Inhibition of SARS-CoV-2 Infection in Vero Cells by Bovine Lactoferrin under Different Iron-Saturation States.

Despite the rapid mass vaccination against COVID-19, the emergence of new SARS-CoV-2 variants of concern, such as omicron, is still a great distress, and new therapeutic options are needed. Bovine lactoferrin (bLf), a multifunctional iron-binding glycoprotein available in unsaturated (apo-bLf) and saturated (holo-bLf) forms, has been shown to exert broad-spectrum antiviral activity against many viruses. In this study, we evaluated the efficacy of both forms of bLf at 1 mg/mL against infection of Vero cells by SARS-CoV-2. As assessed with antiviral assays, an equivalent significant reduction in virus infection by about 70% was observed when either form of bLf was present throughout the infection procedure with the SARS-CoV-2 ancestral or omicron strain. This inhibitory effect seemed to be concentrated during the early steps of virus infection, since a significant reduction in its efficiency by about 60% was observed when apo- or holo-bLf were incubated with the cells before or during virus addition, with no significant difference between the antiviral effects of the distinct iron-saturation states of the protein. However, an ultrastructural analysis of bLf treatment during the early steps of virus infection revealed that holo-bLf was somewhat more effective than apo-bLf in inhibiting virus entry. Together, these data suggest that bLf mainly acts in the early events of SARS-CoV-2 infection and is effective against the ancestral virus as well as its omicron variant. Considering that there are no effective treatments to COVID-19 with tolerable toxicity yet, bLf shows up as a promising candidate.

In Silico Physicochemical Characterization of Fusion Proteins from Emerging Amazonian Arboviruses.

Mayaro (MAYV), Saint Louis encephalitis (SLEV), and Oropouche (OROV) viruses are neglected members of the three main families of arboviruses with medical relevance that circulate in the Amazon region as etiological agents of outbreaks of febrile illnesses in humans. As enveloped viruses, MAYV, SLEV, and OROV largely depend on their class II fusion proteins (E1, E, and Gc, respectively) for entry into the host cell. Since many aspects of the structural biology of such proteins remain unclear, the present study aimed at physicochemically characterizing them by an in silico approach. The complete amino acid sequences of MAYV E1, SLEV E, and OROV Gc proteins derived by conceptual translation from annotated coding regions in the reference sequence genome of the respective viruses were obtained from the NCBI Protein database in the FASTA format and then submitted to the ClustalO, Protcalc, Pepstats, Predator, Proscan, PCprof, Phyre2, and 3Drefine web servers for the determination of sequence identities, the estimation of residual properties, the prediction of secondary structures, the identification of potential post-translational modifications, the recognition of antigenic propensities, and the modeling/refinement of three-dimensional structures. Sequence identities were 20.44%, 18.82%, and 13.70% between MAYV/SLEV, SLEV/OROV, and MAYV/OROV fusion proteins, respectively. As for the residual properties, MAYV E1 and SLEV E proteins showed a predominance of the non-polar profile (56% and 55% of the residues, respectively), whereas the OROV Gc protein showed a predominance of the polar profile (52% of the residues). Regarding predicted secondary structures, MAYV E1 and SLEV E proteins showed fewer alpha-helices (16.51% and 15.17%, respectively) than beta-sheets (21.79% and 25.15%, respectively), while the opposite was observed in the OROV Gc protein (20.39% alpha-helices and 12.14% beta-sheets). Regarding post-translational modifications, MAYV E1, SLEV E, and OROV Gc proteins showed greater relative potential for protein kinase C phosphorylation, N-myristoylation, and casein kinase II phosphorylation, respectively. Finally, antigenic propensities were higher in the N-terminus half than in the C-terminus half of these three proteins, whose three-dimensional structures revealed three distinctive domains. In conclusion, MAYV E1 and SLEV E proteins were found to share more physicochemical characteristics with each other than the OROV Gc protein, although they are all grouped under the same class of viral fusion proteins.

Experimental Dengue Virus Type 4 Infection Increases the Expression of MicroRNAs-15/16, Triggering a Caspase-Induced Apoptosis Pathway.

