Brain-derived neurotrophic factor serum levels following ketamine and esketamine intervention for treatment-resistant depression: secondary analysis from a randomized trial

Abstract Objectives Evidence suggests that ketamine's influence on brain-derived neurotrophic factor (BDNF) might be involved in its mechanism of rapid antidepressant action. We aimed to evaluate the differential impact of ketamine and esketamine on serum BDNF levels and its association with response patterns in treatment-resistant depression (TRD). Methods Participants (n = 53) are from a randomized, double-blind clinical trial comparing the efficacy of single-dose ketamine (0.5mg/kg, n = 27) and esketamine (0.25mg/kg, n = 26) in TRD. Depression severity was assessed before and 24 hours, 72 hours, and 7 days after the intervention, using the Montgomery-Åsberg Depression Rating Scale (MADRS). Blood samples were collected before infusion, 24 hours, and 7 days afterwards. Results There were no significant changes in BDNF levels at post-infusion evaluation points, and no difference in BDNF levels comparing ketamine and esketamine. Both drugs exhibited similar therapeutic effect. There was no association between BDNF levels and response to treatment or severity of depressive symptoms. Conclusion There was no significant treatment impact on BDNF serum levels - neither with ketamine nor esketamine - despite therapeutic response. These results suggest that ketamine or esketamine intervention for TRD has no impact on BDNF levels measured at 24 hours and 7 days after the infusion. This clinical trial is registered on the Japan Primary Registries Network: UMIN000032355.

Exuberant case of verrucous cutaneous leishmaniasis

Abstract Cutaneous leishmaniasis represents a public health problem that affects 85 countries. It is an endemic disease in Brazil, having an important socioeconomic impact. An exuberant case of cutaneous leishmaniasis is reported herein. A 28-year-old male patient with Down syndrome had had verrucous plaques on the back for over a year, with progressive growth. PCR of a lesion sample was positive for Leishmania braziliensis. The patient's condition was classified as atypical cutaneous leishmaniasis. He was successfully treated with amphotericin B and miltefosine. The treatment remains a challenge, given the toxicity and low cure rate of the currently recommended drugs.

Cellular infiltrate in cutaneous leishmaniasis lesions and therapeutic outcome

Abstract Background: The treatment of cutaneous leishmaniasis is a challenge. A better understanding of the in situ mechanisms involved in the evolution and cure of the disease is essential for the development of new therapies. Objective: Correlate histopathological and immunological characteristics of cutaneous leishmaniasis lesions with clinical outcome after different treatment regimens. Methods: The authors analyzed cellular infiltration and immunohistochemistry staining for CD4, CD8 and IL-17 in biopsy samples from 33 patients with cutaneous leishmaniasis before treatment. All patients were recruited in a randomized clinical trial at Corte de Pedra (Bahia-Brazil) and assigned to receive Glucantime®, Glucantime® + Oral Tamoxifen or Glucantime® + Topical Tamoxifen. Patients were followed for 2 to 6 months to define disease outcome. Results: A similar expression of CD4, CD8 and IL-17 was observed in lesion samples regardless of clinical outcome. In general, a higher amount of CD8 cells were observed compared with CD4 cells. An important observation was that all patients whose cellular infiltrate did not contain plasma cells were cured after treatment. Study limitations: Isolated quantification of TCD8 and IL-17 using immunohistochemistry is insufficient to analyze the role of these molecules in the immunopathogenesis of cutaneous leishmaniasis. In addition, the expansion of the immunohistochemistry panel would allow a more complete analysis of the immune response in situ. Conclusions: The absence of plasma cells in cutaneous leishmaniasis lesions was related to a favorable therapeutic outcome.

Plantar ulcer as an atypical manifestation of cutaneous leishmaniasis

Abstract Cutaneous leishmaniasis is characterized by ulcers with raised edges and a granular bottom, mainly on the lower limbs. This is a case report of a male patient with an ulcer on the left plantar region. The diagnosis was confirmed by positive PCR for L. braziliensis and the presence of amastigotes of Leishmania sp. in the histopathological examination. After treatment with Glucantime, the patient showed full healing of the ulcer. The unusual location of the ulceration calls attention to atypical presentations of leishmaniasis, and the importance of histopathological examination and PCR, leading to the appropriate diagnosis and treatment.

