Impacto da pandemia da COVID-19 na doação de córnea e atuação do Banco de Olhos na Região da Zona da Mata Mineira / Impact of the COVID-19 pandemic on cornea donation and Eye Bank operation in the Zona da Mata Mineira Region

RESUMO Objetivo: Avaliar o impacto da pandemia da COVID-19 nas doações de córnea e na atuação de um banco de olhos na região da Zona da Mata Mineira. Métodos: Análise retrospectiva de prontuários de todas as doações obtidas pelo Banco de Olhos Hospital Regional Dr. João Penido, de Juiz de Fora (MG), entre 2017 e 2022, comparando-se os períodos pré (janeiro de 2017 a 11 de março de 2020) e pós-pandemia (12 de março de 2020 a dezembro de 2022). Resultados: Verificou-se uma redução nas doações de córnea e no número de tecidos corneanos liberados para transplantes no período pós pandemia, 68,2 e 67,3% respectivamente. Não houve diferença estatística no sexo, idade média, causa básica de óbito dos doadores, nos números de globos oculares não preservados e de córneas não preservadas entre os períodos pré e pós-pandemia. As taxas de liberação de córneas preservadas e aproveitamento das doações foram maiores no período pós-pandemia: 86,5 versus 79,0% e 68,1 versus 63,0%, respectivamente. O número de tecidos corneanos liberados para transplantes óptico e tectônico foram estatisticamente maiores no período pré-pandemia (p<0,001). Conclusão: A pandemia da COVID-19 impactou negativamente nas doações de córnea e na atuação do banco de olhos na região da Zona da Mata Mineira.

ABSTRACT Objective: To assess the impact of the COVID-19 pandemic on corneal donations and the operation of the eye bank in the Zona da Mata Mineira Region. Methods: Retrospective analysis of medical records of all donations obtained by the Banco de Olhos Hospital Regional Dr. João Penido/FHEMIG, Juiz de Fora - MG between 2017 and 2022, comparing pre (January/2017 - March 11/2020) and post-pandemic (12/March/2020 - December/2022) periods. Results: There was a reduction in cornea donations and the number of corneal tissues released for transplants in the post-pandemic period, 68.2% and 67.3%, respectively. There was no statistical difference in gender, average age, basic cause of death of donors, in the number of non-preserved eyeballs and non-preserved corneas between the pre- and post-pandemic periods. The rates of release of preserved corneas and use of donations were higher in the post-pandemic period, 86.5% vs 79.0%, and 68.1% vs 63.0%, respectively. The number of corneal tissues released for optical and tectonic transplants were statistically higher in the pre-pandemic period (P<0.001). Conclusion: The COVID-19 pandemic had a negative impact on cornea donations and the eye bank's operations in the Zona da Mata Mineira region.

Valentino's syndrome: Simulation of acute appendicitis in the context of peptic ulcer perforation. Case report and literature review.

INTRODUCTION AND IMPORTANCE: Abdominal pain (AP) is one of the main reasons for consultation in the emergency department worldwide. The causes of AP are gathered in a broad group of pathologies whose incidence and prevalence vary according to various factors. The great importance of an adequate approach to AP lies in ruling out or confirming the presence of acute abdomen that requires emergency surgical management. Valentino's Syndrome (VS) simulates the clinical manifestations of acute appendicitis whose origin is the perforation of a peptic ulcer. This is an infrequent entity, with very few reports in the literature, this being the second case reported in Colombia. CASE PRESENTATION: We present a case of VS in a 59-year-old male patient who was admitted to the emergency department with 3 days of pain in the right iliac fossa that met the diagnostic criteria for acute appendicitis. However, upon surgical exploration, it was determined that the cause was secondary to peptic ulcer perforation (PPU). DISCUSSION: PPU is one of the most infrequent complications of the disease, occurring in close to 10 % of cases, and is considered a surgical emergency. Minimally invasive surgery provides a significant benefit over open surgery, outcomes that directly lead to decreased healthcare costs and increased patient satisfaction. CONCLUSION: PPU represents a diagnostic challenge due to the variability of the symptoms and clinical features. Laparoscopic approach fulfills diagnostic and therapeutic roles with lesser morbidity and mortality rates, which is why it should be standardized. Malignancy should be ruled out in all cases.

