Tomografía computarizada en la identificación de la sinusitis odontogénica de origen endodóntico: reporte de un caso / Computerized tomography in the identification of odontogenic sinusitis of endodontic origin: report of a case

Objetivo: se presenta el caso clínico de sinusitis de origen endodóntico, conocida como síndrome en-doantral, haciendo énfasis en la dificultad de diag-nóstico con radiografía periapical y la importancia de la tomografía computarizada. Caso clínico: una mujer de 32 años, con antecedentes de apretamiento dental nocturno y sinusitis recurrente, fue remitida para evaluación endodóntica. El examen clínico reve-ló sensibilidad a la percusión y palpación en la unidad dental. La radiografía periapical no indicó lesión en el diente 16 y la prueba de sensibilidad pulpar fue ne-gativa, además, la tomografía computarizada reveló una extensa lesión periapical y comunicación entre la raíz del diente 16 y el seno maxilar, confirmada por la pérdida de la continuidad de la imagen hiperdensa en el suelo del seno, lo que llevó al tratamiento endo-dóntico. El control de la infección dental resolvió la sinusitis, resaltando la importancia del diagnóstico preciso y el tratamiento en casos de sinusitis odon-togénica. Conclusión: este caso destaca el valor de la tomografía computarizada como herramienta diag-nóstica crucial en contextos clínicos complejos (AU)

Objective: the clinical case of sinusitis of endodontic origin, known as endoantral syndrome, is presented, emphasizing the difficulty of diagnosis with periapical radiography and the importance of computed tomography. Clinical case: a 32-year-old woman, with a history of tooth clenching and recurrent sinusitis, was referred for endodontic evaluation. The clinical examination revealed sensitivity to percussion and palpation in the dental unit. The periapical radiograph did not indicate a lesion in tooth 16 and the pulp sensitivity test was negative, in addition, the computed tomography revealed an extensive periapical lesion and communication between the root of tooth 16 and the maxillary sinus, confirmed by the loss of continuity of the hyperdense image in the sine floor, which led to endodontic treatment. Dental infection control resolved sinusitis, highlighting the importance of accurate diagnosis and treatment in cases of odontogenic sinusitis. Conclusion: this case highlights the value of computerized tomography as a crucial diagnostic tool in complex clinical contexts (AU)

Telerehabilitación en artroplastía de rodilla, alternativa terapéutica y desafío ético / Telerehabilitation in knee arthroplasty, therapeutic alternative and ethical challenge

Como una alternativa al tratamiento tradicional aplicado por kinesiólogos, terapeutas físicos o fisioterapeutas surge la telerehabilitación, que como campo emergente de la telemedicina, es definida como un conjunto de herramientas y procedimientos para desarrollar el proceso de rehabilitación de forma remota. Con cada vez mayor respaldo y evidencia, es utilizado en una amplia gama de afecciones clínicas, brindando una oportunidad para que las personas de zonas rurales y remotas obtengan consultoría y asesoramiento de alta calidad. Un foco de interés son las personas operadas con artroplastía de rodilla, que en su gran mayoría son adultos mayores, y que mientras se mantienen en terapia de rehabilitación cursan por un estado de fragilidad, demandan de la asistencia de familiares o cuidadores y deben asumir costos y tiempo extra para trasladarse a ser atendidos. Para ellos la telerehabilitación se considera una alternativa eficaz después del alta hospitalaria, dado que se obtienen resultados similares al tratamiento convencional en el estado funcional y el nivel de actividad física y al ser desarrollada con una supervisión clínica especializada reduce los costos de atención médica manteniendo una eficacia similar al tratamiento tradicional en el hogar o la clínica.

Acting as an alternative to the traditional treatment applied by kinesiologists, physical therapists or physiotherapists, telerehabilitation emerges, which as an emerging telemedicine field, is defined as a set of tools and procedures to develop the rehabilitation process remotely(1). With increasing support and evidence, it is used in a wide range of clinical conditions, providing an opportunity to people in rural and remote areas to obtain high-quality consulting and advice(2) A main point of interest is people who underwent knee arthroplasty, the vast majority of whom are older adults, and who, while they remain in rehabilitation therapy, are in a state of fragility, demand the assistance of family members or caregivers and must assume costs and extra time to travel to be seen. For them, telerehabilitation is considered an effective alternative after hospital discharge, since similar results are obtained to conventional treatment in functional status and level of physical activity(3) and, as it is developed with specialized clinical supervision, it reduces the costs of care maintaining an efficacy similar to traditional treatment at home or clinic.

