II) on POD21 (p = 0.71); abdominal adhesions (p = 0.7383 POD7; p = 0.5685 POD21), level of edema (p = 0.3006 POD7; p = 0.7990 POD21), vasoproliferation (p = 0.1191 POD7; p = 0.0758 POD21), type I collagen (p = 0.4591 POD7; p = 0.3357 POD21), type III collagen (p = 0.2166 POD7; p = 0.2712 POD21), nitric oxide (p = 0.3980 POD7; p = 0.4796 POD21) and myeloperoxidase (p = 0.580 POD7; p = 0.755 POD21). Conclusion No significant difference in healing response was observed between the two anastomosis techniques (single-layer suture and invagination).

Resumo Objetivo Avaliar a resposta cicatricial da anastomose colocólica por invaginação versus sutura em plano único. Métodos Sessenta cães foram randomicamente distribuídos em dois grupos e anastomosados com sutura em plano único (G-I, controle) ou por invaginação e suturas cardinais (G-II, estudo). Ao final, os animais foram submetidos à eutanásia (10 de cada grupo no 7° dia do pós-operatório [DPO7] e 20 em DPO21) e o segmento anastomosado foi recuperado para estudos histológicos e imunoistoquímicos. Os parâmetros foram: peso corpóreo, aderências, edema, vasoproliferação, colágeno dos tipos I e III, mieloperoxidase e óxido nítrico. Os achados foram analisados com os testes t de Student e de Mann-Whitney. Resultados Não ocorreram óbitos antes da eutanásia. Os grupos eram semelhantes com relação a todos os parâmetros considerados: peso mediano 10,86 Kg (G-I) e 9,98 Kg (G-II) em DPO7 (p = 0,41) e 11,86 Kg (G-I) e 11,55 Kg (G-II) em DPO21 (p = 0,71); aderências abdominais (p = 0,7383 DPO7; p = 0,5685 DPO21), nível de edema (p = 0,3006 DPO7; p = 0,7990 DPO21), vasoproliferação (p = 0,1191 DPO7; p = 0,0758 DPO21), colágeno tipo I (p = 0,4591 DPO7; p = 0,3357 DPO21), colágeno tipo III (p = 0,2166 DPO7; p = 0,2712 DPO21), óxido nítrico (p = 0,3980 DPO7; p = 0,4796 DPO21) e mieloperoxidase (p = 0,580 DPO7; p = 0,755 DPO21). Conclusão: Não foi observada diferença significativa na resposta cicatricial entre as duas técnicas de anastomose (sutura em plano único e invaginação).

Argus T® versus advance® sling for postprostatectomy urinary incontinence: a randomized clinical trial

ABSTRACT Objective To compare the results of two slings, Argus T® and Advance®, for the treatment of postprostatectomy urinary incontinence (PPUI). Material and Methods: From December 2010 to December 2011, 22 patients with PPUI were randomized as follows: 11 (mean age 62.09(±5.30)) underwent treatment with Advance® and 11 (mean age 62.55(±8.54)) with Argus T®. All patients were evaluated preoperatively with urodynamic testing, quality of life questionnaire (ICIQ-SF), voiding diary and 24-hour pad test. Exclusion criteria were: neurological diseases, severe detrusor overactivity and urethral stenosis. Evaluation was performed at 6, 12 and 18 months after the surgery. After implantation of the Argus T® sling, patients who experienced urine leakage equal to or greater than the initial volume underwent adjustment of the sling tension. Results were statistically analyzed using the Fisher’s test, Kolmogorov-Smirnov test, Friedman’s non-parametric test or the Mann-Whitney test. Results Significant improvement of the 24-hour pad test was observed with the Argus T® sling (p=0.038) , With regard to the other parameters, there was no significant difference between the two groups. Removal of the Argus T® device due to perineal pain was performed in one patient (9%). Despite non uniform results, both devices were considered useful to improve quality of life (ICIQ-SF): Argus T® (p=0.018) and Advance® (p=0.017). Conclusions Better results were observed in the 24h pad test and in levels of satisfaction with the Argus T® device. Both slings contributed to improve quality of life (ICIQ-SF), with acceptable side effects.

