Early nutritional intervention does not prevent long-term adverse events in women with breast cancer: A pilot study.

AIM: This study aims to evaluate the effect of early nutritional intervention on adverse clinical events in women with breast cancer undergoing neoadjuvant chemotherapy. DESIGN AND SETTINGS: This is a randomized clinical trial performed at the beginning of neoadjuvant chemotherapy for women with breast cancer treated at an oncology referral center (Brazil) and followed until the end of radiotherapy period, at least. Registered under ClinicalTrials.gov Identifier no. RBR-3SHHXS. METHODS: Participants were allocated to a control group - CG (nutritional guidance on healthy eating practices) or an intervention group - IC (nutritional guidance and individualized food plan). Chemotherapy toxicity (primary endpoint) was considered a precocious adverse clinical event and it was evaluated by self-reported gastrointestinal symptoms observed at any time during the first three cycles of treatment. Post-surgical complications, radiotherapy toxicity, and weight change were considered long-term adverse events. RESULTS: 34 women (19 in the IG and 15 in the CG) were evaluated. The early nutritional intervention was associated with low gastrointestinal chemotoxicity (nausea, vomiting, and constipation, p < 0.001, p < 0.048, and p < 0.024, respectively). However, there were no statically significant differences between both groups in the presence of long-term adverse events (radiotherapy toxicity-88.2% vs 76.9%, weight loss-21.1% vs 26.7% for IC and CG respectively, p > 0.05 for both). CONCLUSION: The early nutritional intervention was associated with a low frequency of precocious events, but not with long-term adverse events in women with breast cancer during treatment.

Agreement between muscle mass assessments by computed tomography and calf circumference in patients with cancer: A cross-sectional study.

BACKGROUND & AIMS: Cancer influences body composition, including a loss of muscle mass (MM), associated with worse outcomes. The study aimed to evaluate the agreement between MM estimated by calf circumference (CC) and computed tomography (CT) image as a reference method. METHODS: A cross-sectional study including patients (>20 years) diagnosed with cancer attending a reference center of oncology. Spearman's correlation was performed to verify the correlation between CC and MM by CT, including skeletal muscle area - SMA and skeletal muscle index - SMI. ROC curves, Kappa coefficient, sensitivity, specificity, positive and negative predictive values were obtained. RESULTS: The study included 219 patients, age 62.9 ± 13.1 years (mean ± standard deviation). Low CC was observed in 43.8% of the patients, and 29.2% had low SMI. CC positively correlated with SMA (rho = 0.333) and SMI (rho = 0.329), and fair agreements (K = 0.268) were observed between CC and SMI, with higher and significant values for males (K = 0.332) and patients below 60 years (K = 0.419). The area under the curve (AUC) for low CC to identifying low SMI was equal to 0.685 (CI 95% 0.606-0.765). Low CC presented fair agreement to identify low SMI in the sample; however, the negative predictive value was almost 80% for all analyses. CONCLUSIONS: Low CC is not a surrogate for low SMI in patients with cancer, but it could be an alternative, non-invasive, easy-to-perform method to pre-screen patients with cancer with adequate SMI.

Accuracy of isolated nutrition indicators in diagnosing malnutrition and their prognostic value to predict death in patients with gastric and colorectal cancer: A prospective study.

BACKGROUND: The study aims to evaluate the accuracy of isolated nutrition indicators in diagnosing malnutrition in patients with gastric and colorectal cancer and their association with mortality. METHODS: Prospective cohort study involving patients with cancer (n = 178) attending a reference center of oncology at any point in the disease trajectory or treatment. Nutrition status was evaluated in a unique moment by body mass index (BMI), Patient-Generated Subjective Global Assessment (PG-SGA), handgrip strength (HGS), and calf circumference (CC). Kappa coefficient, accuracy, sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC) were calculated for each nutrition indicator (PG-SGA as the reference method). The Cox proportional hazards model was used to assess hazard ratio (HR) and CI of mortality. RESULTS: From the total patients, 11% were underweight, 48% were malnourished (PG-SGA B or C), 43% had low HGS, and 55% presented low CC. There were 46 deaths (25.8%). BMI, HGS, and CC showed poor and fair agreements (κ < 0.30 for all ) and poor accuracy (AUC < 0.70 for all) in identifying malnutrition by PG-SGA. After the adjustment for confounders (age, treatment performed, site, and stage of cancer), PG-SGA (HR, 2.9; 95% CI, 1.5-5.9) and low CC (HR, 2.4; 95% CI, 1.1-5.2) were independent predictors of mortality. CONCLUSION: The nutrition indicators are not accurate in diagnosing malnutrition, whereas PG-SGA and low CC could predict mortality in gastric and colorectal cancer patients. Thus, CC should be combined with PG-SGA in nutrition assessments.