O Escore Gensini e a Carga Trombótica Adicionam Valor Preditivo ao Escore SYNTAX na Detecção de No-Reflow após Infarto do Miocárdio / Gensini Score and Thrombus Burden Add Predictive Value to the SYNTAX Score in Detecting No-Reflow after Myocardial Infarction

Resumo Fundamento O fenômeno de no-reflow após a intervenção coronária percutânea está associado a um pior prognóstico em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST). O escore SYNTAX é um bom preditor de no-reflow. Objetivo Nosso objetivo foi avaliar se a carga aterosclerótica (escore Gensini) e a carga trombótica na artéria coronária culpada melhorariam a capacidade do escore SYNTAX para detectar o no-reflow. Métodos Neste estudo coorte prospectivo, foram estudados pacientes com IAMCSST consecutivos que se apresentaram dentro de 12 horas a partir do início dos sintomas. O no-reflow foi definido como fluxo TIMI < 3 ou fluxo TIMI =3 mas grau de blush miocárdico (myocardial blush grade) < 2. A carga trombótica foi quantificada de acordo com o grau TIMI de trombo (0 a 5). Resultados Foram incluídos 481 pacientes no estudo, com idade média de 61±11 anos. O fenômeno de no-reflow ocorreu em 32,8% dos pacientes. O escore SYNTAX (OR=1,05, IC95% 1,01-1,08, p<0,01), a carga trombótica (OR=1,17, IC95% 1,06-1,31, p<0,01), e o escore Gensini (OR=1,37, IC95% 1,13-1,65, p<0,01) foram preditores independentes do no-reflow. Os escores combinados apresentaram uma maior área sob a curva quando comparados ao escore SYNTAX isolado (0,78 [0,73-0,82] vs 0,73 [0,68-0,78], p=0,03). A análise da melhora da reclassificação líquida (NRI) categórica (0,11 [0,01-0,22], p=0,02) e contínua (NRI>0) (0,54 [0,035-0,73], p<0.001) mostrou melhora na capacidade preditiva do no-reflow no modelo combinado, com melhora da discriminação integrada (IDI) de 0,07 (0,04-0,09, p<0,001). Conclusões Nossos achados sugerem que, em pacientes com IAMCSST submetidos à intervenção coronária percutânea, a carga aterosclerótica e a carga trombótica na artéria culpada adicionam valor preditivo ao escore SYNTAX na detecção do fenômeno no-reflow. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

Abstract Background No-reflow after percutaneous coronary intervention is associated with poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). SYNTAX score is a good predictor of no-reflow. Objective We aimed to evaluate whether atherosclerotic burden (Gensini score) and thrombus burden in the culprit coronary artery would improve the ability of the SYNTAX score to detect no-reflow. Methods In this prospective cohort study, consecutive patients with STEMI who presented within 12 h of onset of symptoms were selected for this study. No-reflow was defined as TIMI flow < 3 o r TIMI flow = 3 but myocardial blush grade <2. Thrombus burden was quantified according to the TIMI thrombus grade scale (0 to 5). Results A total of 481 patients were included (mean age 61±11 years). No-reflow occurred in 32.8%. SYNTAX score (OR=1.05, 95%CI 1.01-1.08, p<0.01), thrombus burden (OR=1.17, 95%CI 1.06-1.31, p<0.01), and Gensini score (OR=1.37, 95%CI 1.13-1.65, p<0.01) were independent predictors of no-reflow. Combined scores had a larger area under the curve than the SYNTAX score alone (0.78 [0.73-0.82] vs 0.73 [0.68-0.78], p=0.03). Analyses of both categorical (0.11 [0.01-0.22], p=0.02), and continuous net reclassification improvement (NRI>0) (0.54 [0.035-0.73], p<0.001) showed improvement in the predictive ability of no-reflow in the combined model, with integrated discrimination improvement (IDI) of 0.07 (0.04-0.09, p<0.001). Conclusions Our findings suggest that, in patients with STEMI undergoing percutaneous coronary intervention, atherosclerotic burden and thrombus burden in the culprit artery add predictive value to the SYNTAX score in detecting the no-reflow phenomenon. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

Odontogenic Infection and dental Pain negatively impact Schoolchildrens Quality of Life / Infecção odontogênica e odontalgia impactam negativamente a qualidade de vida de crianças escolares

ABSTRACT The aim of this study is to assess the prevalence of odontogenic infection in lowincome Brazilian schoolchildren and evaluate its association with the subjective variables of oral healthrelated quality of life and dental pain. In this crosssectional study, 230 schoolchildren aged eight to ten years old underwent a clinical oral survey in which the DMFT/dmft and PUFA/pufa indexes were measured. Afterward, children responded individually to the Child Perceptions Questionnaire (CPQ810) and selfreports of dental pain were collected. Data were statistically analyzed using MannWhitney or KruskalWallis test with a posttest by Dunn's and Pearson correlation. Of the children evaluated, 42.6% had odontogenic infection and 80% reported experiencing dental pain. Children's age (p = 0.034) and past experience of dental pain (p < 0.002) were associated with odontogenic sepsis, in addition to impairment of their emotional wellbeing (p = 0.008), social welfare (p = 0.009) and overall impact on quality of life (p = 0.019). Toothache intensity (p < 0.001), frequency (p < 0.001) and duration (p < 0.001) were correlated to the overall impact on children's quality of life. The prevalence of odontogenic infection remains high among lowincome Brazilian schoolchildren. Pediatric infection and its related pain induce not only various biological disorders but also impair children's selfperception of quality of life.