Efficacy of fluoride gel in arresting active non-cavitated caries lesions: a randomized clinical trial.

This study evaluated the efficacy of fluoride gel in arresting active non-cavitated caries lesions in permanent teeth. This randomized, triple-blind, placebo-controlled clinical trial randomized 100 schoolchildren aged 10.7 ± 2.2 years to test treatment (1.23% acidulated phosphate fluoride [APF] gel) or control treatment (placebo gel) for 4-6 applications at weekly intervals. Data collection included the visible plaque index, gingival bleeding index, visible plaque accumulation on the occlusal surfaces, eruption stage, and dental caries. The association between group and lesion arrestment was assessed using logistic regression, and estimates were adjusted for plaque accumulation over the lesion at baseline, surface type, and tooth type. Models were fitted using generalized estimating equations for accounting for the clustering of data (i.e., the same individual contributed > 1 lesion). Ninety-eight children completed the study (48 fluoride and 50 placebo). When all dental surfaces were analyzed, the likelihood of lesion arrestment was similar between both groups (p > 0.05). A secondary analysis including only the occlusal lesions in molars showed that for teeth under eruption, lesions receiving the 1.23% APF gel were about 3-fold more likely to become arrested than lesions receiving the placebo gel (OR = 2.85; 95%CI = 1.23-6.61; p = 0.01). No significant difference was detected for molars with complete eruption (p > 0.05). The benefit of fluoride gel for arresting non-cavitated caries lesions could not be identified by clinical assessment in this short-term trial. Notwithstanding, when the cariogenic challenge was greater (as on the occlusal surfaces of erupting molars), 1.23% APF gel treatment was an important tool for caries control.

Efficacy of fluoride gel in arresting active non-cavitated caries lesions: a randomized clinical trial

Abstract: This study evaluated the efficacy of fluoride gel in arresting active non-cavitated caries lesions in permanent teeth. This randomized, triple-blind, placebo-controlled clinical trial randomized 100 schoolchildren aged 10.7 ± 2.2 years to test treatment (1.23% acidulated phosphate fluoride [APF] gel) or control treatment (placebo gel) for 4-6 applications at weekly intervals. Data collection included the visible plaque index, gingival bleeding index, visible plaque accumulation on the occlusal surfaces, eruption stage, and dental caries. The association between group and lesion arrestment was assessed using logistic regression, and estimates were adjusted for plaque accumulation over the lesion at baseline, surface type, and tooth type. Models were fitted using generalized estimating equations for accounting for the clustering of data (i.e., the same individual contributed > 1 lesion). Ninety-eight children completed the study (48 fluoride and 50 placebo). When all dental surfaces were analyzed, the likelihood of lesion arrestment was similar between both groups (p > 0.05). A secondary analysis including only the occlusal lesions in molars showed that for teeth under eruption, lesions receiving the 1.23% APF gel were about 3-fold more likely to become arrested than lesions receiving the placebo gel (OR = 2.85; 95%CI = 1.23-6.61; p = 0.01). No significant difference was detected for molars with complete eruption (p > 0.05). The benefit of fluoride gel for arresting non-cavitated caries lesions could not be identified by clinical assessment in this short-term trial. Notwithstanding, when the cariogenic challenge was greater (as on the occlusal surfaces of erupting molars), 1.23% APF gel treatment was an important tool for caries control.

Radiographic pattern of inactive occlusal enamel lesions and its relationship with caries progression over 4-5 years.

OBJECTIVE: To assess the radiographic pattern of inactive enamel caries lesions (IECL) in the occlusal surfaces of permanent molars and to investigate whether the presence of radiolucency at baseline could predict lesion progression over 4-5 years. METHODS: A prospective cohort study followed 193 schoolchildren from southern Brazil. At baseline, clinical and radiographic examinations were performed. After 4-5 years, clinical examination was repeated following the same protocol. Logistic regression models were used to investigate the relationship between the presence of radiolucency at baseline and caries progression. RESULTS: This study included 916 permanent molars, classified as sound occlusal surfaces (n = 434), non-cavitated IECL (n = 438), or cavitated IECL (n = 44) at baseline. The proportion of lesions with radiolucency increased as lesion severity increased (p<0.001, chi-square test). The proportion of cases that progressed was significantly higher among teeth showing radiolucency at baseline than among teeth without radiolucency (p<0.001, chi-square test). The presence of radiolucency at baseline was found to be a predictor of caries progression (activity criteria, adjusted OR=3.37, 95%CI=1.66-6.82, p<0.001; severity criteria, adjusted OR=4.01, 95%CI=1.85-8.72, p<0.001). CONCLUSION: Occlusal surfaces (either sound or with IECL) presenting radiolucency at baseline were more likely to progress over 4-5 years of monitoring and should be monitored more closely. CLINICAL RELEVANCE: Bitewing radiographs, when available, may be used to identify which surfaces/lesions are more likely to progress and thus, to define proper recall intervals for patient monitoring.