Low skeletal muscle radiodensity is the best predictor for short-term major surgical complications in gastrointestinal surgical cancer: A cohort study.

The aim of this study was to evaluate whether body composition, muscle function, and their association are predictive factors for short-term postoperative complications in patients with gastric and colorectal cancer. A prospective cohort study was conducted with patients undergoing resection of gastric and colorectal tumors. Nutritional status was assessed using Patient-Generated Subjective Global Assessment (PG-SGA) and anthropometric techniques. Low handgrip strength (HGS) was observed when <16kg for women, and <27kg for men. Computed tomography images were used to measure visceral adipose tissue, skeletal muscle index (SMI), and skeletal muscle radiodensity (SMD). Complications of grade II or above (according to Clavien-Dindo's classification) were considered in a follow-up period of up to 30 days after surgery. Major complications were defined when they reached grade III or above. A total of 84 patients were analyzed (57.1% female, 59.7 ± 12.6 years) and 19% were diagnosed with low HGS + low SMI or SMD. Postoperative complications occurred in 51.2%, and these patients presented significantly longer duration of surgery and hospital stay. Major complications were observed in 16.7% of the total number of patients. Binary logistic regression adjusted by age, sex, and tumor staging showed that low SMD, low HGS + low SMI or SMD, and obesity were independent risk factors for postoperative complications, but only low SMD was an independent risk factor for major postoperative complications. Low SMD is an independent risk factor for short-term major complications following surgery in patients with gastric and colorectal cancer.

Is perioperative fasting associated with complications, length of hospital stay and mortality among gastric and colorectal cancer patients? A cohort study.

BACKGROUND: During a surgical procedure, patients are often subjected to fasting for times that are more prolonged than the ideal, which may lead to complications. OBJECTIVE: To evaluate the duration of perioperative fasting and its association with postoperative complications, length of hospital stay (LOS) and mortality among gastric and colorectal cancer patients. DESIGN AND SETTING: Cohort study developed in a surgical oncology hospital in the city of Natal (Rio Grande do Norte, Brazil). METHODS: Patients aged over 18 years were included. The Clavien-Dindo surgical complication scale was used to evaluate occurrences of postoperative complications. LOS was defined as the number of days for which patients stayed in the hospital after surgery, or until the day of death. RESULTS: Seventy-seven patients participated (59.8 ± 11.8 years; 54.5% females; 70.1% with bowel tumor). The incidences of postoperative complications and death were 59.7% and 3.9%, respectively. The duration of perioperative fasting was 59.0 ± 21.4 hours, and it was higher among non-survivors and among patients with prolonged hospital stay (≥ 6 days). For each one-hour increase in the durations of perioperative and postoperative fasting, the odds of prolonged hospitalization increased by 12% (odds ratio, OR = 1.12; 95% confidence interval, CI 1.04-1.20) and 5% (OR = 1.05; 95% CI 1.02-1.08), respectively. CONCLUSION: Prolonged perioperative fasting, especially in the postoperative period, was observed in a sample of patients with gastric and colorectal cancer, and this was an independent predictor of LOS.

Evaluation of the Enzymatic Arsenal Secreted by Myceliophthora thermophila During Growth on Sugarcane Bagasse With a Focus on LPMOs.

The high demand for energy and the increase of the greenhouse effect propel the necessity to develop new technologies to efficiently deconstruct the lignocellulosic materials into sugars monomers. Sugarcane bagasse is a rich polysaccharide residue from sugar and alcohol industries. The thermophilic fungus Myceliophthora thermophila (syn. Sporotrichum thermophilum) is an interesting model to study the enzymatic degradation of biomass. The genome of M. thermophila encodes an extensive repertoire of cellulolytic enzymes including 23 lytic polysaccharide monooxygenases (LPMOs) from the Auxiliary Activity family 9 (AA9), which are known to oxidatively cleave the ß-1,4 bonds and boost the cellulose conversion in a biorefinery context. To achieve a deeper understanding of the enzymatic capabilities of M. thermophila on sugarcane bagasse, we pretreated this lignocellulosic residue with different methods leading to solids with various cellulose/hemicellulose/lignin proportions and grew M. thermophila on these substrates. The secreted proteins were analyzed using proteomics taking advantage of two mass spectrometry methodologies. This approach unraveled the secretion of many CAZymes belonging to the Glycosyl Hydrolase (GH) and AA classes including several LPMOs that may contribute to the biomass degradation observed during fungal growth. Two AA9 LPMOs, called MtLPMO9B and MtLPMO9H, were selected from secretomic data and enzymatically characterized. Although MtLPMO9B and MtLPMO9H were both active on cellulose, they differed in terms of optimum temperatures and regioselectivity releasing either C1 or C1-C4 oxidized oligosaccharides, respectively. LPMO activities were also measured on sugarcane bagasse substrates with different levels of complexity. The boosting effect of these LPMOs on bagasse sugarcane saccharification by a Trichoderma reesei commercial cocktail was also observed. The partially delignified bagasse was the best substrate considering the oxidized oligosaccharides released and the acid treated bagasse was the best one in terms of saccharification boost.