RESUMO O objetivo deste estudo foi avaliar a prevalência de infecção odontogênica em crianças escolares brasileiras de baixa renda e analisar a sua associação com as variáveis subjetivas da autopercepção de qualidade de vida relacionada à saúde bucal e dor dentária. Neste estudo transversal, 230 crianças escolares com 8 a 10 anos de idade realizaram exame clínico bucal no qual os índices CPOD/ ceod e PUFA/pufa foram mensurados. Com isso, as crianças responderam individualmente ao Child Perceptions Questionnaire (CPQ810) e relatos de dor dentária foram coletados. Os dados foram estatisticamente analisados utilizandose o teste MannWhitney ou KruskalWallis, com posterior teste da correlação de Dunn e Pearson. Dentre as crianças examinadas, 42,6% apresentavam infecção odontogênica e 80% reportou experiência de dor dentária. A idade (p=0,034) e experiência de dor dentária (p<0,002) das crianças foram associadas à infecção odontogênica, bem como o seu bemestar emocional (p=0,008) e social (p=0,009) e impacto geral na qualidade de vida (p=0,019). Além disso, a intensidade (p<0,001), frequência (p<0,001) e duração (p<0,001) da odontalgia foram correlacionadas com o impacto geral na qualidade de vida da criança. A prevalência de infecção odontogênica permanece elevada em crianças escolares brasileiras. Infecção pediátrica e sua dor relacionada induzem não apenas diversas desordens biológicas, mas também afetam negativamente a autopercepção de qualidade de vida das crianças.

Is There Safety in the Use of Clopidogrel Loading Dose in Patients Over 75 Years of Age with Acute Coronary Syndrome?

There is limited evidence in the literature regarding the administration of clopidogrel to acute coronary syndrome (ACS) in patients over 75 years of age. Most studies excluded this age group, making the subject controversial due to the increased risk of bleeding in this population. Objective: This is a retrospective, unicentric, and observational study aimed at assessing whether the administration of clopidogrel loading dose increases bleeding rates in patients over 75 years of age. Methods: Patients were divided into two groups: group I: 75 mg of clopidogrel; group II: 300-to 600-mg loading dose of clopidogrel. A total of 174 patients (129 in group I and 45 in group II) were included between May 2010 and May 2015. Statistical analysis: The primary outcome was bleeding (major and/or minor). The secondary outcome was combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed through Q-square and T-test. The multivariate analysis was performed by logistic regression, being considered significant p < 0.05. Results: Comparisons between groups I and II showed differences in the prevalence of diabetes (46.5% vs. 24.4%, p = 0.01), arterial hypertension (90.7% vs. 75, p = 0.01), dyslipidemia (62% vs. 42.2%, p = 0.021), ST segment elevation (11.6% vs. 26.6%, p = 0.016) and coronary intervention percutaneous (16.5% vs. 62.2%, p < 0.0001), respectively. In the multivariate analysis, significant differences were observed between groups I and II in relation to the occurrence of bleeding (8.5% vs. 20%, OR = 0.173, 95% CI: 0.049 - 0.614, p = 0.007). Conclusion: A loading dose of 300 mg or more of clopidogrel

Prognostic Differences between Men and Women with Acute Coronary Syndrome. Data from a Brazilian Registry / Diferenças Prognósticas entre Homens e Mulheres com Síndrome Coronariana Aguda. Dados de um Registro Brasileiro

