Dorsal and ventral striatal dopamine D1 and D2 receptors differentially modulate distinct phases of serial visual reversal learning.

Impaired cognitive flexibility in visual reversal-learning tasks has been observed in a wide range of neurological and neuropsychiatric disorders. Although both human and animal studies have implicated striatal D2-like and D1-like receptors (D2R; D1R) in this form of flexibility, less is known about the contribution they make within distinct sub-regions of the striatum and the different phases of visual reversal learning. The present study investigated the involvement of D2R and D1R during the early (perseverative) phase of reversal learning as well as in the intermediate and late stages (new learning) after microinfusions of D2R and D1R antagonists into the nucleus accumbens core and shell (NAcC; NAcS), the anterior and posterior dorsomedial striatum (DMS) and the dorsolateral striatum (DLS) on a touchscreen visual serial reversal-learning task. Reversal learning was improved after dopamine receptor blockade in the nucleus accumbens; the D1R antagonist, SCH23390, in the NAcS and the D2R antagonist, raclopride, in the NAcC selectively reduced early, perseverative errors. In contrast, reversal learning was impaired by D2R antagonism, but not D1R antagonism, in the dorsal striatum: raclopride increased errors in the intermediate phase after DMS infusions, and increased errors across phases after DLS infusions. These findings indicate that D1R and D2R modulate different stages of reversal learning through effects localised to different sub-regions of the striatum. Thus, deficits in behavioral flexibility observed in disorders linked to dopamine perturbations may be attributable to specific D1R and D2R dysfunction in distinct striatal sub-regions.

Predictors of Adherence to HIV Post-Exposure Prophylaxis and Retention in Care After an Episode of Sexual Violence in Brazil.

Adherence to nonoccupational post-exposure prophylaxis (nPEP) among sexual violence (SV) victims and their retention in care after SV represent significant challenges. This study aimed at identifying predictors of adherence to nPEP and retention in clinical-laboratory follow-up among SV victims in São Paulo, Brazil. We conducted a retrospective cohort study of SV victims admitted to care and follow-up at the SV unit of the main reference hospital in São Paulo within 72 h following the SV episode. Eligible patients were submitted to a standardized protocol that included nPEP, screening, and management for other sexually transmitted infection as well as emergency contraception. Predictors of adherence to nPEP for 28 days and retention in care until discharge at 180 days after admission were analyzed. A total of 199 SV episodes in 197 victims were recorded from January 2001 to December 2013 (156 months). Of those episodes, 167 were eligible to receive nPEP and 160 (96%) actually received a prescription. Overall 104/160 [65%, 95% confidence interval (CI) 57-72] SV victims, who received nPEP, were fully adherent to nPEP up to 28 days, whereas 89/199 (45%, 95% CI 38-52) were retained in care for 180 days following admission. In multi-variate analysis, patients undergoing at least one psychological consultation (n = 126) were more likely to adhere to nPEP [adjusted odds ratio (adjOR) 8.32; 95% CI 3.0-23.3] and be retained in care for 6 months (adjOR 40.33; 95% CI 8.33-195.30) compared to patients not receiving psychological support. In contrast, study outcomes were not associated with victims' age and sex and with type of perpetrator. In our cohort, provision of psychological care was shown to be associated with enhanced adherence to nPEP and retention in care.

Neisseria gonorrhoeae conjunctivitis in a prepuberal girl - a dilemma: sexual violence or non-sexual transmission? / Conjuntivite por Neisseria Gonorrhoea em menina prepubere ­ um dilema: violência sexual ou transmissão não sexual?