Low calf circumference is an independent predictor of mortality in cancer patients: A prospective cohort study.

OBJECTIVE: Loss of muscle mass is associated with worse outcomes in patients with cancer. The objective of this study was to evaluate the prognostic value of calf circumference (CC) and skeletal muscle index from computed tomography (CT) to predict mortality in patients with cancer. METHODS: A single-center prospective study was conducted with patients aged ≥20 y attending a reference center of oncology and who had recent abdominal CT images. Data were collected through a semistructured form and patients' records and included sociodemographic data (sex, age and ethnicity), clinical data (primary site and staging of tumor and treatments performed), anthropometric variables (body mass index and CC), and outcome (death). Low CC for men was considered to be ≤ 34 cm and for women ≤ 33 cm. Muscle mass was assessed by CT images at the level of L3. The Cox proportional hazard model adjusted for age, sex, and staging of disease was used. RESULTS: A total of 250 patients were evaluated, 52.8% female, with a median age of 63 y (interquartile ratio: 55-73). Normal body mass index was identified in 44.4%; 29.2% had low skeletal muscle index, and 46.4% had low CC. Death by any cause occurred in 16%, and only low CC was a significant predictor of mortality (hazard ratio = 3.01; confidence interval 1.52-5.98; P = 0.002). CONCLUSIONS: Low CC can predict risk of mortality in this cohort of patients. The findings suggest the use of CC as a simple, easy, cost-effective anthropometric measurement to quickly screen patients at risk of death who could benefit from targeted care to improve their prognosis.

Use of an Expanded Polytetrafluoroethylene (ePTFE) Dura Substitute in Glioma Surgeries: A Technical Note

Introduction Reoperations are a common scenario among glioma patients. There is crescent evidence of its benefit in low- and high-grade gliomas. Here we discuss our experience with inert expanded polytetrafluoroethylene (ePTFE) dura substitute in glioma surgeries. Technical note We generally put the ePTFE dura substitute below the dura of the patient, even if it is intact. This membrane should be sutured in place using a tensionfree technique, with 4-0 polypropylene. Expanded polytetrafluoroethylene minimizes tissue attachment and fibrosis when performing reoperation in glioma patients. Discussion Since the literature has shown benefits in survival with reoperation in glioma patients, the use of ePTFE dura substitute can improve surgical time and minimize complications in a second surgery.

Association Between Auditory and Visual Continuous Performance Tests in Students With ADHD.

OBJECTIVE: Continuous Performance Tests (CPTs) are known to measure inattention and impulsivity in students with ADHD. Many CPTs utilize a visual format. It is accepted that auditory tasks reflect attentional demand more closely in the classroom. Thus, the association between deficits found by auditory and visual CPTs needs to be studied. We hypothesized that impulsivity would be dependent on sensory modality and inattention would be a unitary cross-modal construct. METHOD: Forty-four students with ADHD performed two CPTs (visual and auditory). We analyzed correlations between the variables examined by the two tasks. RESULTS: There were strong correlations between variables measuring inattention. Correlations between auditory and visual measures of impulsivity were weak. CONCLUSION: Inattention is partially independent of modality. In contrast, response inhibition is modality-specific. Although ADHD is defined regardless of modality, hyperactive students may exhibit deficits in the auditory modality but not in the visual modality or vice versa.

Neuropsychiatric assessments in patients with multiple sclerosis in early phases and with low disability.

BACKGROUND: In the early phases of multiple sclerosis (MS), patients exhibit slight neuropsychiatric deficits that can only be detected using reliable tools. AIM: The present investigation aimed to examine neuropsychological performance in 35 patients with incipient MS. PATIENTS AND METHODS: For the MS group, the inclusion criteria included time of disease <3 years and low disability. The neuropsychological battery consisted of Rey Auditory Learning Test, Controlled Oral Word Association Test, Hooper Visual Organization Test, and Symbol Digit Modalities Test (SDMT). RESULTS: After correction for the educational level, no significant effect of MS on performance was found for all the tests except for the number of errors of the SDMT (NE-SDMT). Higher levels of education were associated with better performances in all tests, except for the NE-SDMT. MS patients made more errors than the controls. CONCLUSION: The effect on the NE-SDMT may reflect difficulties in the ability to inhibit inadequate responses. Patients may exhibit impulsive control disorders in incipient MS, independent of their educational level.