Overactive bladder - 18 years - Part II

ABSTRACT Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Overactive bladder - 18 years - Part I

ABSTRACT Abstract: Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals – including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

Toxicity of insecticides used in melon crops to Opius scabriventris (Hymenoptera: braconidae) / Toxicidade de inseticidas utilizados na cultura do meloeiro para Opius scabriventris (Hymenoptera: braconidae)

Melon cultivation is an important agricultural activity in the Northeastern Region of Brazil. During its commercial cultivation, the melon crop is attacked by pests, mainly leafminers Liriomyza sativae Blanchard and Liriomyza trifolii (Burgess) (Diptera: Agromyzidae). To keep leafminer populations below an economic issue level, it is essential to adopt control measures such as spraying insecticides and biological control. However, there is little information on the toxicity of insecticides used in the melon crop against leafminers' natural enemies. Therefore, the aim of this study was to evaluate the toxicity of insecticides used in melon crops against the parasitoid Opius scabriventris, a natural enemy of leafminers from the genus Liriomyza (Diptera: Agromyzidae). The experiment was conducted under controlled laboratory conditions, in a completely randomized design, using two bioassays: I - Contact of parasitoids with a recently sprayed surface; and II - Contact of parasitoids with a surface containing dried residues of the insecticides that were significantly toxic in the bioassay I. In both bioassays, the toxicity of the insecticides was evaluated by observing parasitoid mortality. In bioassay I, from eight insecticides tested, only Cartap hydrochloride and Abamectin + mineral oil were considered harmful (Class 4) and Deltamethrin showed to be slightly harmful (class 2). Only Abamectin + mineral oil was harmful (Class 4) to the parasitoid O. scabriventris in the bioassay II. These are the first results regarding the effect of insecticides used in the management of melon pests on the parasitoid of the leafminer fly O. scabriventris.

O cultivo do meloeiro é uma importante atividade agrícola na região Nordeste do Brasil. Durante seu cultivo comercial, o meloeiro é acometido por pragas, destacando-se as moscas minadoras Liriomyza sativae Blanchard e Liriomyza trifolii (Burgess) (Diptera: Agromyzidae). Para manter a população da mosca minadora abaixo do nível de dano econômico, é essencial a adoção de medidas de controle, como a aplicação de inseticidas e o controle biológico. No entanto, são escassas informações sobre a toxicidade dos inseticidas utilizados na cultura do meloeiro sobre os inimigos naturais da mosca minadora. Portanto, o objetivo deste trabalho foi avaliar a toxicidade de inseticidas utilizados na cultura do meloeiro sobre o parasitoide Opius scabriventris, inimigo natural de moscas minadoras do gênero Liriomyza (Diptera: Agromyzidae). O experimento foi conduzido em condições de laboratório, em delineamento inteiramente casualizado, utilizando dois bioensaios: I ­ Contato dos parasitoides com superfície recém pulverizada e II ­ Contato dos parasitoides com superfície contendo resíduos secos dos inseticidas que foram tóxicos no bioensaio I. Nos dois bioensaios, a toxicidade dos inseticidas foi avaliada por meio da observação da mortalidade dos parasitoides. No bioensaio I, dentre os oito inseticidas avaliados, somente Cloridrato de Cartap e Abamectina + óleo mineral foram considerados nocivos (classe 4), e Deltametrina mostrou-se levemente nocivo (classe 2). No bioensaio II, apenas Abamectina + óleo mineral foi prejudicial (classe 4) ao parasitoide O. scabriventris. Estes são os primeiros resultados relacionados ao efeito de inseticidas utilizados no manejo de pragas do meloeiro sobre o parasitoide da mosca minadora O. scabriventris.

Role of preoperative retrograde enema on inflammatory and healing parameters in colonic anastomosis: experimental study in dogs / Papel do enema pré-operatório em parâmetro de inflamação e cicatrização em anastomose cólica: estudo experimental em cães