Personal and familial factors associated with toilet training

ABSTRACT Purpose: Toilet training (TT) is an important marker in a child's physical and psychosocial development. The present study aimed to evaluate aspects associated to delayed TT. Material and Methods: We interviewed 372 parents of children who had completed TT up to 48 months before the interview. The questionnaires were applied at school exits when parents went to pick their children up and at public parks. Questions included demographics, aspects related to TT, dysfunction voiding symptom score and evaluation of constipation. Results: The interviews were performed at a mean of 15.3±10.4 (0 to 47) months after the end of TT. Girls accounted for 53% of the sample. The mean age at finishing TT was 31.6±9.3 months and similar in both genders (p=0.77). TT occurred before school entry in 45.7% of the children and medical advice for TT was sought only by 4.8% of the parents. No association was observed of age at completing TT and presence of lower urinary tract symptoms (LUTS) (p=0.57) and/or constipation (p=0.98). In the univariate analysis, prematurity (OR=2.7 [95% CI 2.3-3.1], p <0.0001) and mothers who work outside their household (OR=1.8 [95% CI 1.4-2.3], p <0.0001) were associated to delayed TT. Conclusion: Children completed TT at a mean of 2 years and 7 months of age. The age of completing TT was not related to LUTS and/or constipation. Premature children and those whose mothers work outside the home finish TT later.

Personal and familial factors associated with toilet training.

PURPOSE: Toilet training (TT) is an important marker in a child's physical and psychosocial development. The present study aimed to evaluate aspects associated to delayed TT. MATERIAL AND METHODS: We interviewed 372 parents of children who had completed TT up to 48 months before the interview. The questionnaires were applied at school exits when parents went to pick their children up and at public parks. Questions included demographics, aspects related to TT, dysfunction voiding symptom score and evaluation of constipation. RESULTS: The interviews were performed at a mean of 15.3±10.4 (0 to 47) months after the end of TT. Girls accounted for 53% of the sample. The mean age at finishing TT was 31.6±9.3 months and similar in both genders (p=0.77). TT occurred before school entry in 45.7% of the children and medical advice for TT was sought only by 4.8% of the parents. No association was observed of age at completing TT and presence of lower urinary tract symptoms (LUTS) (p=0.57) and/or constipation (p=0.98). In the univariate analysis, prematurity (OR=2.7 [95% CI 2.3-3.1], p <0.0001) and mothers who work outside their household (OR=1.8 [95% CI 1.4-2.3], p <0.0001) were associated to delayed TT. CONCLUSION: Children completed TT at a mean of 2 years and 7 months of age. The age of completing TT was not related to LUTS and/or constipation. Premature children and those whose mothers work outside the home finish TT later.

Validação de instrumento de participação da família no cuidado do recém-nascido hospitalizado / Validación de instrumento de participación de la familia en el cuidado del recién nacido hospitalizado / Validation of an instrument for family participation in the care of hospitalized newborns