Estado Nutricional de Pacientes Pediátricos Recém-Diagnosticados com Leucemia Linfoblástica Aguda em um Instituto de Referência em Oncologia do Rio de Janeiro / Nutritional Status of Pediatric Patients Newly Diagnosed with Acute Lymphoblastic Leukemia at an Institute of Reference in Oncology of Rio de Janeiro / Estado Nutricional de Pacientes Pediátricos Recién diagnosticados con leucemia linfoblástica Aguda en un Instituto de Referencia en Oncología de Río de Janeiro

Introdução: a leucemia linfoblástica aguda (lla) constitui a neoplasia mais comum em pediatria e a avaliação nutricional é um instrumento essencial para conhecer as condições de saúde dos pacientes. o presente estudo teve como objetivo avaliar e descrever o estado nutricional de pacientes pediátricos recém-diagnosticados com lla e verificar a relação do índice de massa corporal para idade (iMc/i) com as demais medidas antropométricas. Método: estudo observacional, transversal, realizado com pacientes de 1 a 18 anos, recém- -diagnosticados com lla, no período de janeiro/2004 a dezembro/2009. os dados coletados foram idade, peso corporal, estatura, prega cutânea tricipital (Pct), circunferência do braço (cB) e circunferência muscular do braço (cMB). o iMc foi calculado e a classificação iMc/i utilizada na análise. o teste Qui-quadrado de Pearson e exato de Fisher foram utilizados para analisar a associação entre os parâmetros antropométricos. Resultados: Foram incluídos no estudo 54 pacientes. a classificação do "estado nutricional adequado" foi a mais frequente em todos os parâmetros antropométricos. em adição, observou-se que a associação do estado nutricional pela cMB com o iMc/i (p=0,001) demonstra que este último pode ser adequado para classificação dos pacientes pediátricos com lla ao diagnóstico. e a concordância da cB com a cMB (p=0,01) de 43% (p=0,001) também ratifica a utilização da cB frente à cMB, por ser uma medida mais simples. Conclusão: na população estudada, o estado nutricional encontrava-se preservado. assim como a associação da cMB com o iMc/i, a cB demonstrou ser um parâmetro sensível para classificar eutrofia.

Introduction: acute lymphoblastic leukemia (all) is the most common neoplasm in pediatrics, and nutritional assessment is an essential tool for understanding patients' health conditions. The present study aimed to evaluate and describe the nutritional status of pediatric patients newly diagnosed with all and to verify the relation between body mass index for age (BMi-for-age) and other anthropometric measurements. Method: a cross-sectional, observational study was performed with patients from 1 to 18 years of age, newly diagnosed with all, from January 2004 to december 2009. The data collected were age, body weight, height, triceps skinfold (ts), arm circumference (ac) and arm muscle circumference (aMc). The BMi was calculated and the BMi-for-age classification used in the analysis. Pearson's chi-square test and Fisher's exact test were used to analyze the association between anthropometric parameters. Results: 54 patients were included in the study. The classification of "adequate nutritional status" was the most frequent in all anthropometric parameters. in addition, we observed that the association of nutritional status by aMc with BMi-for-age (p=0.001) shows that the BMi-for-age may be adequate for classification of pediatric patients with all at diagnosis. in addition, ac agreement with aMc (p=0.01) of 43% (p=0.001) also confirmed the use of ac versus aMc, as it is a simpler measure. Conclusion: in the studied population the nutritional status was preserved. Just as the association of aMc with BMi-for-age, ac has been shown to be a sensitive parameter for classifying eutrophy