FLI1 gene influences lesion size and skin test may predict therapeutic response in cutaneous leishmaniasis

Genes associated with wound healing have been shown to be risk factors for cutaneous leishmaniasis (CL) which is caused by Leishmania braziliensis. In this study, we examined whether the genes previously associated with CL influenced the clinical outcome. Patients were genotyped and retrospectively classified as responders, who were cured with a single course of pentavalent antimony (Sbv), or as refractories, who did not respond to Sbv. Patients characterised as responders showed a stronger response to the leishmanin skin test (LST) when compared to the refractory subjects (p = 0.0003). Furthermore, we observed an association between the FLI1 CC genotype and an increased size of ulcers (p = 0.0170). We suggest that the leishmanin skin test may be a predictive tool for therapeutic outcome and reinforce FLI1 as a potential influencer of susceptibility and lesion size in CL.

Disseminated leishmaniasis: clinical, pathogenic, and therapeutic aspects

Abstract: Disseminated leishmaniasis is a severe and emerging form of American tegumentary leishmaniasis. Disseminated leishmaniasis is defined by the presence of more than 10 polymorphic cutaneous lesions, distributed over more than two noncontiguous parts of the body. Nasal mucosal involvement is observed in almost half of cases. Disseminated leishmaniasis patients present with a decreased production of Th1 cytokines in the peripheral blood due to the attraction of leishmania- activated T cells to the multiple cutaneous lesions. Disseminated leishmaniasis development is poorly understood and is related to a complex network involving environmental, host immune response, and parasite factors, in which L. braziliensis polymorphism plays an important role. Disseminated leishmaniasis is a challenging disease to cure, presenting a high failure rate of 75% to pentavalent antimony therapy. Despite its importance and severity, this form of American tegumentary leishmaniasis has been poorly studied and documented, deserving greater attention from professionals working in endemic areas.

Influence of the inflammatory response on treatment of hepatitis C with triple therapy

Abstract INTRODUCTION: Chronic hepatitis C is a leading cause of liver disease. Infection triggers an immediate immune response in the host that is mediated by humoral/cellular mechanisms. T cells respond to infection via secretion of cytokines, which inhibit or stimulate one another, leading to cytokine imbalance and ultimately affecting treatment. Studies using interferon (IFN) and ribavirin (RBV) showed that TCD8+ cells and cytokine levels are associated with sustainable virological response (SVR). However, studies that investigated the effects of triple therapy (TT) are limited. METHODS: The study included hepatitis C virus (HCV)+ RNA, naives, genotype 1, ≥18 years, and advanced fibrosis (F≥3) patients. Samples were collected at baseline and after 12 weeks (W12) of TT. Six cytokines were analyzed by flow cytometry. RESULTS: Of 31 patients, four were excluded (two deaths, one interrupted TT, and one F2 patient). Of the 27 remaining patients, 21 (78%) were cirrhotic. SVR was achieved in 63% of the patients. The patients had a mean age of 55.11 ± 10.03 years. Analyses at baseline showed that the chemokine CCL5/Regulated on Activation, Normal T Cell Expressed and Secreted (RANTES) (p=0.04) and interleukin (IL)-6 (p=0.02), which was associated with SVR. RANTES (p=0.04) and IL-8 (p=0.01) levels were associated with SVR at W12. CONCLUSIONS Similar to patterns observed during double therapy, IL-6, IL-8, and RANTES levels were associated with SVR in TT, indicating the potential role of interferon in immune response to hepatitis C virus.

The link between cognitive state and general self-esteem among institutionalized elderly persons: can health condition serve as a mediating factor? / Associação entre estado cognitivo e autoestima global em idosos institucionalizados: será a condição de saúde um mediador?

Abstract Objective: to assess whether the health condition of an elderly person can serve as a mediating factor between the cognitive state and general self-esteem of the institutionalized elderly. Method: a quantitative, cross-sectional correlational study was performed, based on the path analysis technique.The following instruments were used for data collection: the Mini-Mental State Examination, the Tinetti Performance Oriented Mobility Assessment, the Mini Nutritional Evaluation and the Rosenberg Self-Esteem Scale. Results: the sample was composed of 312 elderly patients of both genders (112 men and 200 women), with an average age of 83.39 (+7.09) years. Most of the elderly persons were widowed, with a low educational level, and had been institutionalized in Residential Care Facilities for the Elderly for on average 54.6 (+51.69) months. The mediating factor of health condition renders the link between the cognitive state and self-esteem of the elderly null. However, the analysis of the decomposition of the effects showed a significant indirect effect between the cognitive state and health condition. The total effect of cognitive state on the health condition of the elderly is significant, positive and direct. Conclusion: based on the results of this study we maintain that cognitive changes can affect the nutritional state and physical balance of the institutionalized elderly. AU