Objective: The purpose of this experimental study was to compare the inflammatory and wound healing response of dogs submitted to colonic anastomosis with and without preoperative retrograde enema. Methods: The study included two groups of 31 female dogs (Canis familiaris). G-I (control): no preoperative bowel preparation; G-II (study): preoperative retrograde enema using a 10% glycerin solution. All the animals were submitted to laparotomy and colotomy at 20 cm from the anal verge, followed by closure with a running extramucosal single-layer suture (Prolene® 000). The animals were then anesthetized and euthanized on the 7th (n = 10) or 21st (n = 20) postoperative day (POD) to remove the anastomosed colon segment for histological and immunohistochemical analysis evaluating the parameters: anastomotic edema, vasoproliferation, abdominal adhesions, type I and III collagen, nitric oxide and myeloperoxidase. The observed differences were analyzed with the Mann-Whitney test for nonparametric data and Student's t test for unpaired samples and parametric data. Results: One animal from G-I and one from G-II died on POD 7 and POD 10 due to anastomotic complications and sepsis, respectively The groups did not differ significantly with regard to inflammatory and healing parameters, although the levels of mature collagen were significantly lower in the animals submitted to preoperative bowel preparation. Conclusion: It has been shown that both procedures are safe to be used, however, the group with bowel preparation showed a lower amount of mature collagen in the immediate postoperative period and may be constituted a preventive factor for surgical complications for this type of surgical procedure, although no evidence in this study could be determined. (AU)

Objetivo: O objetivo deste estudo experimental foi comparar a resposta inflamatória e cicatrização de feridas em cães submetidos a anastomose cólica com e sem enema retrógrada pré-operatório. Métodos: O estudo incluiu dois grupos de 31 cães fêmeas (Canis familiaris). G-I (controle): sem preparo intestinal pré-operatório; G-II (estudo): Enema retrógrada pré-operatória com uma solução de glicerina a 10%. Todos os animais foram submetidos à laparotomia e colotomia a 20 cm da borda anal, seguido de fechamento em sutura extramucosa contínua (Prolene ® 000). Os animais foram anestesiados e, em seguida, submetidos à eutanásia no 7° (n = 10) ou 21 (n = 20) pós-operatório (DPO) para remover o segmento de cólon anastomosado para análise histológica e imunohistoquímica avaliando os parâmetros: edema da anastomose, vasoproliferação, aderências abdominais, colagénio tipo I e III, o óxido nítrico e a mieloperoxidase. As diferenças observadas foram analisadas com o teste de Mann-Whitney para os dados não paramétricos e teste t de Student para amostras não pareadas e dados paramétricos. Resultados: Um animal do GI e um do G-II morreu no dia 7 e 10° DPO devido a complições de anastomose e sepse, respectivamente. Os grupos não diferiram significativamente em relação aos parâmetros inflamatórios e de cura, embora os níveis de colágeno maduro foram significativamente menores nos animais submetidos ao preparo intestinal pré-operatório. Conclusão: Demonstrou-se que ambos os procedimentos são seguros para serem usados, no entanto, o grupo com a preparação do intestino mostrou uma menor quantidade de colágeno maduro no período pós-operatório imediato, podendo ser constituído um fator preventivo para compliçães cirúrgicas para este tipo de procedimento cirúrgico, embora nenhuma evidência neste estudo. (AU)

Enquanto a gente espera: histórias de saúde-doenças-cuidados em uma unidade básica de saúde / While we wait: histories of health-diseases-cares on a basic health unit / Mientras esperamos: historias de salud-enfermedades-cuidados en una unidad basica de salud / Alors que nous attendons: des histoires de la santé-maladies-soins dans l'unité de santé de base

A proposta de humanização no Sistema Único de Saúde (SUS) prima por valorizar o envolvimento dos sujeitos em seus processos de produção de saúde, não entendida simplesmente como ausência de doenças, mas mantendo relações com os aspectos sociais, econômicos e culturais da população. Portanto, acreditamos que a clínica aí pensada deve se deslocar do/para o sujeito para uma clínica com os sujeitos, em que o ato de cuidar perpasse o vínculo, a escuta, a comunicação e a corresponsabilização dos envolvidos. Com isso, desenvolvemos um trabalho grupal de sala de espera na Unidade Básica de Saúde (UBS) do bairro Cruzeiro, em Carnaubal - CE de junho de 2010 a novembro de 2012. Objetivamos com essa prática: apresentar aspectos do trabalho grupal em sala de espera com enfoque na educação popular em saúde e propor a contação de histórias como um instrumento de trabalho na Atenção Básica (AB). O trabalho se centrou nos ditos e nas histórias de saúde-doenças-cuidados que os participantes compartilharam nos encontros, coletadas por nós a partir de apontamentos in loco que serviram para alicerçar os conteúdos e as histórias mnemicamente trabalhadas e que se tornaram o material final de nossa discussão, análise e interpretação. Concluímos que a sala de espera pode ser um espaço continente de conversação, reflexão e compartilhamento de experiências entre os sujeitos (usuários e profissionais), em que estes podem dar voz ao seu pensar, despertar associações entre suas histórias e contribuir para a circularidade do saber sobre seus processos de saúde-doenças-cuidados.