The World Health Organization has estimated the annual occurrence of approximately 392 million dengue virus (DENV) infections in more than 100 countries where the virus is endemic, which represents a serious threat to humanity. DENV is a serologic group with four distinct serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) belonging to the genus Flavivirus, in the family Flaviviridae. Dengue is the most widespread mosquito-borne disease in the world. The ~10.7 kb DENV genome encodes three structural proteins (capsid (C), pre-membrane (prM), and envelope (E)) and seven non-structural (NS) proteins (NS1, NS2A, NS2B, NS3, NS4A, NS4B, and NS5). The NS1 protein is a membrane-associated dimer and a secreted, lipid-associated hexamer. Dimeric NS1 is found on membranes both in cellular compartments and cell surfaces. Secreted NS1 (sNS1) is often present in patient serum at very high levels, which correlates with severe dengue symptoms. This study was conducted to discover how the NS1 protein, microRNAs-15/16 (miRNAs-15/16), and apoptosis are related during DENV-4 infection in human liver cell lines. Huh 7.5 and HepG2 cells were infected with DENV-4, and miRNAs-15/16, viral load, NS1 protein, and caspases-3/7 were quantified after different durations of infection. This study demonstrated that miRNAs-15/16 were overexpressed during the infection of HepG2 and Huh 7.5 cells with DENV-4 and had a relationship with NS1 protein expression, viral load, and the activity of caspases-3/7, thus making these miRNAs potential injury markers during DENV infection in human hepatocytes.

Falo, feijão e fuzil: uma leitura decolonial das questões de gênero, de raça e de classe nas narrativas do barebacking sex / Phallus, beans and rifle: a decolonial reading of gender, race and class issues in barebacking sex narratives / Falo, frijoles y rifle: una lectura decolonial de cuestiones de género, raza y clase en narrativas del barebacking sex

Barebacking sex é o engajamento intencional de homens que fazem sexo com homens na relação anal sem camisinha. Para além de abordagens moralistas, relacionadas à possibilidade de infecção pelo HIV, analisamos como narrativas barebacking classificam os corpos em desejáveis e indesejáveis, a partir da maneira como são apresentados em cartazes de divulgação de orgias brasileiras disponíveis para visualização na internet. Neste artigo, almejamos uma discussão interseccional sobre desejo sexual, gênero, raça e classe, partindo das imagens em circulação nos contextos brasileiros do bareback.

Barebacking sex is the intentional engagement of men who have sex with other men in anal intercourse without a condom. Beyond moralistic approaches, related to the possibility of HIV infection, we analyse how barebacking narratives classify bodies into the desirable and the undesirable, through the way they are shown in posters publicizing Brazilian orgies available for viewing on the internet. In this article, we aim to develop an intersectional discussion about sexual desire, gender, race and class, starting from the images circulating in Brazilian bareback contexts.

Barebacking sex es el compromiso intencional de hombres que tienen sexo con hombres en el coito anal sin condón. Además de los enfoques moralistas relacionados con la posibilidad de infección por el VIH, analizamos cómo las narrativas barebacking clasifican los cuerpos en deseables e indeseables, en función de la forma en que se presentan en carteles para la difusión de orgías brasileñas disponibles para su visualización en Internet. En este artículo,apuntamos a una discusión interseccional del deseo sexual, género, raza y clase, a partir de las imágenes en circulación en contextos de bareback brasileños.

The Complexity of SARS-CoV-2 Infection and the COVID-19 Pandemic.

The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to the death of millions of people worldwide and thousands more infected individuals developed sequelae due to the disease of the new coronavirus of 2019 (COVID-19). The development of several studies has contributed to the knowledge about the evolution of SARS-CoV2 infection and the disease to more severe forms. Despite this information being debated in the scientific literature, many mechanisms still need to be better understood in order to control the spread of the virus and treat clinical cases of COVID-19. In this article, we carried out an extensive literature review in order to bring together, in a single article, the biological, social, genetic, diagnostic, therapeutic, immunization, and even socioeconomic aspects that impact the SAR-CoV-2 pandemic. This information gathered in this article will enable a broad and consistent reading of the main aspects related to the current pandemic.

Influence of iron binding in the structural stability and cellular internalization of bovine lactoferrin.