Introduction: Sexually transmitted infections (STIs) are a public health issue of global concern and frequently lead to important sequelae if not diagnosed and properly treated. Neisseria gonorrhoeae (NG) infection is one of the most prevalent STIs worldwide and recently presents increasing incidence and antimicrobial resistance rates. Apart from the neonatal period, NG infection during childhood is considered evidence of sexual violence (SV). However, defining perpetration of violence can be challenging in clinical practice. Objective: To report a case of conjunctivitis due to NG in a prepuberal girl and discuss possible means of infection acquisition and medical forensic implications. Case report: A 7-year-old female Caucasian student from São Paulo was referred to the Rape Care Center (Núcleo de Atendimento a Vítimas de Violência Sexual ­ NAVIS) outpatient clinic to investigate sexual violence in September 2013. At admission, she reported right ocular hyperemia for 10 days with no response to tobramycin eye drops. Personal history: nothing noteworthy. She lived with her mother and grandmother and visited her father every two weeks. Physical and gynecological examinations were normal. Eye examination: Left eye ­ nothing noteworthy. Right eye ­ palpebral edema, conjunctival hyperemia with purulent exudate and upper corneal perforation. Bacterioscopy of conjunctival secretion was positive for Gram-negative diplococci and NG was isolated in culture. The patient was submitted to suturing of right eye perforation and received 1g intravenous ceftriaxone per day for 10 days. During investigation at the NAVIS outpatient clinic, the mother denied any SV episode or school behaviour change. Multidisciplinary psychosocial care was provided to the child and her mother for over 6 months, but SV could not be characterized. STIs investigation for HIV, hepatitis B and C infections and syphilis resulted negative. Based on the literature, a hypothesis of accidental intra-familial non-sexual transmission of NG was then considered. Endocervical, vaginal and urethral secretions were collected from the mother and yielded isolation of endocervical beta-lactamase producing NG. Hygiene measures and contact isolation were recommended and the mother underwent treatment with ceftriaxone single dose 1G. During follow-up the child developed corneal opacity in her right eye. Conclusion: In prepuberal children presenting with unusual but compatible clinical manifestations, STIs should always be considered and investigated to enable prompt treatment and avoid sequelae. If gonococcal infection is diagnosed, the possibility of sexual violence should be thoroughly investigated, preferably in a comprehensive multidisciplinary approach to rule out non-sexual contamination and avoid emotional damage to the child and family. Clearly defining SV and proposing proper interventions in these circumstances is, however, challenging for healthcare providers.

As infecções sexualmente transmissíveis (ISTs) são um problema de saúde pública global e com frequência deixam sequelas se não diagnosticadas e tratadas adequadamente. A infecção por Neisseria gonorrhoeae (NG) é uma das ISTs mais prevalentes em todo o mundo e, recentemente, tem apresentado crescentes taxas de incidência, além de resistência a antimicrobianos. Após o período neonatal, a infecção por NG na infância pode ser uma evidência de violência sexual (VS), no entanto a comprovação da violência é um desafio na prática clínica. Objetivo: Apresentar um caso de conjuntivite por NG em uma menina pré-púbere e discutir as possíveis vias de contaminação e implicações médicas forenses. Relato de caso: Trata-se de uma criança caucasiana de 7 anos de idade do sexo feminino, estudante, procedente de São Paulo, que, após uma internação, foi encaminhada ao Núcleo de Atendimento a Vítimas de Violência Sexual (NAVIS) para investigação de violência sexual, em setembro de 2013. Na admissão intra-hospitalar, houve relato de hiperemia ocular direita, iniciada havia 10 dias, sem resposta ao tratamento com colírio de tobramicina. Antecedentes pessoais: nada digno de nota. Ela morava com a mãe e a avó e visitava o pai a cada duas semanas. Os exames físico e ginecológico foram normais. Exame oftalmológico: olho esquerdo ­ nada digno de nota. Olho direito ­ edema palpebral, hiperemia conjuntival com exsudato purulento e perfuração da córnea superior. A bacterioscopia de secreção conjuntival foi positiva para diplococos gram-negativos e a NG foi isolada em cultura. A paciente foi submetida a sutura cirúrgica de perfuração do olho direito e, enquanto internada, recebeu 1 g de ceftriaxona endovenoso por dia, por um período de 10 dias. Durante a investigação no ambulatório de NAVIS, a mãe negou qualquer episódio de VS ou mudança de comportamento escolar. Foi oferecida assistência psicológica e social à criança e à mãe por mais de seis meses, mas a VS não pôde ser caracterizada. A investigação de IST para o HIV, infecções por hepatite B e C e sífilis resultou negativa. Com base na literatura, a hipótese de transmissão não sexual acidental de NG intrafamiliar foi então considerada. As secreções genitais da mãe (endocervical, vaginal e uretral) foram coletadas e o isolamento endocervical da NG produtora por betalactamase foi positivo. Medidas de higiene e isolamento de contato foram recomendados, além ser prescrito o tratamento com ceftriaxona em dose única de 1 g para a mãe. Durante o acompanhamento, a criança desenvolveu opacidade corneana em seu olho direito. Conclusão: Em crianças pré-púberes que apresentam manifestações clínicas incomuns, as ISTs devem sempre ser consideradas e investigadas para permitir o tratamento imediato e assim evitar sequelas. Se uma infecção gonocócica for diagnosticada, a possibilidade de (VS) deve ser minuciosamente investigada, de preferência com uma abordagem multidisciplinar abrangente para descartar a contaminação não sexual e evitar danos emocionais à criança e à sua família. Definir com precisão se houve VS e propor intervenções adequadas nessas circunstâncias mostra-se um desafio para os profissionais de saúde.