Resumo Objetivo: testar se a condição de saúde da pessoa idosa é mediadora na associação entre o estado cognitivo e a autoestima global de idosos institucionalizados. Método: estudo de natureza quantitativa, transversal do tipo correlacional, recorreu à análise de caminhos. Na recolha de dados utilizaram-se as versões portuguesas dos seguintes instrumentos: Mini-Mental State Examination, Tinetti Performance Oriented Mobility Assessement, Miniavaliação Nutricional e a Rosenberg Self-Esteem Scale. Resultados: a amostra foi constituída por 312 idosos de ambos os gêneros (112 homens e 200 mulheres), com média etária de 83,39 (±7,09) anos. A maioria dos idosos eram viúvos, com baixa escolaridade, institucionalizados em Equipamentos Residenciais para Pessoas Idosas em média há 54,60 (±51,69) meses. Não se confirmou a mediação da condição de saúde na associação entre estado cognitivo e autoestima nos idosos. Contudo, a análise da decomposição dos efeitos indicou a existência de um efeito significativo indireto do estado cognitivo na autoestima e na condição de saúde. O efeito total do estado cognitivo na condição de saúde dos idosos é significativo, positivo e direto. Conclusão: os resultados desse estudo permitem-nos afirmar que as alterações cognitivas podem afetar o estado nutricional e o equilíbrio corporal dos idosos institucionalizados. AU

Clinical outcomes of psychotherapy dropouts: does dropping out of psychotherapy necessarily mean failure?

Objective: A large proportion of psychotherapy patients remain untreated, mostly because they drop out. This study compares the short- and long-term outcomes of patients who dropped out of psychotherapy to those of therapy completers. Methods: The sample included 63 patients (23 dropouts and 40 completers) from a controlled clinical trial, which compared narrative therapy vs. cognitive-behavioral therapy for major depressive disorder. Patients were assessed at the eighth session, post-treatment, and at 31-month follow-up. Results: Dropouts improved less than completers by the last session attended, but continued to improve significantly more than completers during the follow-up period. Some dropout patients improved with a small dose of therapy (17% achieved a clinically significant change before abandoning treatment), while others only achieved clinically significant change after a longer period (62% at 31-month follow-up). Conclusion: These results emphasize the importance of dealing effectively with patients at risk of dropping out of therapy.Patients who dropped out also reported improvement of depressive symptoms without therapy, but took much longer to improve than did patients who completed therapy. This might be attributable to natural remission of depression. Further research should use a larger patient database, ideally gathered by meta-analysis.

Polymorphisms in genes TLR1, 2 and 4 are associated with differential cytokine and chemokine serum production in patients with leprosy

BACKGROUND Leprosy or hansen’s disease is a spectral disease whose clinical forms mostly depends on host’s immune and genetic factors. Different Toll-like receptors (TLR) variants have been described associated with leprosy, but with some lack of replication across different populations. OBJECTIVES To evaluate the role of polymorphisms in genes TLR1, TLR2 and TLR4 and susceptibility to leprosy in a genetic case control study; to verify the association between genotypes of these markers and the immunological profile in the serum of patients with leprosy. METHODS Pre-designed TaqMan® assays were used to genotype markers at TLR1 (rs4833095, rs5743551), TLR2 (rs7656411, rs3804099) and TLR4 (rs1927914, rs1927911). A panel of cytokines and chemokines was accessed by enzime-linked immunosorbent assay (ELISA) test in the serum of a subgroup of patients with and without leprosy reactions. FINDINGS Our results show an association between the T allele of rs3804099 at the TLR2 gene and increased risk for leprosy per se [Odds ratio (OR) = 1.296, p = 0,022]. In addition, evaluating the association between different genotypes of the TLR1, 2 and 4 markers and cytokine/chemokine serological levels, IL-17 appears as an immunological marker regulated by the polymorphism of the three TLR genes evaluated, whereas different TLR1 genotypes were associated with differential production of IL-12p40 and MCP-1(CCL2). Furthermore, other relevant serum markers such as CXCL-10 and IL-6 seemed to be regulated by TLR2 variants and IL-1β was related to TLR4 genotypes. MAIN CONCLUSIONS All together our data points that the tested TLR markers may have a regulatory role in the immunity against Mycobacterium leprae, by driving the host’s production of key cytokines and chemokines involved in the pathogenesis of this disease.