Lactoferrin (Lf) is an iron-binding glycoprotein and a component of many external secretions with a wide diversity of functions. Structural studies are important to understand the mechanisms employed by Lf to exert so varied functions. Here, we used guanidine hydrochloride and high hydrostatic pressure to cause perturbations in the structure of bovine Lf (bLf) in apo and holo (unsaturated and iron-saturated, respectively) forms, and analyzed conformational changes by intrinsic and extrinsic fluorescence spectroscopy. Our results showed that the iron binding promotes changes on tertiary structure of bLf and increases its structural stability. In addition, we evaluated the effects of bLf structural change on the kinetics of bLf internalization in Vero cells by confocal fluorescence microscopy, and observed that the holo form was faster than the apo form. This finding may indicate that structural changes promoted by iron binding may play a key role in the intracellular traffic of bLf. Altogether, our data improve the comprehension of bLf stability and uptake, adding knowledge to its potential use as a biopharmaceutical.

Astrocyte reactivity in spinal cord and functional impairment after tendon injury in rats.

Astrocyte reactivity in the spinal cord may occur after peripheral neural damage. However, there is no data to report such reactivity after Achilles tendon injury. We investigate whether changes occur in the spinal cord, mechanical sensitivity and gait in two phases of repair after Achilles tendon injury. Wistar rats were divided into groups: control (CTRL, without rupture), 2 days post-injury (RUP2) and 21 days post-injury (RUP21). Functional and mechanical sensitivity tests were performed at 2 and 21 days post-injury (dpi). The spinal cords were processed, cryosectioned and activated astrocytes were immunostained by GFAP at 21 dpi. Astrocyte reactivity was observed in the L5 segment of the spinal cord with predominance in the white matter regions and decrease in the mechanical threshold of the ipsilateral paw only in RUP2. However, there was gait impairment in both RUP2 and RUP21. We conclude that during the acute phase of Achilles tendon repairment, there was astrocyte reactivity in the spinal cord and impairment of mechanical sensitivity and gait, whereas in the chronic phase only gait remains compromised.

Physiotherapeutic evaluation and intervention proposal on a patient with post-chikungunya chronic arthritis.

BACKGROUND: Chikungunya fever is an arboviral disease characterized by a high morbidity rate related to intense and persistent arthralgia, causing a decrease in both quality of life (QoL) and productivity. This study aimed to report functional evaluation and multimodal physiotherapeutic intervention on a patient with post-chikungunya chronic arthritis (PCCA). CASE PRESENTATION: Woman, 47 years old, resident of the municipality of Belém, state of Pará, northern Brazil, with clinical diagnosis of chikungunya fever marked by fever, swelling, pain in the joints of the hands and feet, and headache. The physiotherapeutic treatment started three months after the diagnosis and consisted of 24 sessions composed of electrotherapy, thermotherapy, and kinesiotherapy resources. The patient progressed from an initial status of intense pain in several joints to low pain in a single joint and showed improvement in all domains of QoL, mainly in limitations by physical and emotional aspects and functional capacity. CONCLUSIONS: This case report details a proposal of multimodal physiotherapeutic intervention for a patient with functional impairments due to PCCA, suggesting that the use of physiotherapeutic resources may help this process and bring some assistance to those affected by the disease.

Histopathological lesions of congenital Zika syndrome in newborn squirrel monkeys.

The absence of an adequate animal model for studies has limited the understanding of congenital Zika syndrome (CZS) in humans during the outbreak in America. In this study, we used squirrel monkeys (Saimiri collinsi), a neotropical primate (which mimics the stages of human pregnancy), as a model of Zika virus (ZIKV) infection. Seven pregnant female squirrel monkeys were experimentally infected at three different gestational stages, and we were able reproduce a broad range of clinical manifestations of ZIKV lesions observed in newborn humans. Histopathological and immunohistochemical analyses of early-infected newborns (2/4) revealed damage to various areas of the brain and ZIKV antigens in the cytoplasm of neurons and glial cells, indicative of CZS. The changes caused by ZIKV infection were intrauterine developmental delay, ventriculomegaly, simplified brain gyri, vascular impairment and neuroprogenitor cell dysfunction. Our data show that the ZIKV infection outcome in squirrel monkeys is similar to that in humans, indicating that this model can be used to help answer questions about the effect of ZIKV infection on neuroembryonic development and the morphological changes induced by CZS.

Lactoferrin affects rhinovirus B-14 entry into H1-HeLa cells.

