Reinternações não planejadas após cirurgias em um hospital do norte do Brasil: coorte prospectiva / Reingresos no planificados después de la cirugía en un hospital del norte de Brasil: cohorte prospectiva / Unplanned readmissions after surgery in a hospital in northern Brazil: prospective cohort

Objetivo:analisar as reinternaçõesnão planejadas após procedimentos cirúrgicos e seus fatores de risco em um hospital de grande porte no Norte do Brasil. Método:coorte prospectiva, com dados coletados de prontuários e à cabeceira do leito. Foram realizadas análises descritivas, análise bivariada e múltipla por meio da regressão de Poisson no Stata® v.16.0. Resultados:do total de 486 pacientes, 1,47% reinternaram. A incidência de reinternação foi 68 a cada 1.000 procedimentos (IC95%: 47,10; 93,85). Na análise ajustada apresentaram-se comofatores de risco não ser branco (RR: 2,06; IC95% 1,13; 3,75), usar implante na cirurgia (RR: 2,00; IC95%: 1,05; 3,81) e procedimentos das especialidades urologia/renal (RR: 3,17; IC95%:1,59-6,31) e ginecologia (RR: 2,18; IC95%:1,06-4,49). Conclusão:a incidência de reinternação nesta região é maior do que outras regiões. Características demográficas e tipo de procedimento cirúrgico foram fatores de risco para o desfecho

Objective:to analyze unplanned readmissions after surgical procedures and their risk factors in a large hospital in Northern Brazil. Method:prospective cohort, with data collected from medical records and at the bedside. Descriptive, bivariate and multiple analysis were performed using Poisson regression in Stata® v.16.0. Results: of the total of 486 patients, 1.47% were readmitted. The incidence of readmissions was 68 per 1,000 procedures (95%CI: 47.10; 93.85). In the adjusted analysis, the risk factors were not being white (RR: 2.06; 95%CI 1.13; 3.75), using implants in surgery (RR: 2.00; 95%CI: 1.05; 3.81) and procedures of the urology/renal specialties (RR: 3.17; 95%CI: 1.59-6.31) and gynecology (RR: 2.18; 95%CI: 1.06-4.49). Conclusion:the incidence of readmissions in this region is higher than in other regions. Demographic characteristics and type of surgical procedure were risk factors for the outcome

Objetivo:analizar los reingresos no planificados después de procedimientos quirúrgicos y sus factores de riesgo en un gran hospital del norte de Brasil. Método:cohorte prospectiva, con datos recolectados de historias clínicas y al lado de la cama. Se realizaron análisis descriptivos, bivariados y múltiples mediante regresión de Poisson en Stata® v.16.0. Resultados:del total de 486 pacientes, el 1,47% reingresó. La incidencia de reingresos fue de 68 por 1.000 procedimientos (IC del 95%: 47,10; 93,85). En el análisis ajustado, los factores de riesgo fueron no ser blanco (RR: 2,06; IC 95% 1,13; 3,75), uso de implantes en cirugía (RR: 2,00; IC 95%: 1,05; 3,81) y procedimientos de la urología/especialidades renales (RR: 3,17; IC 95%: 1,59-6,31) y ginecología (RR: 2,18; IC 95%: 1,06-4,49). Conclusión: la incidencia de reingresos en esta región es mayor que en otras regiones. Las características demográficas y el tipo de procedimiento quirúrgico fueron factores de riesgo para el resultado

HLA DQ2/DQ8 haplotypes and anti-transglutaminase antibodies as celiac disease markers in a pediatric population with type 1 diabetes mellitus.