The proposed humanization of the Unified Health System (UHS) prime for value individuals involved in the production of health, considering that it is not the absence of disease but relates to social, economic and cultural aspects of population. Therefore, the treatment must move the clinic to / from subject to with subjects that the act of caring include bonding, listening, communication and co-responsibility of those involved. That way, we development a working group of the waiting room at Basic Health Unit (BHU) Cruzeiro in the neighborhood of Carnaubal - CE of June of 2010 until November of 2012. Considers, in this practice, aspects of group work in the waiting room with a focus on popular education in health and we propose the storytelling as a working tool in Primary Care (PC). The work focuses on the sayings and stories in the health-diseases-cares participants to share in the meetings, collected it for us in appointments in loco that served to build the contents and the histories mnemonically works and through final material of our discussion, analysis and interpretation. We conclude that waiting room (WR) is a continent for a conversation, reflection and sharing of experiences among the subjects (users and professionals), they can give voice to their thoughts, awaken associations between their stories and contribute circularity to know about the processes of health-diseases-cares.

La propuesta de humanización del Sistema Único de Salud (SUS) prima por valorar lo envolvimiento de las personas en sus procesos de producción de salud, teniendo en cuenta que esta no es la ausencia de la enfermedad sino se relaciona a los aspectos sociales, económicos y culturales de la población. Por lo tanto, el espacio del atendimiento debe mover a la clínica del / para el sujeto para la con los sujetos en que el acto de cuidar incluye el vinculo, la escucha, la comunicación y la co-responsabilidad de los participantes. Con eso, desenvolvemos un grupo de trabajo de sitio de espera en la Unidad Basica de Salud (UBS) del barrio Cruzeiro en Carnaubal - CE de junio de 2010 a noviembre de 2012. Contemplase, en esta práctica, presentar los aspectos de trabajo en grupo en sitio de espera con un enfoque en la educación popular en salud y proponer la contacción de historias como una herramienta de trabajo en Atención Primaria (AP). El trabajo se centró en las palabras y las historias de salud-enfermedades-cuidados que los participantes comparten en las reuniones, colectadas por nosotros a partir de apuntamientos in loco que servirán para substanciar los materiales e las historias mnémicamente trabajadas y que se tornaran la materia final de nuestra discusión, análisis e interpretación. Concluimos que el sitio de espera (SE) puede ser un espacio continente de conversación, de reflexión y de intercambio de experiencias entre los sujetos (usuarios y profesionales) en que pueden dar voz a sus pensamientos, despertar asociaciones entre sus historias y contribuir para la circularidad del saber sobre sus procesos de salud-enfermedades-cuidados.

L'article mentionne une possibilité de travail conjoint de la psychologue et l'infirmière dans la Stratégie de Santé de la Famille (SSF), un groupe de travail de la salle d'attente tenue à l'Unité de Santé de Base (USB) Croisière sur le quartier de Carnaubal - CE. Une partie de l'humanisation proposée du Système de Santé Unifié (SSU), tout en valorisant les individus impliqués dans la production de la santé, étant donné que ce n'est pas l'absence de maladie ma se rapporte à los aspcets sociale, économique et culturel de la population. Par conséquent, le traitement doit se déplacer à la clinique de / à la sujet à sujet avec dans l'acte de cautionnement perpasse bienveillance, l'écoute, de communication et de co-responsabilité de ceux qui sont impliqués. Les travaux se déroulent depuis 2010 et se concentre sur les paroles et les histoires de la santé-maladie-soins dans les participants ont partagé lors dans les réunions, l'objectif de notre discussion et d'analyse. Nous croyons en cette pratique, les aspects du travail de groupe dans la salle d'attente avec un accent sur l'éducation à la santé populaire, proposons les histories comme un outil de travail dans les soins primaires (SP). Nous concluons que le traitement dans la salle d'attente (TSA) est un continent pour une conversation, la réflexion et le partage d'expériences entre les sujets (utilisateurs et les professionnels), ils peuvent donner une voix à leurs pensées, d'éveiller les associations entre leurs histoires et de contribuer circularité de connaître les processus de santé-maladie-soins.

