Actualización práctica de diagnóstico y tratamiento de la urticaria crónica / Practical update for the diagnosis and treatment of chronic urticaria

Resumen La urticaria es un patrón distintivo de respuesta inflamatoria de piel y/o mucosas caracterizada por la aparición súbita de ronchas evanescentes, angioedema o ambos, asociados a prurito. Las formas agudas son frecuentes y se limitan a brotes de menos de 6 sema nas; mientras que las crónicas tienen una prevalencia menor al 1%, mayor duración y pueden ser espontáneas o inducibles. Los mecanismos etiopatogénicos involucrados en esta enfermedad incluyen la autoalergia, la autoinmunidad y la inflamación con la activación celular, principalmente del mastocito, lo que lleva a su degranulación con libe ración de mediadores vasoactivos. En su abordaje son fundamentales la confirmación diagnóstica; la búsqueda de indicadores de su etiopa togenia; la detección de cofactores que pueden modular su actividad; el reconocimiento de comorbilidades; la evaluación de posibles biomarcadores y, el impacto en la calidad de vida, el registro de la actividad y el control de la enfermedad. El manejo farmacológico tiene por objetivo controlar los síntomas, mientras la urticaria resuelve de forma espontánea. Este se describe de forma escalonada con una complejidad creciente.

Abstract Urticaria is a distinctive pattern of inflammatory re sponse of the skin and/or mucous membranes charac terized by the sudden appearance of vanishing wheals, angioedema, or both, associated with pruritus. Acute forms are frequent and limited to outbreaks of less than 6 weeks; while the chronic ones have a prevalence of less than 1%, longer duration and can be spontaneous or inducible. The etiopathogenic mechanisms involved in this disease include autoallergy, autoimmunity, and inflam mation with cell activation, mainly of the mast cell, leading to its degranulation with the release of vasoac tive mediators. Along its approach, diagnostic confirmation, search for indicators of its etiopathogenesis, detection of cofactors that can modulate its activity, recognition of comorbidi ties, evaluation of possible biomarkers and the assess ment of disease activity, impact and control are essential. The pharmacological management aims to control the symptoms, until the urticaria, which is self-resolv ing, is gone. This is described in a stepwise fashion with increasing complexity.

Ressonância Magnética Cardíaca como Ferramenta Diagnóstica Etiológica em Pacientes Recuperados de Morte Súbita Cardíaca ou Arritmias Ventriculares Instáveis / Cardiac Magnetic Resonance as an Etiological Diagnosis Tool in Recovered Sudden Cardiac Death or Unstable Ventricular Arrhythmia Patients

Resumo Fundamento A ressonância magnética cardíaca (RMC) tem relevância diagnóstica crescente em sobreviventes de morte súbita cardíaca (MSC) ou arritmia ventricular instável (AVI) em países desenvolvidos. Objetivo Procuramos avaliar retrospectivamente o papel adicional da RMC em um país em desenvolvimento com poucos recursos disponíveis e que pode direcionar um uso mais eficaz desses recursos. Métodos Foram incluídos sobreviventes de MSC ou AVI admitidos entre 2009 e 2019 em uma instituição acadêmica terciária após a realização de RMC. Dados demográficos, clínicos e laboratoriais foram coletados dos prontuários. Imagens e laudos de RMC foram analisados e o impacto disso no diagnóstico etiológico final foi afirmado. Realizou-se análise descritiva e definiu-se p<0,05 como significativo. Resultados Sessenta e quatro pacientes, 54,9±15,4 anos, sendo 42 (71,9%) do sexo masculino. A maioria dos eventos (81,3%) foi extra-hospitalar e a taquicardia ventricular foi o ritmo mais comum. Medicamentos cardiovasculares foram utilizados anteriormente por 55 pacientes, sendo os betabloqueadores os medicamentos mais utilizados (37,5%). O eletrocardiograma apresentava áreas elétricas inativas em 21,9% e todos apresentavam fibrose na RMC. A média da fração de ejeção do ventrículo esquerdo (FEVE) foi de 44±14%, com 60,9% ≤50% e apenas 29,7% ≤35%. Identificou-se realce tardio com gadolínio em 71,9%, com padrão transmural em 43,8%. A miocardiopatia chagásica foi a etiologia mais comum (28,1%), seguida da miocardiopatia isquêmica (17,2%). Entre 26 sem etiologia previamente identificada, foi possível definir com RMC (15 pacientes - 57%). Conclusão De acordo com estudos anteriores em países desenvolvidos, a RMC foi capaz de aumentar o diagnóstico etiológico e identificar o substrato arritmogênico, permitindo melhor atendimento em metade dos pacientes subdiagnosticados.

Abstract Background Cardiac magnetic resonance (CMR) has an increasing diagnostic relevance in survivors of sudden cardiac death (SCD) or unstable ventricular arrhythmia (UVA) in developed countries. Objective To evaluate retrospectively the additional role of CMR in a developing country where few resources are available, and should be used more effectively. Methods The study included SCD or UVA survivors admitted between 2009 and 2019 at a tertiary academic institution referred to CMR. Demographic, clinical, and laboratory data were collected from the medical records. CMR images and reports were reviewed and their impact on the final etiological diagnosis was determined. A descriptive analysis was performed and p<0.05 established as significant. Results Sixty-four patients, 54.9±15.4 years old, and 42 (71.9%) males. Most events (81.3%) were out of the hospital and ventricular tachycardia was the most common rhythm. Cardiovascular medications were previously used by 55 patients, and beta-blockers were the most used medications (37.5%). Electrocardiogram had electrical inactive areas in 21.9% and all of them had fibrosis at CMR. Mean left ventricular ejection fraction (LVEF) was 44±14%, with 60.9% ≤50% and only 29.7% ≤35%. Late gadolinium enhancement was identified in 71.9%, with a transmural pattern in 43.8%. Chagas cardiomyopathy was the most common etiology (28.1%), followed by ischemic cardiomyopathy (17.2%). Among 26 without a previously identified etiology, CMR could define it (15 patients - 57%). Conclusion In accordance with previous studies in developed countries, CMR was capable of increasing etiological diagnosis and identifying the arrhythmogenic substrate, allowing better care in half of the underdiagnosed patients.