Objective: Evaluate the celiac disease (CD) markers, within the scope of its screening, in a pediatric population with diagnosis of type 1 diabetes (T1D) at Hospital de Braga (HB) and determine the prevalence of CD in the sample. Reflect on CD screening algorithm applied in this pediatric population. Methods: Retrospective observational study with 94 patients diagnosed with T1D at age 10 years or younger, followed up at the HB Outpatient Diabetology Consultation, including those referred from other hospitals. Record of clinical information, IgA anti-transglutaminase and anti-endomysium and HLA DQ2/DQ8 haplotypes. Results: We obtained positive serological test for CD in 4 patients. This test had 100% sensitivity and specificity. The prevalence of CD was 4.3% (n = 4). Positive HLA screening in 84.6% of patients, with both sensitivity and negative predictive value of 100% and specificity of 16.67%. Diagnosis of CD was made on average 3.40 ± 3.32 years after the diagnosis of TD1. All cases of CD registered non-gastrointestinal manifestations, none had gastrointestinal symptoms. Conclusion: This study proved that there is a higher prevalence of CD in pediatric population with TD1, when compared to general population, and clarified the importance of CD screening. Furthermore, it was observed that serological screening for CD antibodies is an excellent screening test and HLA typing, although not the most suitable first line test, can be useful in excluding the possibility of patients with T1D developing CD.

HLA DQ2/DQ8 haplotypes and anti-transglutaminase antibodies as celiac disease markers in a pediatric population with type 1 diabetes mellitus

ABSTRACT Objectives: Evaluate the celiac disease (CD) markers, within the scope of its screening, in a pediatric population with diagnosis of type 1 diabetes (T1D) at Hospital de Braga (HB) and determine the prevalence of CD in the sample. Reflect on CD screening algorithm applied in this pediatric population. Subjects and methods: Retrospective observational study with 94 patients diagnosed with T1D at age 10 years or younger, followed up at the HB Outpatient Diabetology Consultation, including those referred from other hospitals. Record of clinical information, IgA anti-transglutaminase and anti-endomysium and HLA DQ2/DQ8 haplotypes. Results: We obtained positive serological test for CD in 4 patients. This test had 100% sensitivity and specificity. The prevalence of CD was 4.3% (n = 4). Positive HLA screening in 84.6% of patients, with both sensitivity and negative predictive value of 100% and specificity of 16.67%. Diagnosis of CD was made on average 3.40 ± 3.32 years after the diagnosis of TD1. All cases of CD registered non-gastrointestinal manifestations, none had gastrointestinal symptoms. Conclusion: This study proved that there is a higher prevalence of CD in pediatric population with TD1, when compared to general population, and clarified the importance of CD screening. Furthermore, it was observed that serological screening for CD antibodies is an excellent screening test and HLA typing, although not the most suitable first line test, can be useful in excluding the possibility of patients with T1D developing CD.

A Pediatric Case of Cowden Syndrome with Graves' Disease.

Cowden syndrome (CS) is a rare dominantly inherited multisystem disorder, characterized by an extraordinary malignant potential. In 80% of cases, the human tumor suppressor gene phosphatase and tensin homolog (PTEN) is mutated. We present a case of a 17-year-old boy with genetically confirmed CS and Graves' disease (GD). At the age of 15, he presented with intention tremor, palpitations, and marked anxiety. On examination, he had macrocephaly, coarse facies, slight prognathism, facial trichilemmomas, abdominal keratoses, leg hemangioma, and a diffusely enlarged thyroid gland. He started antithyroid drug (ATD) therapy with methimazole and, after a 2-year treatment period without achieving a remission status, a total thyroidectomy was performed. Diagnosis and management of CS should be multidisciplinary. Thyroid disease is frequent, but its management has yet to be fully defined. The authors present a case report of a pediatric patient with CS and GD and discuss treatment options.

Systemic polyarteritis nodosa associated with acute Epstein-Barr virus infection.

Polyarteritis nodosa (PAN) is a rare cause of systemic vasculitis in children, affecting medium and small-sized arteries. We report on a patient who presented with prolonged fever, shock, acute renal failure with nephrotic range proteinuria, hypertension, and sudden deterioration of consciousness. Cranial tomography revealed a left extensive hemorrhagic lesion. Renal biopsy revealed a large fibrinoid necrosis lesion consistent with PAN. Epstein-Barr virus (EBV) infection was confirmed by real-time polymerase chain reaction (RT-PCR) detection of EBV DNA. The patient was successfully treated with oral prednisolone and intravenous pulse of cyclophosphamide. To our knowledge, this is the first reported case of c-PAN related to active EBV infection.