Long-term results of a clinical trial comparing isolated vaginal stimulation with combined treatment for women with stress incontinence / Resultados a longo prazo de um estudo clínico comparando estimulação vaginal isolada com tratamento combinado para mulheres com incontinência urinária de esforço

Objective To determine the efficacy of stress urinary incontinence treatments adding pelvic floor muscle training to vaginal electrical stimulation. Methods Forty-eight women with stress urinary incontinence were randomized into 2 groups: 24 underwent isolated vaginal electrical stimulation, and 24 vaginal electrical stimulation plus pelvic floor muscle training. History, physical examination, voiding diary, perineum strength test, and urodynamic study were assessed. Comparisons were made for adherence to treatment, muscle strength improvement, urinary symptoms, and degree of satisfaction immediately, 12 and 96 months after treatment. Results Patients’ degree of satisfaction on vaginal electrical stimulation, and on vaginal electrical stimulation plus pelvic floor muscle training immediately, 12 and 96 months post treatment, were, respectively: 88.2% versus 88.9% 64.7% versus 61.1% and 42.9% versus 28.6% (p>0.05). Conclusion Vaginal electrical stimulation associated to pelvic floor muscle training did not show better results than vaginal electrical stimulation alone. .

Objetivo Determinar a eficácia da eletroestimulação vaginal combinada com treinamento muscular do assoalho pélvico para o tratamento da incontinência urinária de esforço. Métodos Um total de 48 mulheres com incontinência urinária de esforço foi randomizado em 2 grupos, sendo 24 submetidas a eletroestimulação vaginal isolada e 24 a eletroestimulação vaginal e treinamento muscular do assoalho pélvico. Foram avaliados anamnese, exame físico, diário miccional, força perineal e urodinâmica. Compararam-se a adesão ao tratamento, a melhora da força muscular perineal e dos sintomas urinários, e o grau de satisfação imediatamente, 12 e 96 meses após o tratamento. Resultados O grau de satisfação das pacientes no grupo da eletroestimulação isolada e do segundo grupo, imediatamente, com 12 e com 96 meses foi, respectivamente, 88,2% versus 88,9% 64,7% versus 61,1% e 42,9% versus 28,6% (p>0,05). Conclusão A eletroestimulação vaginal associada ao treinamento muscular do assoalho pélvico não foi mais eficaz do que a eletroestimulação isolada. .

Role of bowel preparation on colocolonic anastomosis: experimental study in dogs

The aim of the present study was to evaluate the efficacy of colocolonic anastomosis with and without preoperative bowel preparation. METHODS: The study compared 42 female dogs (Canis familiaris), divided into 2 groups of 21 animals: Group I (control) - submitted to bowel preparation - and Group II (study) - without previous bowel preparation -. All animals were submitted to laparotomy with sectioning of the descending colon and primary anastomosis using polypropylene thread. Following euthanasia on the 21st postoperative day (POD), a second laparotomy was performed to evaluate the anastomosis with regard to complications, intra-abdominal adhesions and anastomotic burst pressure. RESULTS: One animal from each group (4.5%) died. The death in Group I occurred on seventh POD due to anastomotic dehiscence. The death in Group II occurred on tenth POD due to deep incisional infection at the surgical site and complete dehiscence of the abdominal wall. The groups did not differ significantly with regard to adhesion grade or anastomotic burst pressure (one specimen burst in each group) (p>0.05). CONCLUSION: Colocolonic anastomosis without previous bowel preparation was shown to be safe and efficacious, suggesting it is not an indispensable procedure in colorectal anastomosis surgery. (AU)