Oral administration of curcumin (Curcuma longa) can attenuate the neutrophil inflammatory response in zymosan-induced arthritis in rats

PURPOSE: To evaluate the effect of curcumin in the acute phase of zymosan-induced arthritis. METHODS: Twenty-eight male rats were subjected to intra-articular infiltration of zymosan of both knees and, in four the infiltration was made with saline. The animals were divided into five groups second received every six hours by gavage: corn oil by (positive and negative control); curcumin (100 mg/kg); prednisone 1 mg/kg/day; prednisone 8 mg/kg. All animals were sacrificed after six, 12, 24 and 48 hours of the infiltration. The knees were removed for evaluation of neutrophil infiltration. The number of neutrophils was counted by computer-assisted analysis of the images. The neutrophil infiltrate was stratified into four grades: 0 = normal; + = mild; ++/+++ = moderate; > ++++ = severe. The results were compared using the Mann-Whitney test and the variance by Kruskal-Wallis test adopting a significance level of 5% (p<0.05). RESULTS: Curcumin reduces inflammatory activity in the first six hours after zymosan-induced arthritis when compared to saline (p<0.01). This was also observed in animals subjected to administration of prednisone (1 mg/kg) and those treated with prednisone (8 mg/kg). Curcumin was more effective than lower doses of prednisone in the first six hours after induction of the arthritis. After 12, 24 and 48 hours, curcumin does not have the same anti-inflammatory effects when compared to prednisone. After 48 hours, prednisone is more effective than curcumin in reducing the inflammatory infiltrate regardless of the dose of prednisone used. CONCLUSION: Oral administration of curcumin reduces inflammation in the first six hours after experimentally zymosan-induced arthritis. .

Aplicação de modelos de regressão aleatória utilizando diferentes estruturas de dados / Application of random regression models using different data structures

Foram utilizadas 3.202 primeiras lactações de vacas da raça Holandesa de quatro fazendas da região Sudeste, para verificar a influência da estrutura de dados de produção de leite sobre os parâmetros genéticos. Foram testados quatro arquivos com diferentes estruturas: controles semanais (CS), arquivo mensal (CM), bimestral (CB) e trimestral (CT), com 122.842, 30.883, 15.837 e 12.702 controles, respectivamente. Um modelo de regressão aleatória foi empregado nas análises, considerando os efeitos genético aditivo e o de ambiente permanente de animal, como aleatórios. Os efeitos fixos, grupos de contemporâneos (GC) foram comuns para todos os arquivos de dados e foram compostos por fazenda, mês e ano do controle, além da co-variável idade da vaca ao parto (regressão linear e quadrática). As estimativas de herdabilidade apresentaram tendências mais semelhantes entre os arquivos de dados CS, CM e CB. O arquivo de dados CB apresentou estimativas de parâmetros genéticos com as mesmas tendências e magnitudes que os arquivos CS e CM, permitindo afirmar que não houve influência da estrutura dos dados sobre as estimativas dos componentes de (co)variância e que o controle leiteiro poderia ser realizado em uma estrutura CB.

A total of 3.035 lactations of Holstein cows from four farms in the Southeast, to check the influence of data structure of milk yield on the genetic parameters. Four dataset with different structures were tested, weekly controls (CW) with 122.842 controls, monthly controls (CM) 30.883, bimonthly controls (CB) with 15,837 and quarterly controls (CQ) with 12,702. The random regression model was used and was considered as random additive genetic and permanent environment effects, fixed effects of the contemporary groups (herd-year-month of test-day) and age of cow (linear and quadratic effects). Heritability estimates showed similar trends among the data files analyzed, with the greatest similarity between dataset CS, CM and CB. The dataset submitted all the CB estimates of genetic parameters analyzed with the same trend and similar magnitude to the CS and CM dataset, allowing the claim that there was no influence of the data structure on estimates of covariance components for the dataset CS, CM and CB. Thus, milk recording could be accomplished in a CB structure.