Introducción: la leucemia linfoblástica aguda (lla) constituye la neoplasia más común en pediatría y la evaluación nutricional es un instrumento esencial para conocer las condiciones de salud de los pacientes. el presente estudio tuvo como objetivo evaluar y describir el estado nutricional de pacientes pediátricos recién diagnosticados con lla y verificar la relación del Índice de masa corporal por edad (iMc/i) con las demás medidas antropométricas. Método: estudio observacional, transversal, realizado con pacientes de 1 a 18 años recién diagnosticados con lla en el período de enero / 2004 a diciembre / 2009. los datos recogidos fueron edad, peso corporal, estatura, pliegue cutáneo tricipital (Pct), circunferencia del brazo (cB) y circunferencia muscular del brazo (cMB). el iMc fue calculado y la clasificación iMc/i utilizada en el análisis. la prueba chi-cuadrado de Pearson y exacto de Fisher se utilizaron para analizar la asociación entre los parámetros antropométricos. Resultados: se incluyeron en el estudio 54 pacientes. la clasificación del "estado nutricional adecuado", fue la más frecuente, en todos los parámetros antropométricos. en adición, se observo que la asociación del estado nutricional por la cMB con el iMc/i(p=0,001) demuestra que este último puede ser adecuado para clasificación de los pacientes pediátricos con lla al diagnóstico. Y la concordancia de la cB con la cMB (p=0,01) del 43% (p=0,001), también ratifica la utilización de la cB frente a la cMB, por ser una medida más simple. Conclusión: en la población estudiada el estado nutricional se encontraba preservado. así como la asociación de la cMB con el iMc/i, la cB demostró ser un parámetro sensible para clasificar eutrofia.

Revisão da Estrutura Fatorial da Escala de Satisfação Conjugal / Revisión de la estructura factorial de la escala de satisfacción marital / Review of the Marital Satisfaction Scale's Factor Structure

Resumo A satisfação conjugal é um construto relevante para o estudo na Psicologia, dada sua importância no desenvolvimento deste relacionamento interpessoal. Esta investigação revisou a estrutura fatorial da Escala de Satisfação Conjugal (ESC). A ESC, frequentemente, tem sido utilizada na pesquisa brasileira, inclusa como medida convergente para gerar evidências de validade de critério no desenvolvimento de novas medidas psicológicas. Por outro lado, suas propriedades psicométricas não são verificadas há 25 anos. Participou deste estudo uma amostra não probabilística de 249 pessoas do Rio de Janeiro, com idades entre 21 e 77 anos (M = 45,3; DP = 13,26), casadas ou em uniões estáveis há 19,5 anos em média (DP = 12,88). Os dados coletados foram submetidos às Análises Fatorial Exploratória e Confirmatória. O exame revelou alguns itens com desempenhos psicométricos insatisfatórios. Contudo, uma versão reduzida da ESC apresentou simplicidade e índices de ajuste estimados muito bons. Evidências de validade da existência de um fator de segunda ordem também foram produzidas. A fidedignidade estimada para os fatores e a escala toda variou de 0,93 a 0,85.

Resumen La satisfacción marital es un constructo relevante para el estudio de la psicología, dada su importancia en el desarrollo de esta relación íntima. Esta investigación examinó la estructura factorial de la Escala de Satisfacción Marital (MSS). El MSS menudo se ha utilizado en la investigación brasileña, incluso como medida para generar criterio de validez convergente en el desarrollo de nuevas medidas psicológicas. Por otro lado, las propiedades psicométricas no se examinan hace 25 años. Participaron en este estudio una muestra no probabilística de 249 personas de Río de Janeiro, 21-77 años de edad (M = 45.3, DE = 13.26), casadas o en unión estable con 19,5 años de media (DE = 12.88). Los datos fueron sometidos a un análisis factorial exploratorio y confirmatorio. El examen reveló algunos itemes con actuaciones psicométricas pobres. Sin embargo, una versión reducida de la MSS presentó sencillez y los índices de ajuste estimados muy buenos. También se produjeron evidencia de la validez de la existencia de un factor de segundo orden. La fiabilidad estimada para los factores y la escala completa variaron desde 0.93 hasta 0.85.

Abstract Marital satisfaction is a construct that is relevant to psychology research due to its significance in terms of establishing this interpersonal relationship. The present study examines the factor structure of the Marital Satisfaction Scale (MSS). The MSS has frequently been employed in Brazilian studies, incorporated as a convergent measure for producing criterion validity evidence in the elaboration of new psychometric methods. Nonetheless, its psychometric properties have not been substantiated for 25 years. A non-probabilistic sample of 249 people from Rio de Janeiro participated in the present study, their ages ranging between 21 and 77 years (M = 45.3; SD = 13.26). They had been married or involved in a civil union (also known as a "domestic partnership" or "common-law marriage" depending on the location) for an average of 19.5 years (SD = 12.88). The collected data was assessed via exploratory and confirmatory factor analyses. Such assessment revealed several items exhibiting poor psychometric performance. Nevertheless, an abridged version of the MSS provided simplicity and produced excellent fit indices. It also yielded validity evidence of the existence of a second-order factor. The estimated reliability for both the factors and the entire scale ranged between 0.85 and 0.93.