Manejo de hemangioma ulcerado segmentario: combinación de tratamiento sistémico y tópico en dos casos pediátricos / Management of ulcers on a segmental hemangioma: A combination of systemic and topical therapies in two pediatric cases

Los hemangiomas infantiles (HI) son los tumores benignos más frecuentes de la infancia; la variante segmentaria es rara y se asocia con un mal pronóstico. Una de sus principales complicaciones es la ulceración durante la fase de crecimiento del tumor, a pesar de no presentar características macroscópicas compatibles con una lesión agresiva. El manejo en estos casos es dificultoso e impone la necesidad de asociar múltiples estrategias, algunas orientadas específicamente a impedir la proliferación del hemangioma y otras orientadas a la curación de la herida, el manejo del dolor y la prevención de la infección agregada. Presentamos dos casos a fin de comunicar nuestra experiencia respecto del manejo de dicha patología y su evolución final.

Infantile hemangiomas (IHs) are the most common benign tumors of childhood, and segmental ones are rare and associated with a poor prognosis. While these tumors look harmless, one of their main related complications is ulceration during tumor growth. The management in these cases is extremely challenging, requiring a combination of multiple approaches, some specifically aimed at preventing the proliferation of the hemangioma and others aimed at wound care, pain management, and prevention of further infection. Here we discuss two cases to narrate our experience on the management of this condition and its outcome.

ECHO project in atopic dermatitis in Argentina: An innovative strategy to reach underserved areas with up to date knowledge, first year of experience

Abstract Background: The ECHO® (Extension for Community Healthcare Outcomes) project is a model of distance medical education developed in the United States to support health professionals in the management of patients with complex diseases. Since 2019, it has been implemented in atopic dermatitis (AD) in Argentina. The program consists of the periodic presentation of clinical cases by videoconference, virtual classes, and a permanently available open chat between professionals in charge of patients with AD and a group of experts. Objective: The objective of this study was to analyze the impact of the ECHO Project AD on the medical knowledge and medical skills of Argentinian health professionals when treating patients with AD. Methods: A survey was carried out among the participants in order to evaluate the impact of the program on the care of patients with AD. Results: ECHO Project AD revealed a significant improvement in the management of patients with AD. The program contributed to the interpretation and use of severity scores, use of phototherapy, and management and prescription of both classic and innovative topical and systemic treatments. Study limitations: The reduced number of participants and the short period of time. The answers of the survey may be biased by the enthusiasm of the participants. Conclusions: The ECHO project is an educational tool that enhances the medical skills of doctors and institutions, in which a climate of a partnership comes first and the participants look forward to learning from experiences, successes, and mistakes from one another, producing a scientific hub in constant evolution.

Comportamiento fenológico ex situ de Lippia integrifolia "incayuyo" (Verbenaceae) de una población de base genética amplia / Ex situ phenological behavior of Lippia integrifolia "incayuyo" (Verbenaceae) from a population with a broad genetic base

Abstract: Lippia integrifolia "incayuyo" is an aromatic, sub - woody shrub used in popular medicine, aperitit drinks and compound herb s. Its choleretic, antispasmodic, biocidal, antibacterial and larvicidal activity has been proven. The objective of the work was to register the phenology of a sample of 70 genotypes from a population with a broad genetic base. The phenophases studied were : vegetative growth, flower bud, flowering and fruiting fortnightly for two years. The initiation, intensity and prolongation of the phenophases were evaluated. The moment of full bloom occurs during the second half of December. Taking this date as a refer ence, a differentiated beginning of flowering was evidenced. The results of two campaigns were compared, observing that 70% of the specimens had a similar behavor, standing out some genotypes for presenting an early flowering and longer duration. The recor ded variability suggests that much of it could be due to intrinsic factors of the plant, and therefore, feasible to be selected .

Resumen: Lippia integrifolia "incayuyo" es un arbusto aromático, subleñoso empleado en la medicina popular, bebidas aperitivas y yerbas compuestas. Se ha comprobado su actividad colerética, antiespasmódica, biocida, antibacteriana y larvicida. El objetivo del trabajo fue registrar la fenología d e una muestra de 70 genotipos de una población de base genética amplia. Las fenofases estudiadas fueron: crecimiento vegetativo, botón floral, floración y fructificación quincenalmente durante dos años. Se evaluó inicio, intensidad y prolongación de las fe nofases. El momento de plena floración ocurre durante la segunda quincena de diciembre. Tomando esta fecha como referencia, se evidenció un inicio de floración diferenciada. Se compararon los resultados de dos campañas, observando que el 70% de los ejempla res tuvo un compartimiento semejante, destacándose algunos genotipos por presentar una floración temprana y de prolongación superior. La variabilidad registrada sugiere que gran parte de ésta podría deberse a factores intrínsecos de la planta, y por ello, factible de ser seleccionados.

Inter and intra population phenotypic variability of Lippia integrifolia (Verbenaceae) and its natural situation in the west-center of Argentina / Variabilidad fenotípica inter e intra poblacional de Lippia integrifolia (Verbenaceae) y su situación natural en el centro-oeste de Argentina

The species Lippia integrifolia is an aromatic, sub-woody shrub, distributed from Northwest and Central Argentina to Bolivia. It is among the most important native aromatic species. It presents medicinal properties, some of which have been scientifically proven. As an alternative to harvesting, the process of domestication of the species was initiated. The objective of this work was to assess the phenotypic variability based on botanical-taxonomic and morpho-agronomic descriptors and the use of indicators to evaluate its natural situation in the west-center of Argentina. We worked in five wild populations, registering morphological variables, phenology, natural regeneration, herbivory and presence of diseases. L. integrifoliapresents a wide morphological variability, which can be explained with three morphological descriptors. Natural regeneration ́s rate is very low to zero, in four of the sites. The results obtained are of importance to make decisions related to the sustainable use in situ, and to begin a program of domestication of the species.