Artificial insemination of cows with semen in vitro contaminated with Neospora caninum tachyzoites failed to induce neosporosis.

Neosporosis is a major cause of abortion in cattle all over the world. Congenital transmission as well as horizontal transmission by ingestion of oocysts has been described. The detection of Neospora caninum DNA in bull semen warrants the investigation of possible transmission through the use of contaminated semen. In this experiment four cows were artificially inseminated with frozen-thawed semen contaminated in vitro with viable N. caninum tachyzoites (group A) and four control cows were inseminated with tachyzoites-free frozen-thawed semen, from the same bull (group B). Serum samples were collected 15 days before the artificial insemination (AI) and at days 10, 14, 21, 28, 45, 60 and 75 post-insemination. All sera samples were tested for neosporosis by direct agglutination test (DAT). Three of the cows from group A had negative DAT titers (< or =1:20) in all of the samples, while the fourth cow from this group had a low titer of antibodies (1:80) at day 10, and became negative at day 45, suggesting a stimulation of the immune system by the tachyzoites placed in uterus, rather than the induction of an infection. All of the cows from group B had negative DAT titers (< or =1:20) in all of the samples. These results suggest that transmission of neosporosis by artificial insemination with frozen-thawed semen is an unlikely event.

Characterization of the B-cell immune response elicited in BALB/c mice challenged with Neospora caninum tachyzoites.

Activation of B cells occurring in hosts infected with protozoan parasites has been implicated either in protective or parasite-evasion immune-mediated mechanisms. Intraperitoneal inoculation of Neospora caninum tachyzoites into BALB/c mice induces an acute response characterized by a rapid increase in the numbers of CD69-expressing peritoneal and splenic B cells. This early B-cell stimulatory effect preceded an increase in the numbers of total and immunoglobulin-secreting splenic B cells and a rise in serum levels of N. caninum-specific immunoglobulins, predominantly of the immunoglobulin G2a (IgG2a) and IgM isotypes. Increased numbers of B cells expressing the costimulatory molecules CD80 and CD86 were also observed in the N. caninum-infected mice. The B-cell stimulatory effect observed in mice challenged with N. caninum tachyzoites was reduced in mice challenged with gamma-irradiated parasites. Contrasting with the peripheral B-cell expansion, a depletion of B-lineage cells was observed in the bone-marrow of the N. caninum-infected mice. Intradermal immunization of BALB/c mice with diverse N. caninum antigenic preparations although inducing the production of parasite-specific antibodies nevertheless impaired interferon-gamma (IFN-gamma) mRNA expression and caused lethal susceptibility to infection in mice inoculated with a non-lethal parasitic inoculum. This increased susceptibility to N. caninum was not observed in naïve mice passively transferred with anti-N. caninum antibodies. Taken together, these results show that N. caninum induces in BALB/c mice a parasite-specific, non-polyclonal, B-cell response, reinforce previous observations made by others showing that immunization with N. caninum whole structural antigens increases susceptibility to murine neosporosis and further stress the role of IFN-gamma in the host protective immune mechanisms against this parasite.

Prevalence of Neospora caninum infection in dairy cows and its consequences for reproductive management.