Abstract Background: Gender-related differences have been reported in patients with acute coronary syndrome. The description of this comparative finding in a Brazilian registry has not yet been documented. Objective: To compare male vs. female patients regarding the baseline characteristics, coronary findings, treatment and in-hospital and long-term prognosis. Methods: This is a retrospective, multicenter and observational study that included 3,745 patients (2,437 males and 1,308 females) between May 2010 and May 2015. The primary in-hospital outcome was all-cause mortality. The secondary outcome consisted of combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed using the chi-square and the t test, considering p < 0.05 as significant. In the long term, mortality and combined events were assessed using the Kaplan-Meier method, with a mean follow-up of 8.79 months. Results: The mean age was 60.3 years for males and 64.6 for females (p < 0.0001). The most prevalent risk factor was systemic arterial hypertension in 72.9% of the women and 67.8% of the men (p = 0.001). Percutaneous coronary intervention was carried out in 44.9% of the males and 35.4% of the females (p < 0.0001), and coronary artery bypass grafting (CABG) was performed in 17% of the males and 11.8% of females (p < 0.0001), with a higher prevalence of three-vessel coronary artery disease in males (27.3% vs. 16.2%, p < 0.0001). Approximately 79.9% of the female patients received a diagnosis of acute coronary syndrome without ST-segment elevation, while in the male patients, this diagnosis was attained in 71.5% (p < 0.0001). No significant differences were observed between the groups in the short and long term, regarding both mortality and the combined events. Conclusion: Several gender-related differences were observed in patients with acute coronary syndrome regarding the demographic characteristics, coronary artery disease pattern and implemented treatment. However, the prognostic evolution was similar between the groups.

Resumo Fundamento: Existem diferenças relatadas entre pacientes com síndrome coronariana aguda, de acordo com o sexo. A descrição deste achado comparativo em registro brasileiro ainda não foi documentada. Objetivo: Comparar pacientes do sexo masculino vs. feminino quanto a características basais, achados coronarianos, tratamento e prognóstico intra-hospitalar e em longo prazo. Métodos: Trata-se de estudo retrospectivo, multicêntrico e observacional, no qual foram incluídos 3.745 pacientes (2.437 do sexo masculino e 1.308 do sexo feminino) entre maio de 2010 e maio de 2015. O desfecho primário intra-hospitalar foi mortalidade por todas as causas. O desfecho secundário foi eventos combinados (choque cardiogênico, reinfarto, morte, acidente vascular cerebral e sangramento). A comparação entre grupos foi realizada por meio de qui-quadrado e teste t, sendo considerado significativo p < 0,05. Em longo prazo, foram avaliados a mortalidade e os eventos combinados pelo método Kaplan-Meier, com seguimento médio de 8,79 meses. Resultados: A média de idade foi de 60,3 anos no sexo masculino e 64,6 no feminino (p < 0,0001). O fator de risco mais prevalente foi hipertensão arterial sistêmica em 72,9% das mulheres e 67,8% nos homens (p = 0,001). Intervenção coronária percutânea foi realizada em 44,9% no sexo masculino e 35,4% no feminino (p < 0,0001), e revascularização miocárdica cirúrgica em 17% no sexo masculino e 11,8% no feminino (p < 0,0001), com maior prevalência de padrão coronariano triarterial no sexo masculino (27,3% vs. 16,2%; p < 0,0001). Cerca de 79,9% dos pacientes do sexo feminino enquadraram-se no diagnóstico de síndrome coronariana aguda sem supradesnivelamento do segmento ST, enquanto no sexo masculino este número foi de 71,5% (p < 0,0001). Em curto e longo prazos não se observaram diferenças significativas entre os grupos, tanto em mortalidade quanto em eventos combinados. Conclusão: Observaram-se múltiplas diferenças relacionadas ao sexo em pacientes com síndrome coronariana aguda no que se refere a características demográficas, padrão coronariano e tratamento adotado. No entanto, a evolução prognóstica foi semelhante entre os grupos.

Is There Any Relationship between TSH Levels and Prognosis in Acute Coronary Syndrome? / Existe Alguma Relação entre Níveis de TSH e Prognóstico em Síndrome Coronariana Aguda?

Abstract Background: Some small studies have related higher levels of thyrotropin (TSH) to potentially worse prognosis in acute coronary syndromes. However, this relationship remains uncertain. Objective: To analyze the outcomes of patients with acute coronary syndromes in relation to the value of TSH at admission. Methods: Observational and retrospective study with 505 patients (446 in group I [TSH ≤ 4 mIU/L] and 59 in group II [TSH > 4 mIU/L]) with acute coronary syndromes between May 2010 and May 2014. We obtained data about comorbidities and the medications used at the hospital. The primary endpoint was in-hospital all-cause death. The secondary endpoint included combined events (death, non-fatal unstable angina or myocardial infarction, cardiogenic shock, bleeding and stroke). Comparisons between groups were made by one-way ANOVA and chi-square test. Multivariate analysis was determined by logistic regression. Analyses were considered significant when p < 0.05. Results: Significant differences between groups I and II were observed regarding the use of enoxaparin (75.2% vs. 57.63%, p = 0.02) and statins (84.08% vs. 71.19%, p < 0.0001), previous stroke (5.83% vs. 15.25%, p = 0.007), combined events (14.80% vs. 27.12%, OR = 3.05, p = 0.004), cardiogenic shock (4.77% vs. 6.05%, OR = 4.77, p = 0.02) and bleeding (12.09% vs. 15.25%, OR = 3.36, p = 0.012). Conclusions: In patients with acute coronary syndromes and TSH > 4 mIU/L at admission, worse prognosis was observed, with higher incidences of in-hospital combined events, cardiogenic shock and bleeding.