Comparative analysis of the tissue inflammatory response in human cutaneous and disseminated leishmaniasis

Cutaneous leishmaniasis (CL) is the most frequent clinical form of tegumentary leishmaniasis and is characterised by a single or a few ulcerated skin lesions that may disseminate into multiple ulcers and papules, which characterise disseminated leishmaniasis (DL). In this study, cells were quantified using immunohistochemistry and haematoxylin and eosin staining (CD4+, CD68+, CD20+, plasma cells and neutrophils) and histopathology was used to determine the level of inflammation in biopsies from patients with early CL, late CL and DL (ulcers and papules). The histopathology showed differences in the epidermis between the papules and ulcers from DL. An analysis of the cells present in the tissues showed similarities between the ulcers from localised CL (LCL) and DL. The papules had fewer CD4+ T cells than the DL ulcers. Although both CD4+ cells and macrophages contribute to inflammation in early CL, macrophages are the primary cell type associated with inflammation intensity in late ulcers. The higher frequency of CD20+ cells and plasma cells in lesions demonstrates the importance of B cells in the pathogenesis of leishmaniasis. The number of neutrophils was the same in all of the analysed groups. A comparison between the ulcers from LCL and DL and the early ulcers and papules shows that few differences between these two clinical forms can be distinguished by observing only the tissue.

CD8+ T cells in situ in different clinical forms of human cutaneous leishmaniasis

Introduction Leishmania braziliensis infection induces a large spectrum of lesions that clinically manifest as nodules or papules that progress to ulcers. Although it is already known that T helper cells predominate in the lesions, cytotoxic T cells have also been reported to be present, and their role in leishmaniasis immunopathogenesis is not well known. This study investigated the amounts of CD8+ and granzyme B+ cells in different clinical forms of human cutaneous leishmaniasis (CL). Methods Forty tissue fragments from early (E-CL) and late CL (L-CL) lesions and from disseminated leishmaniasis (DL) - papules and ulcers - were characterized. The inflamed area per fragment was calculated, and the CD8 and granzyme B expression levels in the infiltrates were quantified by counting positive cells in 15 fields. The localization of CD8 and granzyme B was graded subjectively. Results Inflammation was higher in L-CL and DL ulcers. CD8 expression was increased in late ulcerated lesions compared to recent lesions. The increase in CD8+ cells also correlated with the duration of the lesion. Papules had a higher frequency of granzyme B+ cells than E-CL lesions, although the frequency was similar to those for late and DL ulcers. CD8+ cells were mostly found in the papillary dermis. Conclusions CD8+ T and granzyme B+ cells are present in the inflammatory infiltrates of CL and DL and may participate in the immunopathogenesis of Leishmania infection. .

Inflammation in disseminated lesions: an analysis of CD4+, CD20+, CD68+, CD31+ and vW+ cells in non-ulcerated lesions of disseminated leishmaniasis

Disseminated leishmaniasis (DL) differs from other clinical forms of the disease due to the presence of many non-ulcerated lesions (papules and nodules) in non-contiguous areas of the body. We describe the histopathology of DL non-ulcerated lesions and the presence of CD4-, CD20-, CD68-, CD31- and von Willebrand factor (vW)-positive cells in the inflamed area. We analysed eighteen biopsies from non-ulcerated lesions and quantified the inflamed areas and the expression of CD4, CD20, CD68, CD31 and vW using Image-Pro software (Media Cybernetics). Diffuse lymphoplasmacytic perivascular infiltrates were found in dermal skin. Inflammation was observed in 3-73% of the total biopsy area and showed a significant linear correlation with the number of vW+ vessels. The most common cells were CD68+ macrophages, CD20+ B-cells and CD4+ T-cells. A significant linear correlation between CD4+ and CD20+ cells and the size of the inflamed area was also found. Our findings show chronic inflammation in all DL non-ulcerated lesions predominantly formed by macrophages, plasmacytes and T and B-cells. As the inflamed area expanded, the number of granulomas and extent of the vascular framework increased. Thus, we demonstrate that vessels may have an important role in the clinical evolution of DL lesions.