What does handedness reveal about ADHD? An analysis based on CPT performance.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder. Continuous performance Tests (CPTs) aid the diagnosis. Handedness is linked to disabilities. OBJECTIVES: 1-To study the association between handedness and ADHD; 2-To verify the usefulness of the CPT in school settings; 3-To exam the relationship between handedness and CPT performance. METHOD: Each child was classified as right-consistent, left-consistent, or non-consistent. From the sample, 171 controls and 68 ADHDs fulfilled the inclusion criteria. The effect of handedness on the CPT was studied using a paired-sample that matched handedness by age, grade, gender, and ADHD. RESULTS: Left-handed students had a probability of suffering from ADHD 2.88 greater than right-handers. ANOVAs on standardized scores indicated that the ADHD students exhibited higher number of errors and higher variability of reaction times as compared to the controls. Discriminant analysis indicated that these CPT parameters could discriminate ADHD from controls. Repeated ANOVAs showed a significant effect of handedness on commission errors (CE) because left-handers made more CEs than right-handers. CONCLUSIONS: 1-The association between ADHD and handedness reflects that left-handers are less lateralized and have decreased interhemispheric connections; 2-The CPT can be used to measure different attention domains in school settings; 3- Left-handers have problems in the impulsive/hyperactivity domain.

Estado nutricional e desfechos clínicos em pacientes pediátricos com leucemia linfoblástica aguda / Nutritional status and clinical outcomes in pediatric patients with acute lymphoblastic leukemia / Estado nutricional y los resultados clínicos en pacientes pediátricos con leucemia linfoblástica aguda

Introdução: A leucemia linfoblástica aguda é a neoplasia mais comum na população pediátrica, e estudos apontam o estado nutricional como um fator prognóstico importante. Objetivo: Avaliar o estado nutricional de uma coorte de crianças e adolescentes durante o tratamento para leucemia linfoblástica aguda, determinar a sua associação com o risco de recaída e com a sobrevida em cinco anos de seguimento. Método: Estudo observacional, retrospectivo, com 54 pacientes de 1 a 18 anos com leucemia linfoblástica aguda, tratados em um hospital de referência em oncologia, entre janeiro de 2004 e dezembro de 2009. Os dados antropométricos foram coletados pela equipe de pesquisadores, nos prontuários, no período de junho a outubro de 2015. Verificaram-se a incidência de recaída e o óbito nos pacientes estudados em cinco anos de seguimento. Resultados: Houve predomínio do sexo masculino (55,6%) e a mediana de idade foi de 7,0 anos no início do seguimento. Observou-se um aumento significativo no escore-z médio do índice de massa corporal para idade durante o tratamento de 0,13±1,19 ao diagnóstico para 0,72±1,07 no início da fase de manutenção (p=0,000). No presente estudo, o estado nutricional ao diagnóstico não foi determinante para o risco de recaída. As curvas de sobrevida não foram diferentes entre os pacientes com ou sem excesso de peso ao diagnóstico. Conclusão: Na população estudada, observou-se um ganho ponderal significativo durante o tratamento, porém não foi encontrada associação entre estado nutricional ao diagnóstico e risco de recaída, e não se verificou influência do excesso de peso na sobrevida.

Introduction: Acute Lymphoblastic Leukemia is the most common neoplasm in the pediatric population, and studies point to nutritional status as an important prognostic factor. Objective: To evaluate the nutritional status of a cohort of children and adolescents during treatment for acute lymphoblastic leukemia, to determine its association with risk of relapse and survival at five years of follow-up Method: Observational retrospective study of 54 patients aged 1 to 18 years old with acute lymphoblastic leukemia treated at an oncology reference hospital, between January 2004 and December 2009. The anthropometric data were collected by the team of researchers from the medical records, from June to October 2015. The incidence of relapse and death was verified in the patients studied at five years of follow-up. Results: There was a predominance of males (55.6%) and the median age was 7.0 years at the beginning of followup. A significant increase was observed in the mean z-score of the Body Mass Index for age during treatment, from 0.13±1.19 at diagnosis to 0.72±1.07 at the beginning of the maintenance phase (p=0.000). In the present study, the nutritional status at diagnosis was not decisive for the risk of relapse. Survival curves did not differ between patients who were and were not overweight at diagnosis. Conclusion: In the studied population, a significant weight gain was observed during treatment, but no association was found between nutritional status at diagnosis and risk of relapse, and no influence of overweight on survival was observed.