Resumo Objetivo Construir e validar um instrumento de participação da família nos cuidados do recém-nascido no contexto neonatal. Métodos Pesquisa metodológica. Os procedimentos de construção de instrumentos de avaliação propostos por Pasquali foram adotados para a condução das etapas teórica, empírica e analítica. Participaram do estudo piloto 40 representantes de famílias de recém-nascido hospitalizados, sendo 20 para a fase de validação semântica e 20 para o teste e resteste. Na análise dos dados o instrumento foi validado por meio da análise psicométrica e dos procedimentos estatísticos para verificar a confiabilidade, validade, estimação dos parâmetros dos itens e da medida da participação da família. Resultados Na fase teórica identificou-se a partir de revisão integrativa da literatura os contructos acolhimento, informação, autonomia compartilhada, autoconfiança e relacionamento colaborativo, que compõem o fenomeno participação da família no cuidado do recém-nascido hospitalizado. Dessa maneira construiu-se a versão I do instrumento de medida, contendo 32 itens, com respostas do tipo Likert, que foi submetida a avaliação entre os juízes e após duas rodadas gerou a versão II com percentual de concordância 81% e índice de validação de conteúdo (IVC) de 0,81. Na validação semântica, representantes de vinte famílias demonstraram compreensão dos itens, considerando-os relevantes, com clareza e sem dificuldade para responde-los. Na fase empírica, o instrumento foi aplicado com vinte representantes de famílias em que se obteve Alpha de Cronbach de 0,92. Na fase analítica, os 32 itens avaliados geraram sete fatores, cujas cargas fatoriais permitiram sua manutenção no instrumento final. Conclusão O instrumento demonstrou uma excelente consistência interna, estabilidade ao longo do tempo e itens que demonstraram pertencerem ao fenômeno analisado. Para que este indicador seja utilizado para direcionar as intervenções com família no contexto da unidade neonatal torna-se necessário ampliar a amostra da população-alvo.

Resumen Objetivo Elaborar y validar un instrumento de participación de la familia en los cuidados del recién nacido en el contexto neonatal. Métodos Investigación metodológica. Se adoptaron los procedimientos de elaboración de instrumentos de evaluación propuestos por Pasquali para conducir la etapa teórica, empírica y analítica. Cuarenta representantes de familias del recién nacido hospitalizado participaron en el estudio piloto, de los cuales 20 formaron parte de la fase de validación semántica y 20 del test-retest. En el análisis de los datos, el instrumento se validó por medio del análisis psicométrico y de los procedimientos estadísticos para verificar la confiabilidad, validez, estimación de los parámetros de los ítems y de la medida de participación de la familia. Resultados En la fase teórica, a partir de la revisión integradora de la literatura, se identificaron los constructos acogida, información, autonomía compartida, autoconfianza y relación colaborativa, que componen el fenómeno participación de la familia en el cuidado del recién nacido hospitalizado. De esta manera, se elaboró la versión I del instrumento de medida, que contenía 32 ítems con respuestas tipo Likert, y que fue evaluada por los jueces y, luego de dos rondas, se creó la versión II con un porcentaje de concordancia de 81 % y un índice de validación de contenido (IVC) de 0,81. En la validación semántica, representantes de 20 familias demostraron comprensión de los ítems, fueron considerados relevantes, con claridad y sin dificultad para responderlos. En la fase empírica, se aplicó el instrumento a 20 representantes de familias y se obtuvo un alfa de Cronbach de 0,92. En la fase analítica, los 32 ítems evaluados generaron 7 factores, cuyas cargas factoriales permitieron que se mantengan en el instrumento final. Conclusión El instrumento demostró una excelente consistencia interna, estabilidad a lo largo del tiempo e ítems que pertenecen al fenómeno analizado. Para que este indicador sea utilizado para orientar las intervenciones con la familia en el contexto de la unidad neonatal, es necesario ampliar la muestra de la población destinataria.

Abstract Objective To build and validate an instrument for family participation in newborn care at the neonatal unit. Methods A methodological research. The construction procedures of assessment instruments proposed by Pasquali were adopted to conduct the theoretical, empirical and analytical steps. Forty representatives of hospitalized newborn families participated in the pilot study; 20 for the semantic validation phase; and 20 for the test and rest. In data analysis, the instrument was validated through psychometric analysis and statistical procedures to verify reliability, validity, estimation of items parameters, and family participation measure. Results In the theoretical phase, the reception, information, shared autonomy, self-confidence and collaborative relationships constructs, which make up the phenomenal family participation in the care of hospitalized newborns, were identified from integrative literature review. Therefore, the measurement instrument's first version was built, containing 32 items, with Likert-type responses, which was submitted to assessment by the judges. After two rounds, the second version was generated with an 81% agreement percentage and 0.81 content validation index (CVI). In the semantic validation, representatives of twenty families demonstrated an understanding of the items. They considered them relevant, clear, and had no difficulty in answering them. In the empirical phase, the instrument was applied with twenty representatives of families in which a 0.92 Cronbach's Alpha was obtained. In the analytical phase, the 32 items assessed generated seven factors, whose factor loads allowed their maintenance in the final instrument. Conclusion The instrument proved to have excellent internal consistency, stability over time and items that demonstrated to belong to the analyzed phenomenon. It is necessary to broaden the target population's sample for this indicator to be used to target interventions with the family at the neonatal unit.