Resumo Fundamento: Estudos pequenos têm relacionado níveis mais elevados de hormônio tireoestimulante (TSH) a pior prognóstico em pacientes com síndrome coronariana aguda (SCA). Tal relação, no entanto, permanece incerta. Objetivo: Analisar os desfechos de pacientes com SCA, relacionando-os aos níveis de TSH medidos no setor de emergência. Métodos: Estudo retrospectivo observacional incluindo 505 pacientes com SCA (446 no grupo I: TSH ± 4 mUI/L; 59 no grupo II: TSH > 4 mUI/L) entre maio de 2010 e maio de 2014. Dados sobre comorbidades e medicamentos usados foram obtidos. O desfecho primário foi mortalidade intra-hospitalar por todas as causas. O desfecho secundário incluiu eventos combinados (morte, angina instável não fatal ou infarto do miocárdio, choque cardiogênico, sangramento e acidente vascular encefálico). A comparação entre grupos foi realizada através de ANOVA de uma via e teste do qui-quadrado. A análise multivariada foi realizada por regressão logística, adotando-se o nível de significância de p < 0,05. Resultados: Diferenças significativas foram observadas entre os grupos I e II relacionadas ao uso de enoxaparina (75,2% vs. 57,63%; p = 0,02) e estatinas (84,08% vs. 71,19%; p < 0,0001), acidente vascular encefálico prévio (5,83% vs. 15,25%; p = 0,007), eventos combinados (14,80% vs. 27,12%, OR = 3,05; p = 0,004), choque cardiogênico (4,77% vs. 6,05%, OR = 4,77; p = 0,02) e sangramento (12,09% vs. 15,25%, OR = 3,36; p = 0,012). Conclusão: Em pacientes com SCA e TSH > 4 mUI/L à admissão hospitalar, observou-se pior prognóstico associado à maior incidência de eventos combinados intra-hospitalares, choque cardiogênico e sangramentos.

Mortality reduction with use of oral beta-blockers in patients with acute coronary syndrome

OBJECTIVES: Recent studies have revealed a relationship between beta-blocker use and worse prognosis in acute coronary syndrome, mainly due to a higher incidence of cardiogenic shock. However, the relevance of this relationship in the reperfusion era is unknown. The aim of this study was to analyze the outcomes of patients with acute coronary syndrome that started oral beta-blockers within the first 24 hours of hospital admission (group I) compared to patients who did not use oral beta-blockers in this timeframe (group II). METHODS: This was an observational, retrospective and multicentric study with 2,553 patients (2,212 in group I and 341 in group II). Data regarding demographic characteristics, coronary treatment and medication use in the hospital were obtained. The primary endpoint was in-hospital all-cause mortality. The groups were compared by ANOVA and the chi-square test. Multivariate analysis was conducted by logistic regression and results were considered significant when p<0.05. RESULTS: Significant differences were observed between the groups in the use of angiotensin-converting enzyme inhibitors, enoxaparin, and statins; creatinine levels; ejection fraction; tabagism; age; and previous coronary artery bypass graft. Significant differences were also observed between the groups in mortality (2.67% vs 9.09%, OR=0.35, p=0.02) and major adverse cardiovascular events (11% vs 29.5%, OR=4.55, p=0.02). CONCLUSIONS: Patients with acute coronary syndrome who underwent early intervention with oral beta-blockers during the first 24 hours of hospital admission had a lower in-hospital death rate and experienced fewer major adverse cardiovascular events with no increase in cardiogenic shock or sustained ventricular arrhythmias compared to patients who did not receive oral beta-blockers within this timeframe.

