Nonsurgical Embryo Recovery as a Feasible Tool for Supporting Embryo Biobanks of Locally Adapted Brazilian Sheep and Goats.

This study assessed the outcomes of nonsurgical embryo recovery (NSER) after superovulation (SOV) in five locally adapted Brazilian breeds of sheep and goats. The objective was to evaluate the feasibility and efficiency of using SOV combined with a less-invasive embryo collection technique for supplying the Brazilian animal gene bank with germplasm from specific genotypes of interest. Morada Nova (n = 20), Santa Inês (n = 20), and Somalis (n = 20) ewes received an intravaginal progesterone (330 mg) device for 9 days, while Canindé (n = 15) and Moxotó (n = 15) goats received an intravaginal medroxyprogesterone acetate (60 mg) device for 6 days. All females received 133 mg of porcine follicle-stimulating hormone (pFSH) administrated in six decreasing doses 12 hours apart, starting 60 hours before device removal, plus 37.5 µg of d-cloprostenol at the fifth and sixth pFSH dose. Donors in estrus were mated with fertile males. The corpora lutea (CL) number was assessed by ultrasonography 1 day before NSER. On day 6.5 or 7 after estrus, NSER was performed following hormonally induced cervical relaxation. A total of 97% of sheep and 90% of goats responded with estrus, and among those, 91% of sheep and 85% of goats presented a CL. In ewes, the numbers of CL were greater (p < 0.05) in the Santa Inês breed, while similar (p > 0.05) CL numbers were found among the goat breeds. All viable embryos were freezable (excellent and good quality) and the number per donor was 7.8 for sheep and 4.9 for goats. All parameters of NSER efficiency, embryo yield, and fertility post-NSER did not differ (p > 0.05) between breeds among each species. The SOV-NSER procedures applied for an embryo biobank supply of locally adapted Brazilian breeds of small ruminants were efficient regarding production of cryopreservable embryos, and preservation of donor fertility. Therefore, SOV followed by NSER is recommended for embryo biobank assembly in sheep and goats.

Potentially harmful materials in the feces of wild ring-tailed coatis (Nasua nasua) and health implications / Materiais potencialmente nocivos encontrados nas fezes de quatis (Nasua nasua) selvagens e implicações para a saúde

In ecological parks, the proximity to tourist activities facilitates the exploration of garbage by coatis, with possible serious consequences for the animals health . We described the contents of wild coatis feces from three ecological parks. After analyzing 62 samples, fragments of plants and animals were identified in all feces. In the feces of two parks, seeds were present between 36.4% and 48.6% of the samples. Arthropod fragments were identified in 100% of the samples from two parks, but only 87.3% in a third park. Scales, bones or bird feathers were present in some samples. Undigested material of industrial origin was detected in 34.3% to 54.5% of the samples, such as fragments of paper, string, plastic, aluminum, latex and glass. Results are in line with other studies on the diet of wild coatis, but the intake of foreign bodies, potentially harmful to health, is described for the first time. Clinical problems resulting from ingesting waste can be dental fractures, mucosal erosions, intestinal perforation, peritonitis, impaction, diarrhea, weight loss, intoxication and infections. Coatis in the three parks are at risk of health, and actions are needed to avoid clinical and potentially fatal problems. Four actions are recommended to avoid ingesting foreign bodies: increasing the environmental education of visitors; improving the storage of waste generated in parks; periodically monitor the health of coatis, in order to make interventions when possible; make a permanent program to study the ecology of species in the three parks.

Em parques ecológicos, a proximidade com atividades turísticas facilita a exploração do lixo por quatis (Nasua nasua), com possíveis consequências graves para saúde dos animais. Descrevemos o conteúdo de fezes de quatis selvagens de três parques ecológicos. Após análise de 62 amostras, fragmentos de plantas e animais foram identificados em todas as fezes. Nas fezes de dois parques, as sementes estiveram presentes entre 36,4% e 48,6% das amostras. Foram identificados fragmentos de artrópodes em 100% das amostras de dois parques, mas apenas 87,3% em um terceiro parque. Escamas, ossos ou penas de pássaros estavam presentes em algumas amostras. Detectou-se material não digerido de origem industrial em 34,3% a 54,5% das amostras, como fragmentos de papel, barbante, plástico, alumínio, látex e vidro. Os resultados estão de acordo com outros estudos sobre a dieta de quatis selvagens, mas a ingestão de corpos estranhos, potencialmente prejudicial à saúde, é descrito pela primeira vez. Os problemas clínicos decorrentes da ingestão de lixo podem ser fraturas dentais, erosões de mucosas, perfuração intestinal, peritonite, impactação, diarreia, emagrecimento, intoxicação e infecções. Os quatis nos três parques estão com a saúde em risco, sendo necessárias ações para evitar problemas clínicos e potencialmente fatais. Quatro ações são recomendadas para evitar a ingestão de corpos estranhos: aumentar a educação ambiental dos visitantes; melhorar o armazenamento dos resíduos gerados nos parques; monitorar periodicamente a saúde dos quatis, de forma a fazer intervenções quando possível; fazer um programa permanente de estudo da ecologia das espécies nos três parques.