Tele-electrocardiography and bigdata: The CODE (Clinical Outcomes in Digital Electrocardiography) study.

Digital electrocardiographs are now widely available and a large number of digital electrocardiograms (ECGs) have been recorded and stored. The present study describes the development and clinical applications of a large database of such digital ECGs, namely the CODE (Clinical Outcomes in Digital Electrocardiology) study. ECGs obtained by the Telehealth Network of Minas Gerais, Brazil, from 2010 to 17, were organized in a structured database. A hierarchical free-text machine learning algorithm recognized specific ECG diagnoses from cardiologist reports. The Glasgow ECG Analysis Program provided Minnesota Codes and automatic diagnostic statements. The presence of a specific ECG abnormality was considered when both automatic and medical diagnosis were concordant; cases of discordance were decided using heuristisc rules and manual review. The ECG database was linked to the national mortality information system using probabilistic linkage methods. From 2,470,424 ECGs, 1,773,689 patients were identified. After excluding the ECGs with technical problems and patients <16 years-old, 1,558,415 patients were studied. High performance measures were obtained using an end-to-end deep neural network trained to detect 6 types of ECG abnormalities, with F1 scores >80% and specificity >99% in an independent test dataset. We also evaluated the risk of mortality associated with the presence of atrial fibrillation (AF), which showed that AF was a strong predictor of cardiovascular mortality and mortality for all causes, with increased risk in women. In conclusion, a large database that comprises all ECGs performed by a large telehealth network can be useful for further developments in the field of digital electrocardiography, clinical cardiology and cardiovascular epidemiology.

Small phospho-donors phosphorylate MorR without inducing protein conformational changes.

Phosphorylation is an essential mechanism of protein control and plays an important role in biology. The two-component system (TCS) is a bacterial regulation mechanism mediated by a response regulator (RR) protein and a kinase protein, which synchronize the regulatory circuit according to the environment. Phosphorylation is a key element in TCS function as it controls RR activity. In the present study, we characterize the behavior of MorR, an RR associated with Mo homeostasis, upon acetylphosphate and phosphoramidate treatment in vitro. Our results show that MorR was phosphorylated by both phospho-donors. Fluorescence experiments showed that MorR tryptophan emission is quenched by phosphoramidate. Furthermore, theoretical and computational results demonstrate that phosphorylation by phosphoramidate is more favorable than that by acetylphosphate. In conclusion, phosphorylated MorR is a monomeric protein and phosphorylation does not appear to induce observable conformational changes in the protein structure.

Hair as a Biomarker of Long Term Mercury Exposure in Brazilian Amazon: A Systematic Review.

Many studies have assessed mercury (Hg) exposure in the Amazonian population. This article performs a literature search of the studies that used hair as a biomarker of Hg exposure in the Brazilian Amazonian population. The search covered the period from 1996 to 2016 and included articles which matched the following criteria: (1) articles related to Hg exposure into Brazilian Amazon; (2) articles that used hair as a biomarker of Hg exposure; (3) articles that used analytical tools to measure the Hg content on hair and (4) articles that presented arithmetic mean and/or minimum and maximum values of Hg. 36 studies were selected. The findings show that most of the studies were performed along margins of important rivers, such as Negro, Tapajós and Madeira. All the population presented mean levels of Hg on hair above 6 µg g-1 and general population, adults, not determined and men presented levels of Hg on hair above 10 µg g-1. The results show that most of the studies were performed by Brazilian institutions/researchers and the majority was performed in the State of Pará. The present study identified that Amazonian population has long-term been exposed to Hg. In terms of future perspectives, this study suggests the implementation of a strategic plan for environmental health surveillance in the region in order to promote health and benefit Amazonian population.