Actividad inhibitoria del crecimiento bacteriano por cobre nanoestructurado obtenido de minerales de la región Marañón: comparación con cobre comercial / Bacterial growth inhibitory activity for nanostructured copper minerals obtained from the Marañon region: comparison with commercial copper

En el presente trabajo se reporta la actividad inhibitoria del crecimiento bacteriano por nanopartículas de cobre cementado y de cobre comercial. Se utilizaron las cepas de Staphylococcus aureus ATCC 6538 (Gram positiva) y Escherichia coli ATCC 35218 (Gram negativa) para determinar el efecto inhibitorio mediante la concentración mínima inhibitoria de las nanopartículas diluidas en caldo de cultivo nutritivo y distribuidas en placas de ELISA. Las muestras de cobre cementado (obtenidas por procesos hidrometalúrgicos) y de cobre comercial fueron nanoestructuradas empleando un equipo de molienda mecánica. Los resultados indican que las nanopartículas de cobre comercial (a 2.5 horas de molienda) muestran acción inhibitoria del crecimiento de la cepa S. aureus y no así en la cepa E. coli. Asimismo, se determinó que la concentración mínima inhibitoria de la muestra de cobre comercial fue de 20 μg/mL frente a S. aureus. El cobre cementado (en su forma sólida y nanoestructurada) no mostró efecto inhibitorio del crecimiento en ninguna de las dos cepas estudiadas.

In this paper, we report on the bacterial growth inhibitory activity of nanoparticles of cemented and commercial copper. Strains of Staphylococcus aureus ATCC 6538 (Gram positive) and Escherichia coli ATCC 35218 (Gram negative) were used to determine the inhibitory effect by the minimal inhibitory concentration of the nanoparticles diluted in nutrient culture broth and distributed in ELISA plates. The copper cements (obtained from hydrometallurgical processes) and the commercial one were nanostructured employing a mechanical milling equipment. The results indicate that commercial copper nanoparticles (after 2.5 hours of milling) show growth inhibitory action of S. aureus strain. However, in the case of E. coli strains no inhibitory action has been observed. It was also determined that the minimal inhibitory concentration of the commercial copper is 20 μg/mL against S. aureus. On the other hand, copper cements (in solid and nanostructured form) do not show inhibitory effects.

Evasive mating behaviour by female nurse sharks, Ginglymostoma cirratum (Bonnaterre, 1788), in an equatorial insular breeding ground

Mating events and aggregations of vulnerable nurse sharks Ginglymostoma cirratum were recorded in the insular protected area of Fernando de Noronha (FEN), Brazil, between April and August 2015. Female sharks were observed clustering in groups of up to 14 individuals in shallow water adjacent to the shore. Several evasive mating behaviours in the presence of males were noticed, including shoreward movement, positioning ventral side up at the sea surface with emerged pectoral and pelvic fins, body rolling and caudal fin thrashing. Fresh bite marks indicative of male courtship and coupling attempts were visible in female's pectoral and caudal fins. Altogether, the observed behaviours match previous reports of non-cooperative female nurse sharks during mating opportunities. An extended mating season coupled with a persistent use of inshore habitats result in nurse sharks being particularly vulnerable to human pressure during a most sensitive stage of their life cycle. The effective conservation of nurse shark populations from the western South Atlantic may thus depend on the protection of critical habitats where this species aggregates to reproduce. Explicitly addressing environmental requirements by vulnerable species in local management strategies is indispensable to ensure that human pressure, including ecotourism development, does not collide with stipulated conservation aims.(AU)

Agregações e eventos reprodutivos do vulnerável tubarão-lixa, Ginglymosytoma cirratum , foram registrados na área insular protegida do Arquipélago de Fernando de Noronha (FEN), Brasil, entre Abril e Agosto de 2015. Grupos constituídos por até 14 fêmeas foram observados em águas rasas adjacentes à linha costeira. Perante a presença de machos, diversos comportamentos evasivos por parte das fêmeas foram identificados, incluíndo movimentação para águas ainda mais rasas, posicionamento na superfície do mar com a face ventral orientada para cima e emersão das nadadeiras peitorais e pélvicas, enrolamento do corpo e batimento da nadadeira caudal na superfície do mar. Foram identificadas marcas recentes de mordida nas nadadeiras peitorais e caudais das fêmeas, sugerindo interações de acasalamento com machos. No geral, os comportamentos observados coincidem com os comportamentos exibidos por fêmeas não aquiescentes à cópula reportados no hemisfério norte. Em FEN, a duração relativamente longa do período de acasalamento, juntamente com a utilização persistente dos habitats mais costeiros, promovem a vulnerabilidade do tubarão lixa às pressões antrópicas durante uma das fases mais sensíveis do seu ciclo de vida. A conservação efetiva das populações de tubarão-lixa do Oceano Atlântico Sul ocidental poderá, assim, depender da proteção dos habitats críticos de agregação onde esta espécie se reproduz. Por conseguinte, a abordagem explícita dos requisitos ambientais associados a espécies vulneráveis no âmbito dos planos de manejo locais deve ser considerada como indispensável para assegurar que as pressões antrópicas, incluíndo o desenvolvimento ecoturístico, não comprometerão os objetivos conservacionistas estipulados.(AU)

Intracardiac embolization of inferior vena cava filter associated with right atrium perforation and cardiac tamponade / Embolização de filtro de veia cava associado à perfuração de átrio direito e tamponamento cardíaco

Insertion of inferior vena cava filters has been well established in literature, reducing occurrence of pulmonary embolism after an episode of deep venous thrombosis in patients with contraindication to anticoagulation. There are a small number of complications related to procedure and embolization is rare. In this context, we described a case of intracardiac embolization associated with cardiac tamponade.