Lactoferrin is part of the innate immune system, with antiviral activity against numerous DNA and RNA viruses. Rhinoviruses, the leading cause of the common cold, are associated with exacerbation of respiratory illnesses such as asthma. Here, we explored the effect of bovine lactoferrin (BLf) on RV-B14 infectivity. Using different assays, we show that the effect of BLf is strongest during adhesion of the virus to the cell and entry. Tracking the internalisation of BLf and virus revealed a degree of colocalisation, although their interaction was only confirmed in vitro using empty viral particles, indicating a possible additional influence of BLf on other infection steps.

Prenatal disorders and congenital Zika syndrome in squirrel monkeys.

During the Zika virus (ZIKV) outbreak in Brazil (2015-2016), the clinical manifestations associated with its infection were complex and included miscarriage and congenital malformations, not previously described. In this study, we evaluated the prenatal conditions of pregnant female squirrel monkeys (Saimiri collinsi) infected during different gestational thirds (GTs) and assessed all clinical aspects, diagnostic imaging, viremia and the immune response. In our study, 75% of the infected animals in the 1st GT group had significant clinical manifestations, such as miscarriage and prolonged viremia associated with a late immune response. Consequently, their neonates showed fetal neuropathology, such as cerebral hemorrhage, lissencephaly or malformations of the brain grooves, ventriculomegaly, and craniofacial malformations. Thus, our study demonstrated the relevance of pregnant squirrel monkeys as a model for the study of ZIKV infection in neonates due to the broad clinical manifestations presented, including the typical congenital Zika syndrome manifestations described in humans.

Do AZT à PrEP e à PEP: aids, HIV, movimento LGBTI e jornalismo / From AZT to PrEP and PEP: AIDS, HIV, LGBTI movement and journalism / Del AZT a la PrEP y a la PEP: Sida, VIH, movimiento LGBTI y periodismo

O objetivo deste artigo é destacar características e atravessamentos dos movimentos LGBTI brasileiros, da aids, do HIV e de coberturas jornalísticas da síndrome que surgiu publicamente no início dos anos 1980. Resgatamos dimensões históricas e questões atuais como desafiadoras para as ciências, a medicina, governos e militantes com o intuito de refletir sobre disputas que estiveram e estão em curso, principalmente aquelas que se relacionam com a LGBTIfobia e outras opressões sociais. A pesquisa foi realizada por meio de levantamento bibliográfico acerca das políticas do movimento LGBTI, do HIV e da aids, bem como do uso de resultados de pesquisa anteriormente realizada sobre homofobia e narrativas jornalísticas. Observou-se uma conexão complexa entre as relações engendradas no surgimento da síndrome, próxima aos primeiros passos do movimento LGBTI no Brasil, como a produção ambivalente de visibilidades, assim como a manutenção de preconceitos históricos que ainda reverberam no tecido social.

The aim of this article is to highlight the characteristics and crossings of Brazilian LGBTI, AIDS, HIV movements and of journalistic coverage of the syndrome that emerged publicly in the early 1980s. We brought up historical dimensions and current issues as challenging for the sciences, medicine, governments and militants in order to reflect on ongoing disputes, especially those that are related to LGBTIphobia and others social oppressions. The research was carried out through a bibliographical survey about policies of the LGBTI, HIV and AIDS movements, as well as the use of previously conducted research results on homophobia and journalistic narratives. It was observed a complex connection between the relations generated in the beginning of the syndrome, close to the first steps of the LGBTI movement in Brazil, as the ambivalent production of visibility, as well as the maintenance of historical prejudices that still reverberate in social world.

El objetivo de este artículo es subrayar puntos y atravesamientos de los movimientos LGBTI brasileños, del Sida, del VIH y de las coberturas periodísticas del síndrome que surgió en público en el principio de los años 1980. Rescatamos dimensiones históricas y cuestiones actuales desafiantes para las ciencias, la medicina, los gobiernos y militantes con el propósito de reflexionar sobre disputas que estuvieron y están en curso, principalmente aquellas que se relacionan con la LGBTIfobia y otras opresiones sociales. La investigación fue realizada por medio de levantamiento bibliográfico acerca de las políticas del movimiento LGBTI, del VIH y del Sida, así como del uso de resultados de investigación previamente realizada sobre homofobia y narrativas periodísticas. Se observó una conexión compleja entre las relaciones engendradas en el surgimiento del síndrome, próxima a los primeros pasos del movimiento LGBTI en Brasil, como la producción ambivalente de visibilidades, así como el mantenimiento de prejuicios históricos que aún reverberan en el tejido social.