Mercury in fish and sediment of Purus River, Acre State, Amazon / Mercúrio em peixe e em sedimento do Rio Purus, Estado do Acre, Amazônia

Abstract Core subject To quantify the Hg content of sediment and fish collected along the Purus River (Acre State, Amazon) in order to identify if those samples could be a potential route of Hg exposure to the population of Manoel Urbano (a riverside community). Methods The total mercury (THg) was quantified using the Cold Vapor Atomic Absorption technique. Results We collected 06 samples of sediment and 264 samples of fish. The Hg in sediments ranged between 0.038 and 0.065 µg.g–1.The results indicate that sediment is in agreement with “uncontaminated” Amazonian rivers. The carnivorous species presented the highest level of Hg on muscle (mean 0.927 μg/g–1), followed by piscivorous (mean 0.873 μg.g–1), planktophagus (mean 0.566 μg.g–1), omnivorous (mean 0.533 μg.g–1) and detritivorous (mean 0.176 μg/g–1). Fourty four percent (44%) of the total species collected presented mean levels of THg on muscle, a percentage greater than the threshold recommended by WHO. Conclusion Some species may be a route for Hg exposure. The sediment is within the normality. The authors suggest that other factors, such as culture and society, should be considered for future researches in order to promote the population healths.

Resumo Tema central Quantificar o teor de mercúrio (Hg) em sedimentos e em peixes coletados ao longo do rio Purus, no Estado do Acre, Região Amazônica, a fim de identificar se essas amostras conferem uma via potencial de exposição do Hg para a população de Manoel Urbano (uma comunidade ribeirinha). Métodos O mercúrio total (HgT) foi quantificado utilizando a técnica de absorção atômica por vapor frio. Resultados Seis amostras de sedimentos e 264 amostras de peixes foram coletadas. O Hg em sedimentos de fundo variou entre 0,038 e 0,065 μg.g–1 (média de 0,050 μg.g–1). Os resultados indicam que os sedimentos estão de acordo com rios amazônicos “não contaminados”. As espécies carnívoras apresentaram o mais alto nível de Hg no músculo (média de 0,927 μg/g–1), seguido por piscívoros (média de 0,873 μg/g–1), planctófagos (média de 0,566 μg/g–1), onívoros (média de 0,533 μg/g–1) e detritívoros (média de 0,176 μg/g–1). Além disso, 44% do total de espécies coletadas apresentaram níveis médios de HgT no músculo superior ao limite recomendado pela Organização Mundial da Saúde (OMS). Conclusão Algumas espécies podem ser uma via para a exposição ao Hg. O sedimento encontra-se dentro na normalidade. Os autores consideram que outros fatores, como a cultura e a sociedade, devem ser considerados para pesquisas futuras a fim de promover a saúde dessa população.

Influência das condições do habitat sobre a estrutura de herbáceas aquáticas na região do Lago Catalão, Manaus, AM / Influence of the habitat conditions on the structure of aquatic herbaceous in the Catalão Lake region, Manaus, AM

In the Amazon, aquatic herbaceous are found in all types of water, but its abundance can be influenced by the limnological conditions of each environment. This study aimed to evaluate the influence of habitat conditions on the structure of aquatic herbaceous in the Catalão Lake region, Manaus, AM. We evaluated seven transects in white water environments (AB), nine in decanted water (AD), and seven in mixed water (AM). In each transect, aquatic herbaceous were identified, relative coverage and frequency of occurrence were measured, and turbidity, conductivity, pH and depth variables were evaluated. Variation in depth indicated that the environments of AD and AM were deeper than AB, yet lower conductivity and more acidic waters were recorded in AM. We recorded 32 taxa of aquatic herbaceous, being the most frequent Paspalum repens, Salvinia auriculata, Pistia stratiotes and Lemna valdiviana. Among the species recorded, 50% were common to all three environments. On the other hand, some species occurred exclusively in AB, in AD or AM environments. In AB, floating forms were more frequent, and this environment had the highest coverage; in AD and AM environments, emerged forms showed higher frequency and coverage. AM had greater richness of aquatic herbaceous compared to other environments. Variations recorded indicate that limnological conditions of white and black water rivers can determine the structure of aquatic herbaceous community, even at small spatial scales.