Conhecimento e percepção de vulnerabilidades para o HIV/ AIDS entre os acadêmicos de uma universidade privada / Knowledge and awareness of vulnerability to HIV / AIDS amongstudents of a private university / Conocimiento y percepción de vulnerabilidades en materia de VIH / SIDA entre los estudiantes de una universidad privada

Este estudo teve como objetivos identificar o nível de conhecimento e percepção de vulnerabilidades para o Vírus da Imunodeficiência Humana/ Síndrome da Imunodeficiência Adquirida (HIV/AIDS) e a adesão ao teste Anti-HIV entre os acadêmicos de uma universidade. Trata-se de uma pesquisa descritiva, de abordagem quantitativa, realizada em uma universidade privada do município do Rio de Janeiro. Os sujeitos foram 160 acadêmicos dos cursos da área de saúde regularmente inscritos no primeiro semestre de 2013. Os dados foram coletados através de um questionário e submetidos à analise estatística. Os resultados apontam que a maioria compreende as medidas de prevenção e as formas de transmissão do HIV, realiza o teste Anti-HIV periodicamente e compreende parcialmente sobre o tempo ideal para o teste após exposição, embora ainda haja equívocos no conhecimento. É necessário ampliar o debate acerca da temática considerando a responsabilidade dos futuros profissionais do grupo estudado.

This study aimed at identifying the level of knowledge and awareness of vulnerability to Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome (HIV / AIDS) and adherence to anti-HIV testing among college students. It is a descriptive quantitative approach piece of research, conducted at a private university in the city of Rio de Janeiro, RJ, Brazil. Subjects totaled 160 students, regularly enrolled in healthcare courses in the first term of 2013. Data were collected through a questionnaire and treated on the basis of statistical analysis. Results show that the majority understands preventive measures and ways of HIV transmission, goes through Anti-HIV testing regularly, and has partial awareness of the optimal time for testing after exposure, despite misconceptions identified. It is necessary to broaden the debate on the subject, in face of the responsibility of those professionals-to-be.

Este estudio tuvo como objetivo identificar el nivel de conocimiento y la percepción de la vulnerabilidad al Virus de Inmunodeficiencia Humana / Síndrome de Inmunodeficiencia Adquirida Humana (VIH / SIDA) y la adhesión a las pruebas anti-VIH entre los académicos de la universidad. Es una pesquisa descriptiva de enfoque cuantitativo, realizada en una universidad privada en la ciudad de Rio de Janeiro-Brasil. Los sujetos fueron 160 académicos de cursos del área de salud regularmente matriculados en el primer semestre de 2013. Los datos fueron recolectados a través de un cuestionario y se sometieron al análisis estadístico. Los resultados muestran que la mayoría comprende las medidas de prevención y las formas de transmisión del VIH, realiza la prueba anti-VIH regularmente y comprende parte del tiempo ideal para las pruebas despuésde la exposición, aun que todavía hay conceptos erróneos en el conocimiento. Es necesario ampliar el debate sobre el tema teniendo en cuenta la responsabilidad de los futuros profesionales en el grupo estudiado.

Perfil de pacientes com cardiopatia congênita submetidos a procedimentos percutâneos em um centro terciário: análise de 1.002 casos / Profile of patients with congenital heart disease submitted to percutaneous procedures at a tertiary center: analysis of 1.002 cases

INTRODUÇÃO: O diagnóstico precoce e o tratamento dos defeitos cardíacos congênitos têm reconhecido impacto na qualidade de vida dos pacientes. Nosso objetivo foi descrever a população de pacientes com cardiopatias congênitas submetidos a procedimentos diagnósticos ou terapêuticos percutâneos em um centro terciário. MÉTODOS: Análise retrospectiva de 1.002 pacientes submetidos a cateterismo cardíaco no período de 2003 a 2009 no Instituto de Cardiologia do Rio Grande do Sul. Variáveis demográficas, clínicas e do procedimento foram obtidas a partir de um banco de dados institucional e dos prontuários dos pacientes. RESULTADOS: A mediana de idade dos pacientes foi de 33 (0-73) anos e a de peso, de 23 (9,6-52,6) kg. Houve predominância do sexo feminino (52%), de doença acianótica (63,2%) e de diagnóstico realizado no período pós-natal (94,8%). Estenose pulmonar (22,9%), comunicação interatrial (22,5%) e persistência do canal arterial (21,6%) foram os defeitos acianóticos mais comuns, e tetralogia de Fallot foi a doença cianótica mais frequente (15,2%). A maioria dos procedimentos (58,6%) foi terapêutica, incluindo valvuloplastias pulmonares (32,9%), fechamento de comunicações interatriais (20,9%) e fechamento de persistências do canal arterial (15%). Em 19,2% dos pacientes foram observadas complicações, sendo os hematomas inguinais (7,8%) ou a febre (7,6%) as mais frequentes. Ocorreram 3 óbitos (0,3%) relacionados aos procedimentos. CONCLUSÕES: Os resultados deste estudo evidenciaram a predominância de procedimentos terapêuticos em pacientes com cardiopatias congênitas acianóticas, realizados com baixo índice de complicações, em centro terciário de referência.