Sodium butyrate improves memory and modulates the activity of histone deacetylases in aged rats after the administration of d-galactose.

Aging is a complex biological process. Epigenetic alterations have been related to both aging and memory decline. Included amongst these alterations is histone acetylation, which may play a crucial role in aging. Thus, the aims of the present study were to standardize the animal model of d-galactose (d-gal), and to evaluate the effects caused by sodium butyrate (SB), which is a histone deacetylase inhibitor on memory, the modulation of histone deacetylases (HDACs), and also DNA damage in 2, 6 or 16-month-old Wistar rats which were subjected to administrations of d-gal. To help choose the best dose of d-gal for the induction of the aging model, we performed a dose-response curve (100, 200 or 300 mg/kg). d-Gal was administered orally to the 2-month-old rats for a period of 30 days. After this, d-gal (200 mg/kg) or water were administered to the 2, 6 or 16-month-old rats for a period of 30 days. On the 24th day, treatment was started with SB (600 mg/kg) intraperitoneally, for a period of 7 days. SB was able to reverse the damage to habituation memory caused by d-gal in the 2 and 6-month-old rats, but was unable to reverse the damage in the 16 month-old animals. In addition, SB was able to reverse the damage caused by natural aging in the 16-month-old animals. In the inhibitory avoidance task, SB improved the damage caused by d-gal in the 2, 6 and 16-month-old animals and had the same result against the effects of natural aging in the 16-month-old rats. Moreover, d-gal caused an increase in the level of HDACs activity in the 16-month-old animals, and SB was able to reverse this effect in the frontal cortex and hippocampus. The 16-month-old animals showed an increase in the frequency of DNA damage in peripheral blood, and SB was able to reduce this damage. Moreover, d-gal caused an increase in the index and frequency of DNA damage in the 2 and 6-month-old animals, and treatment with SB was able to prevent this damage. Thus, the present study showed the protective effects of SB on the memory of naturally aged and d-gal induced aging in rats. Therefore, the present study shows new findings for the use of SB in aging.

Zika Virus Alters the Expression Profile of microRNA-Related Genes in Liver, Lung, and Kidney Cell Lineages.

Zika virus (ZIKV) is an arbovirus belonging to the genus Flavivirus (Flaviviridae). ZIKV infection is associated with alterations in various organs, including the liver, lungs, and kidneys. Studies on the influence of posttranscriptional control on viral infections have demonstrated that microRNAs (miRNAs) interfere with different stages of the replicative cycle of several viruses and may influence the disease outcome. To shed light on ZIKV-induced regulation of host miRNA-processing machinery in the above organs, we analyzed the expression of genes encoding key proteins of the miRNA pathway in different ZIKV-infected continuous primate cell lineages (HepG2, A549, and MA104) by reverse-transcription quantitative polymerase chain reaction (RT-qPCR). Expression of the genes encoding the miRNA-related proteins DGCR8, Ago1, and Ago3 in HepG2 cells and Drosha, Dicer, Ago2, and Ago3 in A549 and MA104 cells was significantly altered in the presence of ZIKV. Our results suggest that ZIKV modulates miRNA levels during infection in liver, lung, and kidney cells, which may be an additional mechanism of host cell subversion in these organs.

Pancreatectomia videolaparoscópica em tumores malignos: experiência inicial e resultados perioperatórios / Videolaparoscopic pancreatectomy in malignant tumors: initial experience and perioperative results