Esse estudo avaliou a eficácia da anastomose colocólica sem preparo intestinal prévio comparando-a com a anastomose realizada com preparo. MÉTODO: Foram utilizados 42 animais (Canis familiares) fêmeas distribuídos em 2 grupos com 21 animais em cada: Grupo I (controle) - com preparo intestinal - e Grupo II (estudo) - sem preparo intestinal prévio -. Os animais de ambos os grupos foram submetidos à laparotomia com secção do cólon descendente e à anastomose primária com fio de polipropileno, bem como à eutanásia no 21º dia de pós-operatório com laparotomia e à avaliação da anastomose colocólica quanto à presença de complicações, grau de aderências intestinais e pressão de ruptura da anastomose. RESULTADOS: Ocorreu um (4,5%) óbito em cada grupo, sendo o do Grupo I no sétimo dia pós-operatório em decorrência da deiscência da anastomose colocólica e o do Grupo II no décimo dia de pós-operatório por causa de infecção em sítio cirúrgico com deiscência total da parede abdominal. Não foi observada diferença estatisticamente significante no grau de aderências intestinais tampouco no teste de pressão de ruptura entre os grupos (um espécime sofreu ruptura em casa grupo) (p>0,05). CONCLUSÃO: A anastomose colocólica sem preparo intestinal apresentou a mesma segurança e eficácia da anastomose realizada com preparo prévio, sugerindo não ser indispensável na cirurgia colorretal com anastomose. (AU)

Occurrence of Lysiphlebus testaceipes parasitizing Aphis gossypii in watermelon in the State of Rio Grande do Norte, Brazil / Ocorrência de Lysiphlebus testaceipes parasitando Aphis gossypii em melancia, no Estado do Rio Grande do Norte, Brasil

This is the first report of the parasitoid Lysiphlebus testaceipes (Cresson) as a biological control agent of the aphid Aphis gossypii Glover in watermelon crop in Vale do Açu, RN. It was observed that near the harvest, almost all collected aphids were mummified, and after analyzing the emerged parasitoids, the parasitoid L. testaceipes was identified. Therefore, in the future, this species may be included in A. gossypii integrated management programs.

Este é o primeiro relato do parasitoide Lysiphlebus testaceipes (Cresson) como agente de controle biológico do pulgão Aphis gossypii Glover na cultura da melancia, na região do Vale do Açu, Rio Grande do Norte (RN). Observou-se que próximo da colheita quase todos os pulgões coletados encontravam-se mumificados e, na análise dos parasitoides emergidos, constatou-se o parasitismo por L. testaceipes. Essa espécie, portanto, poderá ser incluída em um programa de manejo integrado de A. gossypii futuramente.

Green lacewings (Neuroptera: Chrysopidae) associated with Melon Crop in Mossoró, Rio Grande do Norte State, Brazil

A survey of the green lacewings associated with the melon agroecosystem was carried out with the aim of including lacewings into the integrated management program of melon pests. Three species of this predator were found: Ceraeochrysa cubana (Hagen), Chrysoperla externa (Hagen) and Chrysoperla genanigra Freitas. A key to these species is presented.

Bladder involvement in systemic lupus erythematosus / Envolvimento vesical no lúpus eritematoso sistêmico

Objective: To study bladder involvement in systemic lupus erythematosus patients through clinical and laboratorial evaluation, ultrasonography, radiological and endoscopic examination. Methods: Thirty-nine patients, either outpatients or inpatients at the Department of Rheumatology of Hospital das Clínicas da Faculdade de Medicina from Universidade de São Paulo were evaluated as to clinical and laboratorial data. All patients were submitted to ultrasonographic evaluation of the upper urinary tract, radiological and endoscopic examinations of the middle and lower urinary tracts. Results: Mean age of patients varied between 13 and 62 years (median = 29 years). Thirty-six were females and three were males. The disease varied from 6 months to 22 years (median three years and one month). Clinical and laboratory activity of the disease was present in 30 patients. Twenty-two patients had the diagnosis of lupus established for three years or more. Twenty-five patients were asymptomatic and all had received corticosteroids for treatment at least once. Twenty-three received antimalarial drugs; ten received cytostatics, and seven patients received non-steroid anti-inflammatory drugs. Upper urinary tract ultrasonography was normal in all cases but one with staghorn calculus associated with neurogenic bladder secondary to neurological involvement by the disease. Vesicoureteral reflux was observed in two cases. Other two patients had significant post-voiding residual urine, both with neurogenic bladder secondary to nervous system involvement by lupus. The average bladder maximum capacity in an awaken patient was 342 mL, and was decreased in 18.9% of cases. This subgroup of patients presented a greater frequency of urinary symptoms and greater use of cytostatic drugs (Z > Z5%). A pathognomonic cystoscopic pattern of bladder involvement in systemic lupus erythematosus could not be established. Cystoscopic aspects similar to those seen in the initial or minor forms of interstitial cystitis were present in 43.2% of patients. This finding was more frequent when cytostatic drugs were used for treating the disease. Conclusions: There was bladder involvement in systemic lupus erythematosus, even in asymptomatic patients, demonstrated by the occurrence of cystoscopic abnormalities or by reduced bladder maximum capacity associated with the presence of suprapubic pain, urinary irritation symptoms and the use of cytostatic drugs.