A colocação percutânea de filtro de veia cava inferior é bem estabelecida em literatura, reduzindo a chance de ocorrência de tromboembolismo pulmonar após um episódio de trombose venosa profunda em pacientes com contraindicações à anticoagulação. O índice de complicações relacionadas ao procedimento é pequeno, sendo embolização evento extremamente raro. Nesse contexto, descrevemos um caso de embolização intracardíaca de filtro de veia cava inferior associada ao tamponamento cardíaco.

Diagnóstico e primeira manifestação de displasia arritmogênica de ventrículo direito em paciente sexagenário / Clinical manifestations and diagnosis of arrhythmogenic right ventricular dysplasia in sexagenary patient

A displasia arritmogênica de ventrículo direito (DAVD) é uma das principais causas de morte súbita em indivíduos jovens. Suas manifestações e consequente diagnóstico costumam ser precoces ainda na adolescência ou no adulto jovem. Nesse contexto, o diagnóstico em doente sexagenário sem história familiar sugestiva ou sintomas prévios e com possibilidade de tratamento torna esse caso único na literatura.

Arrhythmogenic right ventricular dysplasia is one of the major causes of death in younger patients and its manifestations and diagnosis used to be early. In this context, diagnosis in a sexagenary patient without famylial history or previous symptoms and with possibility of correct treatment make this case unique.

Galvanic vestibular stimulation: a novel modulatory countermeasure for vestibular-associated movement disorders / Estimulacao galvanica vestibular para corrigir transtornos neurologicos associados a disfuncao vestibular

Motion sickness or kinetosis is the result of the abnormal neural output originated by visual, proprioceptive and vestibular mismatch, which reverses once the dysfunctional sensory information becomes coherent. The space adaptation syndrome or space sickness relates to motion sickness; it is considered to be due to yaw, pith, and roll coordinates mismatch. Several behavioural and pharmacological measures have been proposed to control these vestibular-associated movement disorders with no success. Galvanic vestibular stimulation has the potential of up-regulating disturbed sensory-motor mismatch originated by kinetosis and space sickness by modulating the GABA-related ion channels neural transmission in the inner ear. It improves the signal-to-noise ratio of the afferent proprioceptive volleys, which would ultimately modulate the motor output restoring the disordered gait, balance and human locomotion due to kinetosis, as well as the spatial disorientation generated by gravity transition.

A cinetose ou doença do movimento resulta de uma resposta neural anormal originada do desequilíbrio entre estímulos visuais, proprioceptivos e vestibulares, que melhora quando esse desequilíbrio é corrigido. A síndrome de adaptação espacial ou doença do espaço está relacionada à doença do movimento e é desencadeada por mudanças bruscas de direção, inclinação e rotação da cabeça. Têm sido propostas várias medidas comportamentais e farmacológicas para controlar esses transtornos do movimento associados com o sistema vestibular, mas sem sucesso. A estimulação galvânica vestibular pode regular o desequilíbrio sensitivo-motor causado pela cinetose e pela doença do espaço modulando os canais iônicos GABA, relacionados à transmissão de impulsos nervosos no ouvido interno. Essa estimulação melhora a relação sinal-ruído dos impulsos proprioceptivos que acabam modulando a resposta motora, restabelecendo o equilíbrio e a marcha, recuperando a desorientação espacial causada pelos diversos gradientes de gravidade.

Allelic frequency of the Kappa-Casein gene in Colombian and creole cattle breeds / Frecuencia alélica del gen Kappa-Caseína en bovinos criollos y colombianos / Freqüência do alelo de gene de Kappa-Caseína em bovinos crioulos e colombianos