This study was carried out to determine the prevalence of neosporosis in an area of intensive dairy production, in Portugal. Sera samples were obtained in a random basis from 114 cows in 49 herds (group A), and from 1237 cows in 36 herds with a history of abortion outbreaks (group B). All sera samples were tested for neosporosis by direct agglutination test (DAT). Additionally, attempts to isolate Neospora caninum in 42 aborted bovine fetuses from 38 dairy herds (group C) were carried out, utilizing a bioassay with immuno-depressed Swiss Webster mice. Parasitological confirmation was done by indirect fluorescent antibody test (IFAT). The prevalence of neosporosis in the group A was 28%. Group B had a significantly (P < 0.001) higher prevalence (46%) and Neospora caninum was isolated in 36% of the aborted fetuses (group C). These results indicate that neosporosis, a disease only recently (2001) diagnosed in Portugal, has a high prevalence in the country, particularly in populations with a story of abortion. Thus, neosporosis should systematically be considered in the differential diagnosis of abortion. In the context of embryo transfers, the importance of selecting Neospora-free embryo recipients is discussed, as well as the pertinence of assessing the Neospora status of traded and imported cattle.

First Portuguese isolate of Neospora caninum from an aborted fetus from a dairy herd with endemic neosporosis.

Neospora caninum was isolated from the brain of an aborted 4-month-old fetus from a dairy cow herd with endemic neosporosis in Porto, Portugal. The fetal brain homogenate was inoculated interperitoneally first into outbred Swiss Webster mice given dexamethasone and then the peritoneal exudates from these mice was co-inoculated with mouse sarcoma cells in the peritoneal cavity of mice given dexamethasone. N. caninum tachyzoites were seen in peritoneal exudate of the second passage. Tachyzoites from the peritoneal exudate reacted positively with anti-N. caninum antibodies and not with anti-Toxoplasma gondii antibodies and contained N. caninum specific DNA. This Portuguese isolate of N. caninum has been successfully maintained in cell culture. The dam of the aborted fetus had an antibody titer of 1:10240 in the Neospora agglutination test (NAT). Antibodies to N. caninum were found in 76 of 106 cows from this herd in titers of 1:40 in 31, 1:80 in 22, > or =1:160 or more in 23 in the Neospora agglutination test. This is the first isolation of a viable N. caninum-like parasite from any host in Portugal.

Isolation of viable Toxoplasma gondii from naturally infected aborted bovine fetuses.

Neospora caninum and Toxoplasma gondii are related parasites. The former is a common cause of abortion in dairy cattle. The latter has not been conclusively demonstrated in bovine fetuses. During the course of attempts to isolate N. caninum from aborted fetuses, T. gondii was isolated from 2 aborted fetuses, 1 from Portugal and 1 from the United States. Both isolates were made by bioassay of fetal brains in mice. The fetus from Portugal was about 5 mo in gestational age, and the fetus from the United States was a full-term stillborn.

Phylogenetic relationships among brazilian howler monkeys, genus Alouatta (Platyrrhini, Atelidae), based on gamaû-globin pseudogene sequences

Os guaribas, do gênero Alouatta, que säo os primatas do Novo Mundo com maior distribuiçäo geográfica, têm sido colocados em três grupos de espécies: o grupo Alouatta palliata da América Central, e os grupos sulamericanos Alouatta seniculus e Alouatta caraya. Este último é monotípico, mas o grupo A. seniculus inclui pelo menos três espécies (A. seniculus, A. belzebul e A. fusca). Neste estudo, foram seqüenciados aproximadamente 600 pares de base do pseudogene globina gamaû nas quatro espécies brasileiras (A. seniculus, A. belzebul, A. fusca e A. caraya). Os métodos de máxima parcimônia e máxima verossimilhança produziram árvores filogenéticas com o mesmo arranjo: {A. caraya [A. seniculus (A. fusca, A. belzebul)]}. A árvore mais parcimoniosa apresentou valores de bootstrap maiores de 82 por cento para todos os agrupamentos, e valores de força de ligaçäo de pelo menos 2, apoiando o agrupamento irmäo de A. fusca e A. belzebul. O estudo também confirmou a presença em A. fusca do elemento de inserçäo Alu, com 150 pares de base, e uma deleçäo de 1,8 kb no pseudogene globina gamaû ja conhecidos nas demais espécies de guaribas. A classificaçäao cladística baseada em dados moleculares é congruente com as de estudos morfológicos, com um isolamento claro do grupo monoespecífico A. caraya em relaçäo ao grupo A. seniculus.