La especie Lippia integrifolia es un arbusto aromático, sub-leñoso, distribuido desde el noroeste y centro de Argentina hasta Bolivia. Es una de las especies aromáticas nativas más importantes. Presenta propiedades medicinales, algunas de las cuales han sido científicamente probadas. Como alternativa a la cosecha, se inició el proceso de domesticación de la especie. El objetivo de este trabajo fue evaluar la variabilidad fenotípica basada en descriptores botánico-taxonómicos y morfo-agronómicos y el uso de indicadores para evaluar su situación natural en el centro-oeste de Argentina. Trabajamos en cinco poblaciones silvestres, registrando variables morfológicas, fenología, regeneración natural, herviboría y presencia de enfermedades. L. integrifolia presenta una amplia variabilidad morfológica, que puede explicarse con tres descriptores morfológicos. La tasa de regeneración natural es muy baja a cero, en cuatro de los sitios. Los resultados obtenidos son importantes para tomar decisiones relacionadas con el uso sostenible in situ y para comenzar un programa de domesticación de la especie.

Citizenship fatigue as mediator between compulsory citizenship behavior and work-family conflict / Fadiga de cidadania como mediador entre comportamentos obrigatórios de cidadania e conflito trabalho-família / La fatiga de la ciudadanía como mediadora entre comportamientos obligatorios de ciudadanía y conflicto trabajo-familia

Framed by the conservation of resources theory, we investigated the mediating role of citizenship fatigue in the relationship between compulsory citizenship behavior and work-family conflict. Using a sample of 171 women (M = 41.16, SD = 10.18) working in facilities for the elderly in Portugal, we examined the direct and indirect relationship between compulsory citizenship behavior and work-family conflict. The data, collected using a self-reported questionnaire, shows that compulsory citizenship behavior influences work-family conflict with citizenship fatigue as a mediator. Theoretical and practical implications are discussed.

Apoiados na teoria da conservação de recursos, investigamos o papel mediador da fadiga de cidadania na relação entre os comportamentos obrigatórios de cidadania organizacional e o conflito trabalho-família. Com base numa amostra de 171 mulheres (M = 41,16; SD = 10,18) a trabalhar em instituições para idosos em Portugal, examinámos a relação direta e indireta entre comportamentos obrigatórios de cidadania organizacional e o conflito trabalho-família. Os dados recolhidos através de um questionário de autopreenchimento mostram que os comportamentos obrigatórios de cidadania influenciam o conflito trabalho-família e que esta relação é mediada pela fadiga de cidadania. Implicações teóricas e práticas são discutidas.

Con base en la teoría de la conservación de recursos, investigamos el papel mediador de la fatiga de la ciudadanía en la relación entre los comportamientos de ciudadanía organizacional y el conflicto trabajo-familia. A partir de una muestra de 171 mujeres (M = 41.16; SD = 10,18) que trabajan en instituciones para la tercera edad en Portugal, examinamos la relación directa e indirecta entre comportamientos obligatorios de ciudadanía organizacional y el conflicto trabajo-familia. El resultado muestra que los comportamientos obligatorios de ciudadanía influyen en el conflicto trabajo-familia y que esta relación está mediada por la fatiga ciudadana. Se discuten las implicaciones teóricas y prácticas.

Three dimensional analysis and comparison of human anterior teeth and experimentally created bitemark depressions

A system was proposed to scan dental models to record three-dimensional features seen in the anterior teeth to create a database of dental profiles. Dental casts were randomly selected to create indentations in cowhide leather. Reid Bite Reader was used to measure the bite forces generated by Reynolds Controlled Bite Force Generator to make the teeth impressions. Using the Immersion MicroScribe® 3D, information from the 53 bitemark depressions and 62 sets of dental casts were transferred to an Excel Spreadsheet. Software was developed to perform the 3D comparison using metric and pattern analysis. Statistical analysis showed 100% success when comparing both arches together of the dental casts with the bitemarks or different dental casts.

Lipoprotein(a) levels in children and adolescents: Ouro Preto Study

Abstract Background Lipoprotein (a) is a cardiovascular risk factor in adult. Studies have shown the presence of this emergent risk factor in school children, which may contribute to the development of atherosclerosis in adulthood. Objective To evaluate the association between lipoprotein (a) and cardiovascular risk factors in school children. Methods Lipoprotein (a) levels were measured in 320 school children (6-14 years) selected from a population survey carried out in Ouro Preto (southeast of Brazil). Demographic (sex and age), biochemical (total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, triglycerides, and glucose), anthropometric (body mass index, waist circumference, body fat percentage), clinical (arterial blood pressure, pubertal stage and birth weight) and economic (family income) parameters, as well as family history (obese and/or hypertensive parents) were analyzed. Non-parametric analysis was used to evaluate lipoprotein (a) levels in each subgroup. Variables with p≤0.20 in the univariate analysis were included in binary regression logistic model. Differences with p < 0.05 were considered significant. Results Lipoprotein (a) levels were associated with total cholesterol (p=0.04), body fat (p=0.009), and mother´s systolic (p=0.02) and diastolic blood pressure (p=0.04). In a logistic regression analysis, children with high lipoprotein (a) levels and body fat, and children born from hypertensive mothers were, respectively, at 3.2(p=0.01) and 1.4 (p=0.03) times higher risk than other children. In clustering these factors, elevated lipoprotein (a) was 2.6 times more likely to be seen in school children with high body fat and born hypertensive mothers. Conclusions Lipoprotein (a) was correlated with cardiovascular risk factors in children and adolescents. Persistence of these risk factors in childhood suggests a contribution of elevated lipoprotein (a) to future cardiovascular disease. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Muerte súbita en el ámbito prehospitalario en época de COVID-19 / Sudden death in the prehospital setting in times of COVID-19