Na Amazônia, as herbáceas aquáticas são encontradas em todas as tipologias de água, mas sua abundância pode ser influenciada pelas condições limnológicas de cada ambiente. Assim, este trabalho teve como objetivo avaliar a influência das condições do habitat sobre a estrutura de herbáceas aquáticas na região do Lago Catalão, Manaus, AM. Foram avaliadas sete transecções em ambientes de água branca (AB), nove em água decantada (AD) e sete em água mista (AM). Em cada transecção foram identificadas as herbáceas aquáticas, estimada a área de cobertura relativa, calculada a frequência de ocorrência e avaliadas as variáveis turbidez, condutividade elétrica, pH e profundidade. A variação na profundidade indicou que os ambientes de AD e AM eram mais profundos do que AB, já águas mais ácidas e com menor condutividade foram registradas na AM. Foram registrados 32 táxons de herbáceas aquáticas sendo as espécies mais frequentes Paspalum repens, Salvinia auriculata, Pistia stratiotes e Lemna valdiviana. Entre as espécies levantadas, 50% foram comuns aos três ambientes. Por outro lado, algumas espécies ocorreram exclusivamente em ambientes de AB, em AD e em AM. Na AB foram mais frequentes as formas flutuantes, que também apresentaram a maior cobertura neste ambiente; na AD e na AM as emersas apresentaram maior frequência e cobertura. A AM apresentou maior riqueza de herbáceas aquáticas em relação aos demais ambientes. As variações registradas indicam que as condições limnológicas dos rios de água branca e preta podem determinar a estrutura da comunidade de herbáceas aquáticas, mesmo em pequenas escalas espaciais.

Aerococcus viridans como agente etiológico de endocardite em valva nativa / Aerococcus viridans as etiological agent in native valve endocarditis

Aerococcus viridans é um patógeno humano incomum e endocardite por este agente na literatura é rara. Relata-se o caso de paciente feminina, 56 anos,hospitalizada devido a quadro de picos febris que, após investigação, foi diagnosticada através dos critérios clínicos de Duke, com endocardite em valva nativa. Foi evidenciado através das hemoculturas o crescimento de A. viridans, sendo o primeiro casoreportado no Brasil. Há relatos desse agente também em infecções urinárias, bacteremia, meningite e artrite séptica. No presente caso, a paciente teve melhorresposta clínica após o início da ampicilina, confirmando alguns artigos que orientam o tratamento com penicilinas.

Aerococcus viridans is an uncommon human pathogen and reports of endocarditis caused by this agent arerare in the literature. This clinical case study describes a 56 year-old female patient admitted to hospital forspiking fevers. After investigation, this was diagnosed as native valve endocarditis, based on the Duke clinicalcriteria and confirmed through the growth of A. viridans in blood cultures, making this the first reported case in Brazil. There are also reports of thisagent in urinary tract infections, bacteremia, meningitis and septic arthritis. In this case, the patient had a better clinical response after starting on ampicillin, confirmed by some articles that recommend treatment withpenicillins.

Biomarkers of mercury exposure in the Amazon.

Mercury exposure in the Amazon has been studied since the 1980s decade and the assessment of human mercury exposure in the Amazon is difficult given that the natural occurrence of this metal is high and the concentration of mercury in biological samples of this population exceeds the standardized value of normality established by WHO. Few studies have focused on the discovery of mercury biomarkers in the region's population. In this way, some studies have used genetics as well as immunological and cytogenetic tools in order to find a molecular biomarker for assessing the toxicological effect of mercury in the Amazonian population. Most of those studies focused attention on the relation between mercury exposure and autoimmunity and, because of that, they will be discussed in more detail. Here we introduce the general aspects involved with each biomarker that was studied in the region in order to contextualize the reader and add information about the Amazonian life style and health that may be considered for future studies. We hope that, in the future, the toxicological studies in this field use high technological tools, such as the next generation sequencing and proteomics skills, in order to comprehend basic questions regarding the metabolic route of mercury in populations that are under constant exposure, such as in the Amazon.

[Acute abdomen as initial manifestation of metastatic melanoma]. / Abdome agudo como manifestação inicial de melanoma metastático: relato de caso.

The malignant melanoma is a relatively common neoplasia, with origin generally in the melanocytics cells in the skin, but with presentation of other possible primary lesions, being presented in this, a case witnessed of liver and mesentery metastases with unknown primary sites.

Is it advantageous to add epinephrine to the arthroscopic infusion solution for the treatment of rotator cuff injury? / E vantajosa a adicao de epinefrina na solucao de infusao artroscopica no tratamento da lesao do manguito rotador?