Objetivo: Estudar o envolvimento vesical em pacientes com lúpus eritematoso sistêmico (LES) por meio de avaliações clínica, laboratorial, ultrassonográfica e de estudos radiológico e endoscópico. Métodos: Trinta e nove pacientes ambulatoriais ou internados no Serviço de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo foram avaliados clínica e laboratorialmente. Todos foram submetidos à avaliação do trato urinário superior por meio da ultrassonografia, e a exames radiológicos e endoscópicos para a avaliação dos tratos médio e inferior. Resultados: A idade dos pacientes variou de 13 a 62 anos (mediana = 29 anos). Trinta e seis pacientes eram do sexo feminino e três do sexo masculino. O tempo de doença variou de seis meses a 22 anos (mediana = três anos e um mês). Trinta pacientes apresentavam atividade da doença na ocasião do estudo. O diagnóstico de lúpus havia sido estabelecido havia três anos ou mais em 22 pacientes. Vinte e cinco pacientes eram assintomáticos em relação às queixas urinárias e todos haviam feito uso de corticoides em alguma fase do tratamento. Vinte e três receberam antimaláricos; dez, citostáticos e sete anti-inflamatórios não-hormonais. A ultrassonografia do trato urinário superior foi normal em todos os casos, exceto um que apresentou cálculo coraliforme associado à bexiga neurogênica devido a envolvimento neurológico pelo lúpus. Refluxo vésico-ureteral foi demonstrado em dois pacientes e, em outros dois casos, observava-se grande resíduo pós-miccional secundário à lesão neurológica pela doença de base. A média da capacidade vesical máxima com paciente desperto foi de 342 ml e, em 18,9% dos casos este parâmetro estava diminuído. Este subgrupo apresentou maior incidência de manifestações urinárias e maior frequência de emprego de citostáticos (Z > Z5%). Não se caracterizou padrão diacrítico de participação vesical na doença. Em 43,2% dos pacientes, detectaram-se aspectos cistoscópicos semelhantes aos descritos para a forma precoce ou menor de cistite intersticial, guardando dependência apenas com o emprego de citostáticos no tratamento do lúpus eritematoso sistêmico. Conclusões: Demonstrou-se o envolvimento vesical no lúpus eritematoso sistêmico, mesmo em pacientes assintomáticos e que se manifestou pela ocorrência de alterações cistoscópicas e pela diminuição da capacidade vesical máxima em paciente desperto, estando esta associada à presença de dor suprapúbica à repleção vesical e manifestações irritativas urinárias, bem como ao uso de citostáticos.

Histological aspects of the bladder in systemic lupus erythematosus / Aspectos histopatológicos da bexiga no lúpus eritematoso sistêmico