RESUMEN Una de cada cinco muertes de adultos en países desarrollados se debe a causas cardiovasculares; la mitad de esas muertes se produce de forma súbita y un gran porcentaje en el ámbito extrahospitalario. Múltiples estudios demostraron que el acceso de la población general al aprendizaje de maniobras de reanimación cardiopulmonar sencillas y pragmáticas y la presencia de desfibrilador externo automático se traducen en un gran aumento de sobrevida sin secuelas en casos de muerte súbita cardíaca extrahospitalaria. Hoy en día existe una situación especial representada por la pandemia por COVID -19, que deja bajo un interrogante todo lo aprendido hasta la fecha y nos enfrenta a dos situaciones sumamente complejas. Por un lado, la afectación cardiovascular y el aumento consecuente de arritmias ventriculares malignas que genera esta infección, tanto en pacientes sanos como en sujetos con patologías preexistentes, han puesto de manifiesto un aumento en la incidencia de episodios de muerte súbita extrahospitalaria. Por otro lado, se vuelve necesario reevaluar todo el accionar puesto en marcha cuando un paciente presenta un episodio de muerte súbita cardíaca extrahospitalaria, ya que ahora se agrega la posibilidad de transmisión de esta enfermedad de alta contagiosidad durante las maniobras de reanimación. Volver a encontrar un equilibrio riesgo-beneficio que permita aumentar la sobrevida del paciente con el mínimo riesgo posible para la persona que realiza la reanimación es el verdadero desafío hoy en día.

ABSTRACT One in five adult deaths in developed countries is due to cardiovascular causes; half of these deaths occur suddenly and a large percentage in the out-of-hospital setting. Multiple studies demonstrated that the access of the general population to learning simple and pragmatic cardiopulmonary resuscitation maneuvers and the presence of automatic external defibrillator translates into a large increase in survival without sequelae in victims of sudden out-of-hospital sudden cardiac death. Today there is a situation represented by the pandemic by COVID -19, which questions what we have learned to date and makes us face two extremely complex situations. On the one hand, the cardiovascular involvement and the consequent increase in malignant ventricular arrhythmias generated by this infection, both in patients with previous pathologies or not, has shown an increase in the incidence of episodes of sudden out-of-hospital death. On the other hand, it forces us to rethink all the actions put into place at the moment that a patient presents with an episode of sudden out-of-hospital sudden cardiac death since now the possibility of transmission of this highly contagious disease is added during resuscitation maneuvers. Refinding a risk-benefit balance that allows increasing the patient's survival with the least possible risk for the person who is resuscitating is the real challenge we are facing today.

Analysis of the chemerin and resistin adipokines in children and adolescents

SUMMARY OBJECTIVES To compare the serum concentrations of adipokines resistin and chemerin in children and adolescents with eutrophic and overweight and to evaluate their relationship with anthropometric, biochemical, and blood pressure variables. METHODS a cross-sectional epidemiological study was conducted with 234 students enrolled in public elementary schools in the city of Juiz de Fora / MG. Anthropometric evaluation, biochemistry, and blood pressure measurement were performed. Statistical analyzes included the Student-t or Mann-Whitney tests, Pearson or Spearman correlation, used according to the distribution of the variables, and linear regression analysis, by means of the evaluation of the effect of the independent variables on the serum levels of chemerin and resistin, adjusted for age and sex. For the data analysis, SPSS® software version 21.0 and STATA® version 10.1 were used, assuming a significance level of 5%. RESULTS the concentrations of chemerin were higher in eutrophic individuals than in those with excess weight (p> 0.05). In contrast, levels of resistin were higher in the young with excess weight than in the eutrophic ones (p <0.05). In the multiple linear regression analysis, the levels of chemerin were associated with the values of resistin, systolic, and diastolic blood pressure. Resistance levels maintained association only with BMI and chemerin values. CONCLUSION the adipokines analyzed presented a distinct profile in the groups of children and adolescents with eutrophic and overweight.

RESUMO OBJETIVOS Comparar as concentrações séricas das adipocinas resistina e quemerina em crianças e adolescentes com eutrofia e excesso de peso e avaliar sua relação com as variáveis antropométricas, bioquímicas e a pressão arterial. MÉTODOS Estudo epidemiológico transversal realizado com 234 estudantes matriculados em escolas públicas do ensino fundamental no município de Juiz de Fora/MG. Realizou-se avaliação antropométrica, bioquímica e aferição da pressão arterial. As análises estatísticas compreenderam os testes t de Student ou Mann-Whitney, correlação de Pearson ou Spearman, utilizados de acordo com a distribuição das variáveis, e análise de regressão linear, realizada por meio da avaliação do efeito das variáveis independentes nos níveis séricos de quemerina e resistina, ajustado por idade e sexo. Para a análise dos dados foram utilizados os softwares SPSS® versão 21.0 e Stata® versão 10.1, admitindo-se nível de significância de 5%. RESULTADOS As concentrações de quemerina foram maiores nos indivíduos eutróficos do que nos com excesso de peso (p>0,05). Em contrapartida, os níveis de resistina estiveram maiores nos jovens com excesso ponderal do que nos eutróficos (p<0,05). Na análise de regressão linear múltipla, os níveis de quemerina apresentaram associação com os valores de resistina, pressão arterial sistólica e diastólica. Os níveis de resistina mantiveram associação apenas com os valores de IMC e quemerina. CONCLUSÃO As adipocinas analisadas apresentaram perfil distinto nos grupos de crianças e adolescentes com eutrofia e com excesso de peso.