OBJECTIVE: To evaluate the use of epinephrine in arthroscopic infusion serum as a measure to improve the quality of surgical viewing during procedures for treating rotator cuff tears. METHODS: This was a prospective randomized double-blind comparative study in which 49 arthroscopic repair procedures on rotator cuff tears were evaluated. Patients presenting ASA I and II surgical risk were included. The patients were placed into two groups: the first with epinephrine (1 mg/L) in the infusion serum and the second with pure physiological solution. A single surgeon was responsible for the procedures, without knowledge of the medication usage. The surgeon rated his quality of viewing during the operation, on an increasing scale from 0 to 10. Interscalene block or suprascapular nerve block was chosen randomly and used in association with general anesthesia. The anesthetist issued final report relating to possible intercurrences. RESULTS: The group with epinephrine received an average score of 9.29 and the group without epinephrine received an average score of 7.16. The difference was statistically significant (p < 0.05). There was no important clinical alteration relating to use of this drug. CONCLUSION: As well as being safe, addition of epinephrine at a concentration of 1 mg/L to the infusion serum was shown to be effective for improving the visual field during arthroscopy to repair rotator cuff injuries.. .

OBJETIVO:Avaliar o uso da epinefrina no soro de infusão artroscópica como medida para melhorar a qualidade da visualização cirúrgica durante procedimentos de tratamento das rupturas do manguito rotador. MÉTODOS: Este é um estudo prospectivo, randomizado, comparativo e duplo cego, em que foram avaliados 49 procedimentos de reparo artroscópico da lesão do manguito rotador. Foram incluídos pacientes com risco cirúrgico ASA I e II. Os pacientes foram colocados em dois grupos, contendo o primeiro grupo epinefrina (1mg/L) no soro de infusão e o segundo grupo solução fisiológica pura. Um único cirurgião foi responsável pelos procedimentos sem conhecimento sobre o uso da medicação. O cirurgião atribuiu uma nota crescente (0-10) referente à sua visualização durante o ato operatório. O bloqueio interescalênico ou o bloqueio no nervo supraescapular foram associados à anestesia geral, escolhidos de forma aleatória. O anestesista emitiu um relatório final referente às possíveis intercorrências. RESULTADOS : O grupo que recebeu epinefrina obteve nota média de 9,29 e o grupo que não recebeu obteve a nota média de 7,16. A diferença foi estatisticamente significativa (p < 0,05). Não houve alteração clínica importante relacionada ao uso do fármaco. CONCLUSÃO : Além de segura, a adição da epinefrina na concentração de 1mg/L ao soro de infusão se mostrou eficaz quanto à melhoria do campo visual durante a artroscopia para reparo das lesões do manguito rotador. .

Abdome agudo como manifestação inicial de melanoma metastático: relato de caso / Acute abdomen as initial manifestation of metastatic melanoma

The malignant melanoma is a relatively common neoplasia, with origin generally in the melanocytics cells in the skin, but with presentation of other possible primary lesions, being presented in this, a case witnessed of liver and mesentery metastases with unknown primary sites.

Is it advantageous to add epinephrine to the arthroscopic infusion solution for the treatment of rotator cuff injury?

Objective: To evaluate the use of epinephrine in arthroscopic infusion serum as a measure to improve the quality of surgical viewing during procedures for treating rotator cuff tears. Methods: This was a prospective randomized double-blind comparative study in which 49 arthroscopic repair procedures on rotator cuff tears were evaluated. Patients presenting ASA I and II surgical risk were included. The patients were placed into two groups: the first with epinephrine (1 mg/L) in the infusion serum and the second with pure physiological solution. A single surgeon was responsible for the procedures, without knowledge of the medication usage. The surgeon rated his quality of viewing during the operation, on an increasing scale from 0 to 10. Interscalene block or suprascapular nerve block was chosen randomly and used in association with general anesthesia. The anesthetist issued final report relating to possible intercurrences. Results: The group with epinephrine received an average score of 9.29 and the group without epinephrine received an average score of 7.16. The difference was statistically significant (p < 0.05). There was no important clinical alteration relating to use of this drug. Conclusion: As well as being safe, addition of epinephrine at a concentration of 1 mg/L to the infusion serum was shown to be effective for improving the visual field during arthroscopy to repair rotator cuff injuries.