BACKGROUND: Early diagnosis and treatment of congenital heart defects have a well-known impact on patient´s quality of life. This study aimed to describe the population of patients with congenital heart disease submitted to percutaneous diagnostic or therapeutic procedures at a tertiary referral center. METHODS: Retrospective analysis of 1,002 patients submitted to cardiac catheterization between 2003 and 2009 at Instituto de Cardiologia do Rio Grande do Sul. Clinical, demographic and procedure variables were obtained from an institutional database and patient charts. RESULTS: Median age was 33 (0-73) years and median weight was 23 (9.6-52.6) kg. Patients were predominantly females (52%), with acyanotic heart disease (63.2%) and postnatal diagnosis (94.8%). Pulmonary stenosis (22.9%), atrial septal defect (22.5%) and patent ductus ateriosus (21.6%) were the most common acyanotic heart defects, whereas tetralogy of Fallot was the most frequent cyanotic heart disease (15,2%). Most of the procedures (58,6%) were therapeutic, including pulmonary balloon valvuloplasty (32.9%), atrial septal defect closure (20.9%) and ductus arteriosus closure (15%). Complications were observed in 19.2% of patients, and inguinal hematomas (7.8%) and fever (7.6%) were the most frequent findings. There were 3 procedure-related deaths (0.3%). CONCLUSIONS: The study results demonstrated the prevalence of therapeutic procedures in patients with acyanotic heart disease, performed with a low complication rate at a tertiary referral center.

The role of human T cell lymphotrophic virus type 1, hepatitis B virus and hepatitis C virus coinfections in leprosy

Leprosy spectrum and outcome is associated with the host immune response against Mycobacterium leprae. The role of coinfections in leprosy patients may be related to a depression of cellular immunity or amplification of inflammatory responses. Leprosy remains endemic in several regions where human T cell lymphotrophic virus type 1 (HTLV-1), hepatitis B virus (HBV) or hepatitis C virus (HCV) are also endemic. We have evaluated the evidence for the possible role of these viruses in the clinical manifestations and outcomes of leprosy. HTLV-1, HBV and HCV are associated with leprosy in some regions and institutionalization is an important risk factor for these viral coinfections. Some studies show a higher prevalence of viral coinfection in lepromatous cases. Although HBV and HCV coinfection were associated with reversal reaction in one study, there is a lack of information about the consequences of viral coinfections in leprosy. It is not known whether clinical outcomes associated with leprosy, such as development of reactions or relapses could be attributed to a specific viral coinfection. Furthermore, whether the leprosy subtype may influence the progression of the viral coinfection is unknown. All of these important and intriguing questions await prospective studies to definitively establish the actual relationship between these entities.

Produtividade e valor nutritivo de pastos consorciados com diferentes espécies de leguminosas / Productivity and nutritive value of mixed pastures with different legume species

O objetivo desta pesquisa foi avaliar a produtividade e o valor nutritivo de dois sistemas forrageiros (SF) constituídos por capim elefante (CE), azevém (AZ), trevo branco (TB) e espécies de crescimento espontâneo (ECE), como SF1; e CE + AZ + amendoim forrageiro (AF) + ECE, como SF2. O CE foi estabelecido em linhas espaçadas a cada quatro metros. Entre elas, foi estabelecido azevém, durante o período hibernal, permitindo-se o desenvolvimento de ECE no período estival. Para avaliação, foram utilizadas vacas da raça Holandesa e o método de pastejo foi o rotacionado. Avaliaram-se a massa de forragem inicial (MFI) e a composição botânica e estrutural dos pastos. Para as estimativas de valor nutritivo, foram feitas amostragens simulando o pastejo e analisados a fibra em detergente neutro (FDN), fibra em detergente ácido (FDA), proteína bruta (PB), digestibilidade in vitro da matéria seca (DIVMS) e digestibilidade in vitro da matéria orgânica (DIVMO). O delineamento experimental foi o inteiramente casualizado com dois tratamentos e duas repetições, em parcelas subdivididas no tempo. Os valores médios de massa de forragem inicial e da carga animal foram similares entre os SF. Observou-se resultado superior para o teor médio de PB da forragem do SF2. O uso do azevém, das leguminosas e das espécies de crescimento espontâneo em consórcio com o CE permite manter massa de forragem uniforme no decorrer dos pastejos.