Yeasts and filamentous fungi in psittacidae and birds of prey droppings in midwest region of Brazil: a potential hazard to human health / Leveduras e fungos filamentosos em excretas de psittacideos e aves de rapina em cativeiro na região centro-oeste do Brasil: um risco potencial para a saúde humana

Abstract Birds of prey and from Psittacidae family are host to fungal microbiota and play an important role in the epidemiology of zoonoses. Few studies in the literature have characterized mycelial and yeast fungi in the droppings of these birds and correlated the isolates with the zoonotic potential of the microorganisms. Droppings from 149 birds were evaluated and divided into two groups: captive: Rhea americana araneipes, Primolius maracana, Ara ararauna, Ara chloropterus, Anodorhynchus hyacinthinus, Amazona aestiva, Ara macao macao, Ramphastos toco, Sarcoramphus papa, Busarellus nigricollis, Bubo virginianus nacurutu, Buteogallus coronatus, Buteogallus urubitinga urubitinga, Spizaetus melanoleucus, Spizaetus ornatus ornatus, Buteo albonotatus, Geranoaetus albicaudatus albicaudatus, Rupornis magnirostris magnirostris and Harpia harpyja, and quarantined birds: Amazona aestiva and Eupsitulla aurea. The fungal isolates were identified according to macroscopic (gross colony appearance), micromorphological and biochemical characteristics. Among birds displayed in enclosures, Aspergillus niger (41.1%) and Candida kefyr (63.8%) were the fungi most frequently isolated in Harpia harpyja and Ramphastos toco, respectively. For quarantined birds, the following percentages were observed in Eupsittula aurea , (76.6%) C. krusei, (84.4%) C. kefyr and (15.2%) C. famata, while in Amazona aestiva, (76.2%) C. krusei was observed. These findings indicate potentially pathogenic species in the bird droppings assessed, which constitute a risk of exposure for keepers and individuals who visit the zoo. Birds of the Cerrado and Pantanal of Mato Grosso (Central Western region of Brazil) could act in the epidemiological chain of important zoonoses.

Resumo Aves de rapina e psitacídeos são hospedeiras de uma rica microbiota fúngica e desempenham um papel importante na epidemiologia de zoonoses. Poucos estudos na literatura têm caracterizado fungos micelianos e leveduras nos excrementos de pássaros e correlacionados estes isolados com o potencial zoonótico dos microrganismos isolados. Excrementos de 149 aves foram divididas e avaliados em dois grupos: Em cativeiro: Rhea americana araneipes, Primolius maracana, Ara ararauna, Ara chloropterus, Anodorhynchus hyacinthinus, Amazona aestiva, Ara macao macao, Ramphastos toco, Sarcoramphus papa, Busarellus nigricollis , Bubo virginianus nacurutu, Buteogallus coronatus, Buteogallus urubutinga urubitinga, Spizaetus melanoleucus, Spizaetus ornatus ornatus, Buteo albonotatus, Geranoaetus albicaudatus albicaudatus, Rupornis magnirostris magnirostris e Harpia harpyja e aves em quarentena: Amazona aestiva e Eupsittula aurea). Os isolados de leveduras e de fungos micelianos foram identificados em observações macroscópicas (aspectos das colônias), características micromorfológicas e bioquímicas. Entre as aves indicadas em compartimentos, Aspergillus niger (41,1%) e Candida kefyr (63,8%) foram os fungos mais isolada em Harpia harpyja e Ramphastos toco, respectivamente. Para as aves em quarentena, os seguintes percentuais foram observados em Eupsittula aurea (76,6%) C. krusei, (84,4%) C. kefyr e (15,2%) C. famata, enquanto em Amazona aestiva (76,2%) de C. krusei foi observada. Estes resultados indicam a presença de espécies potencialmente patogênicos nas excretas das aves avaliadas, constituem um risco a exposição para os criadores e pessoas que visitam o zoológico. Aves do Pantanal e do Cerrado de Mato Grosso (região Centro-Oeste do Brasil) poderia atuar na cadeia epidemiológica das zoonoses importantes.

Perfil da gestão do negócio do personal trainer de Curitiba-PR / Profile of the business management for personal trainer in Curitiba-PR

O sucesso do mercado de academia de musculação e seu consequente crescimento necessitam de profissionais capacitados na área da gestão, com conhecimento em marketing, finanças, administração e gerenciamento. Dentre as inúmeras áreas que o profissional formado em Bacharelado em Educação Física pode atuar, o enfoque deste trabalho está no segmento de Personal Trainer (PT). Esta demanda abre uma grande oportunidade e procura pelo serviço dos PTs, sendo que as pessoas procuram estes com vários objetivos, como: qualidade de vida, status, preparação física, dentre outros. O crescimento no número de oportunidades de trabalho ao PT é compatível com o ascendente número de profissionais atuantes no mercado, logo "preparação" e "qualificação" são diferenciais para obter melhores retornos financeiros. Sendo assim, o objetivo deste trabalho foi de apresentar o atual perfil da gestão do negócio do PT atuante em Curitiba/PR. Foi realizada uma pesquisa descritiva quantitativa, através da aplicação de um questionário com 282 participantes, dos quais apenas 262 foram credenciados para a pesquisa. As constatações principais foram que no setor de gestão de pessoas os profissionais estão preocupados em fazer atualizações e/ou cursos na área, além de buscarem fazer de alguma maneira uma avaliação de seu trabalho com seus clientes. Em relação ao marketing observou-se que os profissionais pretendem fidelizar seus clientes, porém, não realizam pacotes de aderência, o que seria recomendável; além disso, se preocupam em saber o motivo da desistência de seus serviços por parte de seus clientes, contudo não possuem um padrão para estipular o preço de seus serviços ficando, portanto, vulnerável ao mercado. Por fim, a gestão financeira também carece de maior preocupação haja vista que poucos profissionais confeccionam planilhas de gastos, formalizam contratos com os clientes ou preocupam-se com seus planos de previdência....(AU)