Colombia has one of the most genetically diverse creole cattle populations, with eight creole breeds and two improved creole (Colombian) breeds. A high demand for meat and milk has led to the inevitable selection of highly productive cattle and the introduction of foreign breeds. Unfortunately, these breeds are often ill-suited for tropical conditions. These factors threaten the size of the creole livestock population, which is considered part of Colombia's national heritage. Objective: to estimate the allelic frequencies of the Kappa-Casein gene (CNS3) in Colombian creole cattle breeds (GCC). Methods: a total of 354 blood samples were taken from 30 animals of each of the following breeds: Blanco Orejinegro (BON), Caqueteño (CQT), Casanareño (CAS), Horned Costeño (Costeño con Cuernos, CCC), Chino Santandereano (ChS), Hartón del Valle (HV), Romosinuano (ROM), and Sanmartinero (SM), each representing the 8 established ''criollo'' (creole) breeds; the Lucerna (LUC) and Velasquez (VEL) representing the two Colombian improved breeds; and Brahman and Holstein as control breeds. DNA was extracted by a salting-out procedure and a 453 bp fragment on chromosome 6 was amplified by PCR. CSN3 alleles were identified using single strand conformation polymorphism (SSCP) and their sequence compared with those of the Genebank for Bos taurus and Bos indicus. Results: higher frequencies for allele variants of CSN3 A (0.39) and B (0.41) were found relative to the frequencies of I (0.038), G (0.095), A1 (0.025), E (0.006), and N (0.006). The allele of interest (CSN3 B) had a high frequency in the CCC (0.81), ROMO (0.66), CQT (0.55), ChS (0.48), and VEL (0.43) breeds. Conclusions: these findings suggest that Colombian creole breeds harbor a high genetic diversity which enriches its gene pool and warrants future conservation efforts to protect its integrity.

Colombia es uno de los países más diversos en recursos genéticos criollos. Posee ochos razas de ganado criollo (GCC) y dos razas de criollo mejorado o razas colombianas. La creciente demanda de alimentos ha generado una forzosa selección de individuos altamente productivos e introducción de razas foráneas (Holstein y Brahman) poco adaptadas a condiciones tropicales, lo que ha puesto en riesgo el tamaño efectivo del ganado criollo, considerado patrimonio nacional. Objetivo: estimar la frecuencia alélica del gen (CNS3) de la Kappa-Caseína en el (GCC). Métodos: se usaron 354 muestras de sangre de ocho razas bovinas criollas (30 individuos por raza): Blanco Orejinegro (BON), Caqueteño (CQT), Casanareño (CAS), Costeño con Cuernos (CCC), Chino Santandereano (ChS), Hartón del Valle (HV), Romosinuano (ROMO) y Sanmartinero (SM), dos colombianas Lucerna (LUC) y Velásquez (VEL) y dos controles Brahman y Holstein. Con el fin de estimar la frecuencia de los alelos k-caseína (k-CN) se amplificó un fragmento de 453 pb para k-CN (cromosoma 6). Los alelos se identificaron mediante la técnica PCR-SSCP. Resultados: se encontró mayor frecuencia para las variantes de k-CN A (0.39) y B (0.41), en comparación a I (0.038), G (0.095), A1 (0.025), E (0.006) y N (0.006). El alelo de interés k-CN B presentó alta frecuencia en las razas CCC (0.81), ROMO (0.66), CQT (0.55), ChS (0.48), y VEL (0.43). Conclusiones: la alta frecuencia del alelo de interés del gen k-CN ratifica al GCC como alternativa viable en esquemas sostenibles de producción de leche de mejor calidad y corrobora la necesidad de evaluación y caracterización de recursos zoogenético, como primer paso para su conservación.

A Colômbia é um dos países mais diversificado em recursos genéticos crioulos, tem oito bovinos da raça nativa e duas raças melhoradas ou raças crioulo colombiano (GCC). A alta demanda por alimentos tem levado a uma seleção forçada das pessoas altamente produtivas e/ou introdução de raças estrangeiras mal adaptados às condições tropicais, que têm prejudicado o tamanho efetivo de animais considerados património crioulo. Objetivo: estimar a frequência do alelo do gene Kappa-Caseína (CNS3) na (GCC). Métodos: foram utilizados 354 amostras de sangue de oito raças nativas (30 indivíduos por raça): Blanco Orejinegro (BON), Caqueteño (CQT), Casanareño (CAS), Costeño con Cuernos (CCC), Chino Santandereano (ChS), Hartón del Valle (HV), Romosinuano (ROM) e Sanmartinero (SM), dois Colombianas Lucerna (LUC) e Velásquez (VEL) e dois controles (Brahman and Holstein). Para estimar a freqüência de alelos de κ-caseína (CSN3), amplificaram um fragmento de 453 pb para CSN3. Os alelos foram identificados por PCR-SSCP. Resultados: encontramos uma maior freqüência de variantes do CSN3 A (0.39) e B (0.41), comparado com I (0.038), G (0.095), A1 (0.025), E (0.006) e N (0.006). O alelo de interesse CSN3 B apresentou alta freqüência em raças CCC (0.81), ROMO (0.66), CQT (0.55), CHS (0.48) e VEL (0.43). Conclusões: estes resultados sugerem que o CCG é um recurso genético, que abriga uma grande diversidade genética e apoia a necessidade de avaliação e caracterização dos recursos genéticos animais como um primeiro passo para a conservação.