Introducción: La leucemia linfoblástica aguda es el cáncer más común en los pacientes pediátricos, y los estudios indican el estado nutricional como un factor pronóstico importante. Objetivo: Evaluar el estado nutricional de una cohorte de niños y adolescentes durante el tratamiento para la leucemia linfoblástica aguda, determinar su asociación con el riesgo de recaídas y la supervivencia a los cinco años de seguimiento. Método: estudio observacional, retrospectivo con 54 pacientes de 1 a 18 años con leucemia linfoblástica aguda tratados en un hospital de referencia en oncología, entre enero de 2004 y diciembre de 2009. Los datos antropométricos fueron recogidos por el equipo de investigadores, en los prontuarios, en el período de junio a octubre de 2015. Se verificó la incidencia de recaída y muerte en los pacientes en cinco años de seguimiento. Resultado: Hubo un predominio del sexo masculino (55,6%) y la edad mediana fue de 7,0 años al inicio del estudio. Se observó un aumento significativo en el escore-z medio del índice de masa corporal para la edad durante el tratamiento, de 0,13±1,19 en el diagnóstico para 0,72±1,07 en el período de mantenimiento (p=0,000). En este estudio, el estado nutricional al momento del diagnóstico no fue decisivo para el riesgo de recaída. Las curvas de supervivencia no fueron diferentes entre los pacientes con o sin exceso de peso al momento del diagnóstico. Conclusión: En la población estudiada, hubo un aumento significativo de peso durante el tratamiento, pero no se encontró asociación entre el estado nutricional al momento del diagnóstico y el riesgo de recaída y no hubo influencia del exceso de peso en la supervivencia.ncia, basándose en los estudios de las necesidades físicas, emocionales, sociales y económicos de este creciente grupo.

Crovirin, a snake venom cysteine-rich secretory protein (CRISP) with promising activity against Trypanosomes and Leishmania.

BACKGROUND: The neglected human diseases caused by trypanosomatids are currently treated with toxic therapy with limited efficacy. In search for novel anti-trypanosomatid agents, we showed previously that the Crotalus viridis viridis (Cvv) snake venom was active against infective forms of Trypanosoma cruzi. Here, we describe the purification of crovirin, a cysteine-rich secretory protein (CRISP) from Cvv venom with promising activity against trypanosomes and Leishmania. METHODOLOGY/PRINCIPAL FINDINGS: Crude venom extract was loaded onto a reverse phase analytical (C8) column using a high performance liquid chromatographer. A linear gradient of water/acetonitrile with 0.1% trifluoroacetic acid was used. The peak containing the isolated protein (confirmed by SDS-PAGE and mass spectrometry) was collected and its protein content was measured. T. cruzi trypomastigotes and amastigotes, L. amazonensis promastigotes and amastigotes and T. brucei rhodesiense procyclic and bloodstream trypomastigotes were challenged with crovirin, whose toxicity was tested against LLC-MK2 cells, peritoneal macrophages and isolated murine extensor digitorum longus muscle. We purified a single protein from Cvv venom corresponding, according to Nano-LC MS/MS sequencing, to a CRISP of 24,893.64 Da, henceforth referred to as crovirin. Human infective trypanosomatid forms, including intracellular amastigotes, were sensitive to crovirin, with low IC50 or LD50 values (1.10-2.38 µg/ml). A considerably higher concentration (20 µg/ml) of crovirin was required to elicit only limited toxicity on mammalian cells. CONCLUSIONS: This is the first report of CRISP anti-protozoal activity, and suggests that other members of this family might have potential as drugs or drug leads for the development of novel agents against trypanosomatid-borne neglected diseases.

Molecular characterization of Rhodnius prolixus' embryonic cuticle.

The embryonic cuticle (EC) of Rhodnius prolixus envelopes the entire body of the embryo during hatching and provides physical protection, allowing the embryo to pass through a narrow chorionic border. Most of the knowledge about the EC of insects is derived from studies on ultrastructure and secretion processes during embryonic development, and little is known about the molecular composition of this structure. We performed a comprehensive molecular characterization of the major components extracted from the EC of R. prolixus, and we discuss the role of the different molecules that were identified during the eclosion process. The results showed that, similar to the post-embryonic cuticles of insects, the EC of R. prolixus is primarily composed of carbohydrates (57%), lipids (19%), and proteins (8%). Considering only the carbohydrates, chitin is by far the major component (approximately 70%), and it is found primarily along the body of the EC. It is scarce or absent in its prolongations, which are composed of glycosaminoglycans. In addition to chitin, we also identified amino (15%), neutral (12%) and acidic (3%) carbohydrates in the EC of R. prolixus. In addition carbohydrates, we also identified neutral lipids (64.12%) and phospholipids (35.88%). Proteomic analysis detected 68 proteins (55 were identified and 13 are hypothetical proteins) using the sequences in the R. prolixus genome (http://www.vectorbase.org). Among these proteins, 8 out of 15 are associated with cuticle metabolism. These proteins are unequivocally cuticle proteins, and they have been described in other insects. Approximately 35% of the total proteins identified were classified as having a structural function. Chitin-binding protein, amino peptidase, amino acid oxidase, oxidoreductase, catalase and peroxidase are all proteins associated with cuticle metabolism. Proteins known to be cuticle constituents may be related to the function of the EC in assisting the insect during eclosion. To our knowledge, this is the first study to describe the global molecular composition of an EC in insects.