The success of the fitness market and its consequent growth needs trained professionals in the area of management with knowledge in marketing, finance, administration and management. Among the many areas that the professional degree in Bachelor of Physical Education can act, the focus of this work is in the Personal Trainer (PT) segment. This demand opens a great opportunity and demand for the service of PTs, where people seek these for various purposes, such as quality of life, status, physical preparation, among others. The growth in the number of job opportunities for personal trainer is compatible with the growing number of professionals working in the market, so "preparation and qualification" are differential for better financial returns. Thus the aim of this study was to show the current profile of the business management of the active PT in Curitiba/PR. A quantitative descriptive research, by applying a questionnaire with 282 participants, of which only 262 were accredited for research. The main findings were that in people management industry professionals are concerned to make updates and / or courses in the area, in addition to seeking to somehow an evaluation of its work with its customers. Regarding marketing, it was observed that the professionals intend to keep their customers loyal, but they do not carry out adherence packages, which would be advisable. In addition, professionals are concerned about the reason for the abandonment of their services from their customers, however, they do not have a standard to stipulate the price of their services, and is therefore vulnerable to the market. Finally, financial management is also of greater concern since few professionals prepare a spreadsheet, formalize contracts with clients, or care about their pension plans....(AU)

Use of uracil-DNA glycosylase enzyme to reduce DNA-related artifacts from formalin-fixed and paraffin-embedded tissues in diagnostic routine

Background: Detection of somatic mutations is a mandatory practice for therapeutic definition in precision oncology. However, somatic mutation detection protocols use DNA from formalin-fixed and paraffin-embedded (FFPE) tumor tissues, which can result in detection of nonreproducible sequence artifacts, especially C:G > T:A transitions, in DNA. In recent studies, DNA pretreatment with uracil DNA glycosylase (UDG), an enzyme involved in base excision repair, significantly reduced the number of DNA artifacts after mutation detection by next-generation sequencing (NGS) and other methods, without affecting the capacity to detect real mutations. This study aimed to evaluate the effects of UDG enzymatic pretreatment in reducing the number of DNA sequencing artifacts from FFPE tumor samples, to improve the accuracy of genetic testing in the molecular diagnostic routine. Methods: We selected 12 FFPE tumor samples (10 melanoma, 1 lung, and 1 colorectal tumor sample) with different storage times. We compared sequencing results of a 16-hotspot gene panel of NGS libraries prepared with UDG-treated and untreated samples. Results: All UDG-treated samples showed large reductions in the total number of transitions (medium reduction of 80%) and the transition/transversion ratio (medium reduction of 75%). In addition, most sequence artifacts presented a low variant allele frequency (VAF < 10%) which are eliminated with UDG treatment. Conclusion: Including UDG enzymatic treatment before multiplex amplification in the NGS workflow significantly decreased the number of artifactual variants detected in FFPE samples. Thus, including this additional step in the current methodology should improve the rate of true mutation detection in the molecular diagnostic routine.

Taxa de recuperação e características morfológicas de embriões muares (Equus caballus x Equus asinus) / Recovery rate and morphologic features of cross bred embryos (Equus caballus x Equus asinus)

A Transferência de Embrião (TE) contribuiu efetivamente para a produção de equinos e outras espécies. O mercado de muares tem apresentado um contínuo crescimento, entretanto, a aplicação das biotecnologias para a produção desses animais ainda é escassa. O presente estudo avaliou a taxa de recuperação embrionária e as características dos embriões provenientes do cruzamento de éguas com jumentos. Os embriões foram recuperados entre os dias 6 e 9 após a ovulação, dessa forma foi realizada a avaliação da taxa de recuperação embrionária e avaliação das características relacionadas com a idade, morfologia e diâmetro embrionário. A taxa de recuperação embrionária total foi de 55,9% (71/127), e não apresentou diferença para as colheitas realizadas em diferentes dias (D6-D9). Foram recuperados embriões nos estágios de mórula, blastocisto inicial, blastocisto e blastocisto expandido. O tamanho dos embriões variou entre 147-1688μm e a média do diâmetro de todos os embriões recuperados foi de 438,04μm. A recuperação de embriões muares pode ser realizada entre os dias 6 e 9 após a ovulação, e propicia a recuperação de embriões nos primeiros estágios de desenvolvimento.(AU)

Production biotechnologies, particularly embryo transfer (ET) has constantly been contributed to reproduce horses and other species. The mules market has shown continuous growth, however, the biotechnology for mule assisted reproduction is still scarce. The aim of this study was to evaluate the embryo recovery rate and the features of the embryos from mares bred with donkeys. The embryos recovery attempts were performed on days 6 to 9 after ovulation, in order to evaluate the embryo recovery rate and the features related to age, morphology and embryonic diameter in each day. The overall embryo recovery rate was 55,9% (71/127), and there was no significant difference (p>0,05) on different days (D6-D9). Embryos were recovered in stages of mórula, early blastocyst, blastocyst and expanded blastocyst. The diameter of the embryos ranged from 147-1688μm and the mean diameter of all the embryos collected was 438,04μm. The collection of hybrid embryos might be performed between days 6 and 9 after ovulation, and provides recovery of embryos in the early stages of development.(AU)

Nasal mucociliary transportability of male and female smokers / Transportabilidade mucociliar nasal de homens e mulheres tabagistas