Acute pancreatitis associated with lamivudine therapy for chronic B hepatitis.

Hyperamylasemia is a common complication during lamivudine use. We report a case of a pancreatitis following lamivudine therapy. A careful monitoring of amylase levels during treatment with lamivudine is discussed, mainly in the first weeks, considering the cost of this exam and further complication.

Acute pancreatitis associated with lamivudine therapy for chronic B hepatitis

Hyperamylasemia is a common complication during lamivudine use. We report a case of a pancreatitis following lamivudine therapy. A careful monitoring of amylase levels during treatment with lamivudine is discussed, mainly in the first weeks, considering the cost of this exam and further complication.

Tratamento da leishmaniose tegumentar americana, com lesäo em mucosa, por meio do isotionato de pentamidina / Treatment of mucocutaneous leishmaniasis, with mucosal lesion, with pentamidine isothianate

Ten patients with mucosal lesions caused by American tegumental leishmaniasis were treated with pentamidine isethionate at the dose 4 mg/kg on alternate days by the intravenous route. The mean posology was 2,140 mg. Healing of the lesions occurred in 9 (90 per cent) of the patients who completed treatment. There was no recurrence during a follow-up time of 1 to 24 months (mean, 7,7 months). One patient discontinued treatment before healing of the lesion because be developed diabetes mellitus. In 3 (30 per cent) patients, blood exams showed increased urea and creatinine levels and leucopenia, which were corrected by increasing the interval between administrations of the drug. Pentamidine isethionate is efficient in bringing about cicatrization of the lesions but needs further evaluation in terms of its value in preventing recurrence.

Utilizaçäo do tubo em "T" de silicone para tratamento de um caso de leishmaniose tegumentar americana com traqueomalácia / The use of a silicone T tube for the treatment of a case of American mucocutaneous leishmaniasis with tracheomalacia

Trata-se do relato de caso de leishmaniose tegumentar americana, no qual houve ocorrência de traqueomalácia e insuficiência respiratória. A natureza da enfermidade, o estado geral do paciente e a longa extensao do segmento traqueal comprometido tornaram inviável a realizaçao de ressecçao e anastomose. Optou-se pelo emprego de tubo em "T" de silicone, que se mostrou útil, motivando divulgaçao do procedimento.

Complementemia em doadores de sangue portadores do antígeno de superfície do vírus da hepatite B / Complementemia in HBsAg positive blood donors

Os autores estudaram 104 doadores do Banco de Sangue do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo, positivos para o antígeno de superfície do vírus da hepatite B (HBsAg) no soro, em relaçäo à presença de marcadores laboratoriais de doenças do tecido conectivo. O complemento hemolítico total mostrou-se em 24 doadores (23%). Fator reumatóide foi encontrado em 11 individuos (10,5%) à prova do látex e em 8 deles (7,6%) pela técnica de Waaler-Rose. Näo se evidenciou, no entanto, positividade na pesquisa de fator anti-nuclear. Os achados laboratoriais näo se correlacionaram com antecedentes clínicos de distúrbios cutâneos ou articulares ou com alteraçöes da bioquímica hepática. Embora assintomáticos observou-se que os doadores HBsAg positivo podem apresentar alteraçöes imunológicas, sugestivas de doenças por imunecomplexos, comumente encontradas em pacientes com doença do conectivo