Vitamin D and tuberculosis / Vitamina D e tuberculose

BACKGROUND AND OBJECTIVES: The vitamin can be obtained from certain foods or through the exposition to solar light. It works together the parathyroid hormone to keep the sanguineous calcium levels, but it has an interesting participation inimmunologic mechanisms of regulation, mainly of the infectious illnesses, being present in the history of the tuberculosis for a long time. The aim of this study is to revise what has been published, on the role of vitamin D in the tuberculosis physiopathology.CONTENTS: This review deals with immunological mechanisms in tuberculosis infection, the involvement of vitamin D in this mechanisms and what is its applicability in clinical practice for the treatment of tuberculosis.CONCLUSION: Vitamin D can be beneficial as adjuvant therapy in the treatment of tuberculosis. It would be appealing, in a country with our features, that a greater interest in the study of this topic occurred.

JUSTIFICATIVA E OBJETIVOS: A vitamina pode ser obtida dos alimentos ou através da exposição à luz solar. Trabalha junto com o hormônio paratireoideano para manter os níveis de cálcio sanguíneo, mas tem uma interessante participação em mecanismos de regulação imunológicos, principalmente das doenças infecciosas,estando presente na história da tuberculose há muito tempo. O objetivo deste estudo foi revisar o do que já foi publicado,sobre o papel da vitamina D na fisiopatologia da tuberculose.CONTEÚDO: Esta revisão trata sobre mecanismos imunológicos na infecção por tuberculose, o envolvimento da vitamina D nesses mecanismos e qual a sua aplicabilidade na prática médica para o tratamento da tuberculose.CONCLUSÃO: A vitamina D pode ser benéfica como terapia adjuvante no tratamento da tuberculose. Seria atraente, em um país com características climáticas e econômicas como o Brasil,que ocorresse um interesse maior no estudo desse tema.

Validity and reliability of a teacher's scale developed in Brazil for assessment of hyperactive: impulsive behavior and inattention in children and adolescents / Validade e confiabilidade de uma escala para professores desenvolvida no Brasil para avaliação de comportamento hiperativo: impulsivo e desatenção em crianças e adolescentes

This study was designed to develop and assess the internal consistency and factor structure of a teacher's scale for the assessment of hyperactive/impulsive and inattentive behavior in a sample of 221 children from different cities in the State of Rio de Janeiro, Brazil. Forty-five teachers rated the children. The internal consistency of the scale was evaluated using Cronbach's alpha. An orthogonal varimax rotation that maximizes the variance of the squared loadings for each factor was used to find the simplest possible factor structure. There is no internal discrepancy in the item content of the scale. Exploratory factor analysis showed four primary factors (hyperactivity/impulsivity; inattention; social isolation; self-confidence) that are psychologically meaningful. When factor analysis was carried out there was no substantial difference from other studies when compared with the results of other western and oriental countries. It was concluded that this teacher's scale can be a useful aid to clinicians in the identification of children with hyperactivity/impulsivity and inattention problems.(AU)

Este estudo foi elaborado para avaliar a consistência interna e a estrutura fatorial de uma escala para professores, destinada à avaliação de comportamento hiperativo/impulsivo e desatenção em uma amostra de 221 crianças de diferentes cidades do Estado do Rio de Janeiro. Quarenta e cinco professores avaliaram as crianças. A consistência interna da escala foi avaliada usando o coeficiente alfa de Cronbach. Uma rotação Varimax (ortogonal), que maximiza a variância ao quadrado das cargas para cada fator, foi usada para encontrar a estrutura fatorial mais simples. Não houve discrepâncias no conteúdo dos itens da escala. A análise fatorial exploratória indicou quatro fatores primários (hiperatividade/impulsividade; desatenção; isolamento social; autoconfiança) com significado psicológico. Os resultados obtidos neste estudo não diferem daqueles realizados em outros países ocidentais e orientais. Conclui-se que esta escala para professores pode auxiliar na identificação de crianças com queixas de hiperatividade/impulsividade e desatenção.(AU)