Objectives: to study pathological data from bladders of systemic lupus erythematosus patients, correlate them to clinical events and the use of therapeutic drugs, and compare them to bladder histopathological findings in individuals not affected by systemic lupus erythematosus. Methods: thirty-nine out or inpatients of the Department of Rheumatology at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, diagnosed with systemic lupus erythematosus were clinically and cystoscopically evaluated. Bladder biopsy was also performed. As a normal parameter, bladders taken from 20 corpses collected at the Death Verification Department of São Paulo city, without autolysis or evidence of urinary tract or autoimmune disease were also histologically studied. This group was considered as a Control Group. A correlation among clinical, cystoscopic and histopathological data was carried out. Results: the patients mean age was 29 years (range 13-62). Thirty-six were females and three were males. Twenty-five patients were asymptomatic during the study period. In the Control Group the age range was 20-65 years. Nineteen were females (95%) and one was male (5%). Cystoscopic examination of the group with systemic lupus erythematosus showed interstitial pattern in 16 cases (41.0%) and normal in 15 (38.5%). The bladder was normal in four patients (10.3%). Chronic unspecific cystitis was observed in 18 (46.2%) patients. In the remaining, several alterations were found, including bladder vasculitis in seven patients (17.9%). The mean number of mast cells in the bladder area was 2.223/mm2. In the Control Group, unspecific cystitis was found in three cases (15.0%). No other abnormalities were found. The mean number of mast cells in this group was 0.777/mm2 (±2.7). Chronic unspecific cystitis, bladder vasculitis and the mean number of mast cells were compared with each other and no statistical differences were found (p > 0.05). There were statistically significant differences between the two groups regarding chronic unspecific cystitis and bladder vasculitis (Z = 2.078 > Z5% = 1.645 and Z = 1.777 > Z5% = 1.645) and also mean number of mast cells (Z = 2.387 > Z5% = 1.673). There were statistically significant differences between the proportion of mast cell infiltrate and presence of suprapubic pain as well as use of antimalarial drugs. The other analysis did not show statistically significant differences. There was no statistical evidence of dependence among the events: cystoscopy with interstitial pattern and chronic unspecific cystitis (p > 0.237); cystoscopy with interstitial pattern and bladder vasculitis(p > 0.325); cystoscopy with interstitial pattern and mast cell infiltrate (p > 0.277). Conclusions: the bladder in systemic lupus erythematosus may be involved even in the absence of clinical manifestations. The involvement of the bladder in systemic lupus erythematosus was characterized mainly by the finding of chronic unspecific cystitis, bladder vasculitis and mast cell infiltrate. The presence of chronic unspecific cystitis was significantly greater in patients with the disease than in the Control Group, and the same occurred with bladder vasculitis. The number of mast cells/mm2 was higher than normal in patients with systemic lupus erythematosus. This finding was associated to suprapubic pain upon bladder repletion and to use of antimalarial drugs.

Isolated anterior urethral trauma in man after coitus:a case report / Trauma isolado de uretra anterior masculina após coito: relato de caso

Penile fracture with or without urethral injury after coitus presents with severe pain and immediate penile detumescence accompanied by a cracking sound. Hematuria or voiding difficulty are common findings and suggest associated urethral injury. The objective of this report is to describe an unusual complication of coital trauma diagnosed based on clinical findings. The isolated urethral injury is rare but is one of the causes of male coital trauma and may be suspected when patients present urethral bleeding.

Fratura de pênis com ou sem lesão de uretra é a principal lesão ocorrida durante o ato sexual e se apresenta com dor intensa, rápido intumescimento e estalido. Hematúria ou dificuldade miccional são sintomas incomuns, que sugerem lesão de uretra associada. O objetivo do trabalho foi relatar essa rara complicação de lesão isolada de uretra durante o intercurso sexual cujo diagnóstico se acha baseado em achados clínicos. A lesão isolada de uretra, embora rara, pode ocorrer durante o intercurso sexual e deve ser suspeitada na presença de uretrorragia.

Female urethral diverticulum associated witha large urinary calculus / Divertículo de uretra feminina associado a grande cálculo urinário

The diverticula of female urethra are very uncommon, but more frequently found between the third and fifth decade of life. Diverticula area mostly relate to repeated urinary infections of the periurethral glands or urethras trauma. The diverticula may cause infection, calculus formation and rarely endometriosis or cancer. A case of a 65-year old Caucasian female with vaginal mass over six months is herein reported. There was no urinary loss, urethral secretion or urinary symptoms. A cystourethrography showed diverticula with calculus inside. The patient was submitted to surgery and dismissed from the hospital on the first postoperative day. The pathologic examination revealed no malignancy. In six months of follow-up, the patient was continent with no complaints.

Os divertículos de uretra feminina são incomuns, porém mais frequentes entre a terceira e a quinta década de vida. A maioria dos divertículos de uretra está relacionada a infecções recorrentes das glândulas periuretrais ou traumatismo uretral. Os divertículos podem ser sítio de infecções, formação de cálculos e, mais raramente, endometriose ou neoplasia. Relata-se o caso de paciente de 65 anos, branca, com queixa de nódulo em parede vaginal notado há seis meses. Negava incontinência urinária, derrame uretral e sintomas urinários de armazenamento ou de esvaziamento. A uretrocistografia miccional revelou divertículo uretral associado a cálculo. Submetida à cirurgia, teve alta hospitalar no primeiro dia pós-operatório. O resultado do exame anatomopatológico não evidenciou malignidade. Após seis meses de seguimento, a paciente encontra-se sem queixas urinárias ou vaginais e com continência urinária preservada.