The objective of this research was to evaluate the productivity and nutritive value of two pasture-based systems (PS) with elephant grass (EG) + ryegrass (RG) + white clover (WC) + spontaneous growing species (SGS), for PS1; and EG + RG + forage peanut (FP) + SGS, for PS2. EG was established in rows spaced by four meters. Ryegrass was seeding in the space between rows during cool-season and development of SGS was permitted in the warm-season. Holstein cows under rotational grazing were used in the evaluation. The initial forage mass (IFM), the botanical composition and the structural components were evaluated. Samples from hand-plucking method were collected to analyze neutral detergent fiber (NDF), acid detergent fiber (ADF), crude protein (CP), in vitro dry matter digestibility (IVDMD) and in vitro organic matter digestibility (IVOMD). The experimental design used was completely randomized with two treatments, two repetitions in complete split-plot time. The mean values of initial forage mass and stocking rate were similar among PS. Superior results were found for mean of CP in PS2. The use of ryegrass, legumes and spontaneous growing species mixed to EG allow the forage mass to be uniform during the grazing pastures.

Desempenho de um motor de trator agrícola em bancada dinamométrica com biodiesel de óleo de frango e misturas binárias com óleo diesel / Performance of an agricultural tractor engine in dynamometer with chicken oil biodiesel and binary mixtures with diesel oil

O Brasil, terceiro maior produtor de biodiesel do mundo e terceiro maior produtor mundial de frango, pode incrementar, na sua matriz energética, o uso de óleo oriundo de aves como alternativa aos combustíveis fósseis e à redução da dependência do óleo de soja para esse fim. O país dispõe de mais de 350 milhões de litros de óleo de frango por ano. Considerando a aplicação dos combustíveis alternativos para os motores a diesel, em máquinas agrícolas, o trabalho teve por objetivo avaliar o desempenho do motor de um trator agrícola de 53kW acoplado pela TDP em bancada dinamométrica, operando com biodiesel metílico de óleo de frango e misturas com óleo diesel, sendo: B5 (testemunha), B20, B40, B60, B80 e B100. Avaliaram-se a potência, o torque, a reserva de torque, o consumo de combustível, o consumo de energia e a eficiência térmica do motor. O ensaio foi instalado com delineamento inteiramente casualizado (DIC) em esquema fatorial com seis tratamentos. Os resultados foram submetidos à análise de variância e as médias ajustadas por equações de regressão. Foram observadas perdas na geração de potência e torque, aumento no consumo de combustível, redução do consumo energético e melhoria na eficiência térmica do motor, de acordo com o aumento da proporção de biodiesel na mistura.

Brazil, the world third largest producer of biodiesel, and also the third largest producer of chicken, may increase the energy matrix, using oil derived from chicken, as an alternative to fossil fuels and reduce dependence on soybean oil for this purpose. The country can produce over 350 million liters of chicken oil per year. Considering the application of alternative fuels on diesel engines in agricultural machinery. The study aimed to evaluate the performance of a engine agricultural tractor with 53kW coupled by PTO in dynamometer bench operating with methyl biodiesel oil chicken and mix with diesel oil. Fuels B5 (reference), B20, B40, B60, B80 and B100 mixtures were used. The power, torque, torque reserve, fuel consumption, energy consumption and thermal efficiency of the engine were evaluated. The trial was conducted with a completely random design (CRD) in a factorial design with six treatment, which was held after the analysis of variance and adjusted means for the regression equations. Losses were observed in the generation of power and torque, increase in fuel consumption, reduction of energy consumption and improvement in engine thermal efficiency, according to the increasing proportion of biodiesel in the blend.