Abstract Introduction: Female smoker's present increased susceptibility to several diseases when compared to the opposite gender. However, there are no studies showing differences in nasal mucociliary transport behavior between male and female smokers. Objective: To compare the nasal mucociliary transportability in male and female smokers and non-smokers, taking into consideration age, anthropometric data, smoking load and pulmonary function. Methods: The analysis included 139 individuals (33 men and 37 women smokers and 32 men and 37 women non-smokers). All participants answered an initial interview to obtain personal data and smoking load. Anthropometric data and carbon monoxide in the exhaled air were assessed. Individuals also performed pulmonary function test and Saccharin Transit Time test. To compare saccharin transit time values between men and women, smokers and non-smokers, stratification of all independent variables was performed (sociodemographic, smoking and respiratory variables) into two categories: below and above the median values. Results: There was no difference between men and women, smokers and non-smokers, regarding nasal mucociliary transportability. Significant differences were only observed between non-smokers. Among those with less forced vital capacity values (<97.37% of predicted), women presented mucociliary transport faster than men. Moreover, it was observed influence of BMI and COex (women smokers), FCV and FEV1 (men non-smokers) and FEF25-75% (women non-smokers) on saccharin transit time values. Conclusion: Based on the findings of this study, nasal mucociliary transport in male and female adult smokers, apparently healthy, are similar.

Resumo Introdução: Mulheres tabagistas apresentam maior susceptibilidade à diversas doenças quando comparadas ao sexo masculino. No entanto, não há estudos mostrando diferenças no comportamento do transporte mucociliar nasal entre tabagistas do sexo masculino e feminino. Objetivo: Comparar a transportabilidade mucociliar nasal em homens e mulheres fumantes e não fumantes, levando em consideração idade, dados antropométricos, carga tabágica e função pulmonar. Método: A análise incluiu 139 indivíduos (33 homens e 37 mulheres fumantes e 32 homens e 37 mulheres não fumantes). Todos os participantes responderam a uma entrevista inicial para a obtenção de dados pessoais e a carga tabágica. Dados antropométricos e monóxido de carbono no ar expirado foram avaliados. Os indivíduos também fizeram teste de função pulmonar e o teste de trânsito de sacarina. Para comparar os valores do teste de trânsito de sacarina entre homens e mulheres, fumantes e não fumantes, foi feita a estratificação de todas as variáveis independentes (variáveis sociodemográficas, tabágicas e respiratórias) em duas categorias: abaixo e acima dos valores médios. Resultados: Não houve diferenças entre homens e mulheres, fumantes e não fumantes, em relação à transportabilidade mucociliar nasal. Diferenças significativas foram observadas apenas entre não fumantes. Entre os que apresentaram valores menores de capacidade vital forçada (< 97,37% do previsto), as mulheres apresentaram transporte mucociliar mais rápido do que os homens. Além disso, observou-se influência do IMC e COex (mulheres fumantes), CVF e VEF1 (homens não fumantes) e FEF25%-75% (mulheres não fumantes) sobre os valores do teste de trânsito de sacarina. Conclusão: Com base nos achados deste estudo, o transporte mucociliar nasal em tabagistas masculinos e femininos adultos, aparentemente saudáveis, são semelhantes.

Intracellular reactive oxygen species production and phagocytosis of Staphylococcus aureus by milk neutrophils as tool to diagnose mastitis and identify susceptible dairy cows / Produção intracelular de espécies reativas de oxigênio e fagocitose de Staphylococcus aureus por neutrófilos lácteos como ferramentas para o diagnóstico da mastite e identificação de vacas leiteiras susceptíveis à mastite

The immune response capacity of the mammary gland plays a major role to determine if mastitis will or not be established. Thus, we hypothesize that a better understanding of polymorphonuclear neutrophil leukocyte (PMN) function will elucidate mechanisms that will improve our knowledge of how we could avoid an inflammatory process by increasing the immune capacity of the cow, and even further, to search for a tool to diagnose mastitis or a possible way to select and identify non-susceptible animals. The present study utilized 112 quarters from 28 Holstein dairy cows that were divided into quarters milk samples with somatic cell count (SCC) <2×105 cells mL-1 (n=72) and SCC >2×105 cells mL-1 (n=40). The percentages of milk PMNs and the levels of intracellular reactive oxygen species (ROS) and the phagocytosis of Staphylococcus aureus by milk neutrophils were evaluated by flow cytometry. Our results showed a higher percentage of neutrophils in quarter milk samples with high SCC (P=0.0003), and this group also had a significantly higher percentage of neutrophils that produced ROS (P=0.008). On the other hand, the phagocytosis intensity of S. aureus by milk neutrophils was higher in quarters with low SCC (P=0.003), suggesting a better mammary gland immunity against invading pathogens. Analyzing the results of the predictive values of the measured PMN functions, they cannot be used isolated as a good diagnosis test since none of them had a satisfactory sensitivity and specificity values, which was also confirmed by the Youden index values being far from one. In conclusion, the assessment of milk bovine neutrophil functions could improve our understanding of the cellular basis of mastitis. Although, the intracellular ROS production and S. aureus phagocytosis by milk neutrophil did not have high predictive values to detect intramammary infections, our results strengthen the idea that that poor bovine mammary gland neutrophil phagocytic ability may be associated with high SCC, and might be considered to identify susceptible dairy cows to mastitis.(AU)