Com os resultados cirurgia minimamente invasiva em outras áreas, houve interesse em estender a videolaparoscopia para a cirurgia do pâncreas, contudo, ainda existem controvérsias na literatura. Buscou-se descrever a morbimortalidade perioperatória dos primeiros pacientes submetidos à pancreatectomia videolaparoscópica por neoplasia maligna em um serviço de cirurgia do aparelho digestivo. Trata-se de um estudo descritivo e retrospectivo, em uma população de pacientes com câncer de pâncreas/periampular, que foram submetidos à pancreatectomia videolaparoscópica. Todos os pacientes foram incluídos. Buscou-se descrever os principais resultados do intraoperatório até 60 dias após a cirurgia. Entre 2013 e 2015, 9 pacientes foram submetidos à pancreatectomia videolaparoscópica. A média de idade foi de 57 anos e os tumores do tipo adenocarcinoma foram os mais comuns (78%). 3 pacientes foram submetidos a pancreatectomia distal laparoscópica e 6 foram submetidos a gastroduodenopancreatectomia laparoscópica. A morbidade perioperatória foi de 67%, entretanto, apenas um paciente apresentou complicação grave. Houve dois casos de fístula pancreática. Não ocorreram óbitos no período perioperatório. Todas as ressecções apresentaram margens cirúrgicas negativas. Os dados indicam que a pancreatectomia videolaparoscópica é segura e apresenta viabilidade técnica em relação aos resultados perioperatórios.

The results of minimally invasive surgery in other areas have led to interest in extending the laparoscopic approach to pancreatic surgery, however, controversies still exist in the literature. The aim was to describe the perioperative morbidity and mortality of the first patients that underwent laparoscopic pancreatectomy for malignancy in a service of gastrointestinal surgery. This is a descriptive/retrospective study in a population of patients with pancreatic/periampullary cancer, who underwent laparoscopic pancreatectomy. All patients were included. We aimed to describe the main results from the intraoperative up to 60 days after surgery. Between 2013 and 2015, 9 patients underwent laparoscopic pancreatectomy. The average age was 57 years and adenocarcinoma were the most common tumor type (78%). 3 patients underwent laparoscopic distal pancreatectomy and 6 underwent laparoscopic gastroduodenopancreatectomy. Perioperative morbidity was 67%, however, only one patient had serious complications. Pancreatic fistula occurred in two cases. There were no deaths in the perioperative period. All resections showed negative surgical margins. The data indicate that laparoscopic pancreatectomy is safe and feasible regarding perioperative results.

Reduction of Pain and Edema of the Legs by Walking Wearing Elastic Stockings.

Aim. The objective of the current study was to evaluate the reduction of edema and pain with the use of elastic stockings. Method. The effect of walking on a treadmill for 50 minutes in the evening wearing elastic compression stockings on pain and edema was evaluated in a prospective randomized crossover clinical trial. In Assessment 1, the legs of participants were measured by volumetry at 7:00 a.m. and they were asked to perform their normal daily activities and to return at 4:00 p.m. Forty-two legs of 21 female patients with ages of the participants ranged from 32 to 72 years with signs and symptoms of chronic venous disease. The sizes of the legs of all patients were evaluated by water displacement volumetry and a visual analog scale was used to assess pain. Results. After walking for 50 minutes on the treadmill, the volume reduced (paired t-test: p value < 0.03). In relation to pain, there was a reduction in pain after the treadmill session using the elastic stocking (Wilcoxon signed rank test: p value < 0.007). Conclusion. The reduction of edema and pain of the legs during the course of the day can be accomplished with the use of elastic stockings, as well as walking.

The importance of three-dimensional anorectal ultrasound in the study of patients with anal pain / A importância da ultra-sonografia anorretal tridimensional no estudo de pacientes portadores de dor anal

OBJECTIVES: Anal pain can be caused by various medical conditions; the exclusion of organic causes for proper treatment is important. Three-dimensional anorectal ultrasound can identify organic causes of anal pain. The objective of this study was to evaluate the importance of three-dimensional anorectal ultrasound in the detection of organic abnormalities in patients with anal pain. METHODS: Twenty-two patients (mean age: 49 years; 13 women) with chronic anal pain were enrolled to join a prospective study between June 2009 and June 2011. A complete proctology and colonoscopy examination was normal. Subsequently, the patients underwent three-dimensional anorectal ultrasound. RESULTS: Intersphincteric sepsis was found in 14 patients (63.6%). Two female patients (9.1%) had anal sphincter injury, one of them with the presence of a grade II rectocele. There was an increase in the thickness of the subepithelial tissue in three patients (13.6%). In one patient (4.6%), the presence of a hypoechoic circular retrorectal (presacral) cyst of the middle and lower rectum was observed. The three-dimensional anorectal ultrasound examination showed no abnormalities in two patients (9.1%). CONCLUSION: The three-dimensional anorectal ultrasound is a simple, economical, fast and useful test for the study of anorectal diseases and should be included in the examination of patients with anal pain, to exclude organic causes. (AU)