A resposta imune da glândula mamária desempenha um papel importante ao determinar o estabelecimento da infecção. Desta forma, a melhor compreensão da função dos neutrófilos irá nos subsidiar conhecimentos, pelo qual podemos evitar o processo inflamatório pela otimização da resposta imune de bovinos leiteiros, e fornece ferramentas para diagnosticar a mastite ou um possível instrumento para identificar e selecionar animais resistentes à infecção intramamária, aumentando a produtividade do rebanho. O presente estudo utilizou 112 amostras provenientes de quartos mamários de 28 vacas Holandesas que foram divididos em amostras de leite com baixa (n=72; <2×105 células mL-1) ou alta (n=40; 2×105 células mL-1) contagem de células somáticas (CCS). A porcentagem de neutrófilos no leite, a produção intracelular de espécies reativas de oxigênio (ERO) e a fagocitose de Staphylococcus aureus pelos neutrófilos do leite foram avaliadas por citometria de fluxo. Os resultados do presente estudo demonstraram maior percentagem de neutrófilos (CH138+; P=0,0003) e percentagem de neutrófilos que produziram ERO (P=0,008) em amostras de leite com alta CCS. Por outro lado, a intensidade de fagocitose de S. aureus por neutrófilos em amostras de leite com baixa CCS (P=0,003), que demonstra maior atividade funcional destas células neste grupo. As funções neutrofílicas para o diagnóstico da mastite não apresentaram valores de sensibilidade e especificidade altos, que foram confirmados pelo índice Youden. Desta forma, conclui-se que a produção intracelular de ERO e fagocitose de S. aureus pelos neutrófilos do leite não apresentaram valores preditivos altos para detecção de mastite. Além disto, os resultados do presente estudo reforçam a ideia de neutrófilos do leite com menor capacidade fagocítica podem ser associados à alta CCS, e pode ser considerado como uma ferramenta para identificar animais mais susceptíveis à infecções intramamárias.(AU)

Fatores associados ao evento queda em idosos assistidos pela Estratégia de Saúde da Família: Um estudo comparativo / Factors associated with the event falling in the elderly assisted by the Family Health Strategy: A comparative study / Factores asociados al evento caída en ancianos asistidos por la Estrategia de Salud de la Familia: Un estudio comparativo

O objetivo desse estudo foi comparar os fatores associados ao evento queda entre idosos caidores e não caidores assistidos pela Estratégia de Saúde da Família no Distrito Sanitário IV. A amostra foi composta por 30 idosos divididos em dois grupos de acordo com o número de quedas nos últimos seis meses: o grupo 1 (não caidores) e o grupo 2 (caidores). Os grupos mostraram-se homogêneos quanto aos dados sociodemográficos, mobilidade e capacidade funcional. As pessoas idosas do grupo dos não caidores demonstraram realizar mais exercícios físicos do que os caidores (p = 0,04). A falta de atividade física entre idosos é um fator de risco para acidentes por quedas; desse modo, são necessárias ações que estimulem a prática regular na comunidade.

The objective of this study was to compare the factors associated with the fall event (s) between elderly gulls and non-gulls assisted by the Family Health Strategy in District IV. The sample consisted of 30 elderly people divided into two groups according to the number of falls in the last six months, group 1 (not caidores) and group 2 (caidores). The groups were homogeneous regarding sociodemographic data, mobility and functional capacity. Elderly people in the non-cautery group demonstrated more physical exercises than caidores (p = 0.04). The lack of physical activity among the elderly is a risk factor for accidents due to falls, thus, actions that stimulate their regular practice in the community are necessary.

El objetivo de este estudio fue comparar los factores asociados al evento caída entre ancianos caidores y no caidores asistidos por la Estrategia de Salud de la Familia en el Distrito Sanitario IV. La muestra fue compuesta por 30 ancianos divididos en dos grupos de acuerdo con el número de caídas en los últimos seis meses: el grupo 1 (no caidores) y el grupo 2 (caidores). Los grupos se mostraron homogéneos en cuanto a los datos sociodemográficos, movilidad y capacidad funcional. Las personas mayores del grupo de los no caidores demostraron realizar más ejercicios físicos que los caidores (p = 0,04). La falta de actividad física entre ancianos es un factor de riesgo para accidentes por caídas; de ese modo, son necesarias acciones que estimulen la práctica regular en la comunidad.

Manifestaciones mucocutáneas de intoxicación por metotrexato / 4pp Mucocutaneous manifestations of methotrexate toxicity

El metotrexato es un antimetabolito análogo al ácido fólico que inhibe competitivamente la enzima dihidrofolato reductasa y timidilato sintetasa, indispensables para la síntesis de ADN y ARN. Se utiliza ampliamente en dermatología y sus efectos adversos en la piel y mucosas son variados, incluyendo reacciones leves y graves. Las erosiones y úlceras cutáneas como manifestación de citotoxicidad por metotrexato son infrecuentes y representarían un signo cutáneo temprano de pancitopenia por toxicidad medular secundaria a dicha droga. En la mayoría de los casos existen enfermedades cutáneas previas a la ulceración, principalmente psoriasis. En ausencia de dermatitis subyacente, la presencia de ulceraciones es excepcional. Se presentan ocho casos de pacientes con signos cutáneos de intoxicación por metotrexato, con y sin dermatosis previas. En la mayoría hubo asociación de mucositis y compromiso medular. Se recomiendan pautas de tratamiento.

Methotrexate is an antimetabolite analog to folic acid that competitively inhibits the enzyme dihydrofolate reductase and thymidylate synthetase, essential for the synthesis of DNA and RNA. It is widely used in dermatology and its adverse effects on the skin and mucous membranes are varied, including mild and severe reactions. The appearance of erosions and skin ulcers as a manifestation of methotrexate cytotoxicity are quite infrequent. These would represent an early cutaneous sign of pancytopenia due to marrow toxicity secondary to this drug. In most of the cases there are cutaneous diseases prior to ulceration, mainly psoriasis. In the absence of underlying dermatitis, the presence of ulcerations is very rare. We present eight cases of patients with cutaneous signs of methotrexate poisoning, with and without previous dermatoses. Most of them associated mucositis and bone marrow involvement. Treatment guidelines are recommended.