OBJETIVOS: A dor anal pode resultar várias condições clínicas e se faz necessário excluir causas orgânicas para o tratamento adequado. A ultra-sonografia anorretal tridimensional (3D-US) pode identificar causas orgânicas de dor anal. O objetivo deste estudo foi avaliar a importância da 3D-US para detectar anomalias orgânicas em pacientes com dor anal. MÉTODOS: Vinte e dois pacientes (média de idade: 49 anos; treze mulheres) com dor anal crônica foram incluídos em um estudo prospectivo entre junho de 2009 e junho de 2011. O exame proctológico completo e colonoscopia foram normais. Posteriormente, os pacientes foram submetidos à 3D-US. RESULTADOS: Sepse interesfincteriana foi evidenciada em quatorze pacientes (63,6%). Duas pacientes (9.1%) apresentaram lesão do esfíncter anal, sendo uma com presença de retocele grau II. O aumento da espessura do tecido subepitelial apresentou-se em três pacientes (13,6%). Em um paciente (4,6%), foi evidenciada a presença de cisto retrorretal circular hipoecoico no reto médio e inferior. O exame de US-3D não evidenciou anormalidades em dois indivíduos (9.1%). CONCLUSÃO: A ultra-sonografia anorretal tridimensional é um exame simples, econômico, rápido e útil no estudo de doenças anorretais e deve ser incluído no estudo dos pacientes com dor anal para descartar causas orgânicas. (AU)

Primary liver leiomyoma: a review of this unusual tumour.

Primary liver leiomyoma (PLL) should be considered in the differential diagnosis of liver lesions. A literature review has been completed and two cases are reported. The first is a 45-year-old white woman complaining of vague abdominal pain. She was initially evaluated with abdominal ultrasonography (US) that revealed a heterogeneous liver mass measuring 18 cm in greatest diameter. The tumour demonstrated hypointensity on T1-weighted and hyperintensity on T2-weighted magnetic resonance imaging. The second case is a 45-year-old Asian male who had undergone kidney transplantation 16 years ago for IgA glomerulonephritis and who developed mild, self-limiting epigastric pain. US showed a 4.3-cm-diameter lesion that was predominantly hypoechoic and was either compressing or arising from segment 2 of the liver. Computed tomography showed a well-circumscribed 4-cm-diameter mass that appeared to be arising from segments 2/3 of the liver and was adjacent to the anterior gastric wall. He underwent an uneventful laparoscopic left lateral sectionectomy and discharged on post-operative day 3. Pathological examination of the resection specimen confirmed the lesion as a PLL in each case. Herein, we report two cases of PLL and review the literature regarding this uncommon disorder.

Effectiveness of biofeedback therapy in patients with chronic constipation

PURPOSE: The purpose of this study was to evaluate the effect of physical therapy in women diagnosed with chronic constipation using functional training of the pelvic floor (biofeedback). PATIENTS AND METHODS: From March 2009 to March 2010, 67 women with chronic constipation were prospectively evaluated. The patients were evaluated and the constipation score proposed by Agachan et al. was applied. Then, they were sent to biofeedback. These patients were divided into 2 groups: with anismus (group I: mean age of 46.90 years old) and without anismus (group II: mean age of 44.89 years old) and diagnosed by anorectal electromanometry. The treatment was performed with different exercises for each group, associated with some hygieno-dietetic directions. At the end of treatment, the constipation score was reapplied. RESULTS: Pre-biofeedback constipation score in group I was 15.04 (standard deviation - SD=2.48) and post-biofeedback constipation score was 3.39 (SD=1.62) (p<0.0001). Pre-biofeedback constipation score in group II was 14.82 (SD=2.401) and post-biofeedback constipation score was 2.90 (SD=1.64) (p<0.0001). Besides, a significant difference (p<0.005) was observed between the groups regarding the number of biofeedback sessions. CONCLUSION: Thus, the authors conclude that biofeedback is effective in the treatment of constipation. (AU)

OBJETIVO: Este trabalho objetivou avaliar o efeito do tratamento fisioterapêutico, em mulheres diagnosticadas com constipação crônica, utilizando treinamento funcional do assoalho pélvico (biofeedback). CASUÍSTICA E MÉTODO: No período de março de 2009 a março de 2010, foram avaliadas, prospectivamente, 67 mulheres com constipação intestinal. As pacientes foram avaliadas e o escore de constipação, proposto por Agachan et al., foi aplicado; então, foram encaminhadas ao biofeedback. Essas pacientes foram divididas em 2 grupos: com anismus (56 pacientes do grupo I: média de idade 46,90 anos) e sem anismus (11 pacientes do grupo II: média de idade 44,89 anos), diagnosticadas pela eletromanometria anorretal. Para o tratamento, foram estipulados exercícios diferentes para cada grupo, associados com orientações higienodietéticas. Ao fim do tratamento, foi reaplicado o escore de constipação. RESULTADOS: O escore de constipação do grupo I, na avaliação pré-biofeedback, foi 15,04 (desvio padrão - DP=2,48) e, no pós-tratamento, foi 3,39 (DP=1,62) (p<0,0001). O escore de constipação do grupo II, na avaliação pré-biofeedback, foi 14,82 (DP=2,401) e, no pós-tratamento, foi 2,90 (DP=1,64) (p<0,0001). Além disso, em relação ao número de sessões de biofeedback entre os grupos, houve diferença significativa (p<0,005). CONCLUSÃO: Concluiu-se que o biofeedback é eficaz no tratamento da constipação intestinal. (AU)

Importância da ultra-sonografia anorretal tridimensional na decisão terapêutica da endometriose profunda / Importance of the three-dimensional anorectal ultrasonography in deep endometriosis

OBJETIVO: Este estudo visa demonstrar a importância da ultra-sonografia anorretal tridimensional (US 3D) no diagnóstico da endometriose profunda e o grau de acometimento do trato intestinal na decisão terapêutica da endometriose do septo retovaginal. MÉTODOS: Estudo prospectivo realizado entre março de 2007 e julho de 2009. Sessenta e cinco mulheres com endometriose pélvica e com queixas gastrointestinais foram avaliadas e submetidas a US 3D. Vinte pacientes, média de idade 33,7anos, com suspeita de foco endometriótico intestinal foram submetidas ao procedimento laparoscópico para a realização de inventário da cavidade abdominal e tratamento cirúrgico. RESULTADOS: Em dezenove mulheres (95 por cento), os achados laparoscópicos confirmaram a presença do foco endometriótico retal. O procedimento realizado à laparoscopia foi: exérese de foco peritoneais (n= 1); ressecção parcial do retossigmóide (n= 9); exérese de nódulo de reto (n= 10). O tempo operatório médio por procedimento foi de 120 minutos. O tempo médio de alta foi 1,7 dias. Duas pacientes apresentaram como complicação o aparecimento de fistula retovaginal. CONCLUSÃO: Conclui-se que a ultra-sonografia anorretal tridimensional é exame específico na avaliação do segmento anorretal, decisivo na detecção de focos endometrióticos do septo retovaginal e avalia eventuais doenças associadas nesse segmento, determinando a estratégica terapêutico-cirúrgica adequada.

OBJECTIVE: This study aims to demonstrate the importance of three-dimensional anorectal ultrasonography (US 3D) in the diagnosis of deep endometriosis and level of intestinal involvement in the decision of the therapy of endometriosis of rectovaginal septum. METHODS: A prospective study between March 2007 and July 2009. Sixty-five women with pelvic endometriosis and gastrointestinal complaints were evaluated and submitted to 3D U.S.. Twenty patients, mean age 33.7 years, with suspected of intestinal endometriosis were submitted to laparoscopic procedure and surgical treatment. RESULTS: In nineteen women (95 percent), the laparoscopic findings confirmed endometriosis in the rectum. The procedure was performed to laparoscopy: the focus peritoneal excision (n = 1), partial resection of rectosigmoid (n = 9), excision of a nodule of rectum (n = 10). The average operative time per procedure was 120 minutes. The average time to stay in hospital was 1.7 days. Two patients had the appearance as complication of rectovaginal fistula. CONCLUSION: We conclude that three-dimensional anorectal ultrasonography is specific in the assessment of anorectal segment, crucial for detecting endometriosis focus of the rectovaginal septum and evaluates possible associated diseases in this segment, determining the appropriate therapeutic strategy and surgical.