A importância da sedimentoscopia em amostras de urina com exame físico-químico negativo

Objetivo: Identificar a existência de elementos clinicamente importantes no sedimento urinário de amostras de urinas com exame físico-químico negativo como os cristais, leveduras e bactérias. Métodos: O presente estudo concebeu uma análise descritiva quali-quantitativa de dados clínicos contidos no sistema do laboratório. Foram analisados dados do período de julho a dezembro de 2019. Resultados: Foram extraídos dados referentes a 48.755 sumários de urina, e foi constatado que 9.160 exames (18,79%) não apresentaram alterações na sedimentoscopia. Conclusão: A técnica é necessária para triar possíveis doenças e por isso é indispensável, pois pode mostrar ao clínico que existem elementos anormais, mesmo em urinas com o exame físico-químico negativo.

Objective: To identify the existence of clinically important elements in the urine sediment of urine samples with negative physical-chemical examination such as crystals, yeasts and bacteria. Methods: The present study designed a qualitative and quantitative descriptive analysis of clinical data contained in the laboratory system. Data from July to December 2019 were analyzed. Results: Data referring to 48,755 urine summaries were extracted, and it was found that 9,160 tests (18.79%) did not show changes in sedimentcopy. Conclusion: However, such a technique is necessary to screen for possible diseases and is therefore essential, as it can show the clinician that there are abnormal elements, even in urines with negative physical-chemical examination.

Latent tuberculosis screening before kidney transplantation in the South of Brazil / Rastreamento de tuberculose latente antes do transplante renal no Sul do Brasil

Abstract Background: Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral. Methods: We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019. Results: There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402). Conclusion: In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.

Resumo Histórico: Tuberculose (TB) é uma infecção relativamente comum pós-transplante renal (TR) em países com alta prevalência da doença. O rastreamento de infecção latente por tuberculose (ILTB) inclui histórico prévio de TB, achados de radiografia do tórax, resultados do teste tuberculínico (TT) e/ou de ensaio de liberação de interferon-gama (IGRAs). Nosso objetivo foi comparar nossa avaliação de rotina de candidatos ao TR e doadores vivos (DV) com seus resultados de IGRA, avaliando se aumentaria o encaminhamento para tratamento com isoniazida (INH). Métodos: Avaliamos candidatos adultos ao TR e DV com rastreamento para ILTB de rotina completo e coleta de testes QuantiFERON-TB® Gold In-Tube (QFT). Coletamos amostras sanguíneas de 4 de Abril, 2014 - 31 de Outubro, 2018, com acompanhamento até 31 de Outubro, 2019. Resultados: Avaliamos 116 receptores de TR, 30% sendo QFT-positivo. QFT positivo foi associado ao histórico prévio de TB (p=0,007), TT positivo (p<0,0001), lesões radiográficas residuais (p=0,003), diabetes (p=0,035). Avaliamos 25 DV, 40% apresentaram QFT positivo. QFT positivo foi associado a TT positivo (p=0,002). Resultados positivos do QFT aumentaram o encaminhamento para INH em 80%. A incidência de TB pós-transplante foi 2,6% em uma mediana de acompanhamento de 2 (1-33) meses. Nenhuma variável foi associada à TB pós-transplante. Pacientes com TB tiveram sobrevida do enxerto em 5 anos inferior, embora não-significativa (66,7% vs. 76,5%) (p = 0,402). Conclusão: Neste estudo, a associação do QFT à nossa avaliação de ILTB de rotina aumentou o encaminhamento para tratamento com INH, mas ainda houve alta incidência de TB pós-transplante, possivelmente relacionada a outras formas de infecção, como nova exposição e transmissão pelos doadores.

Factor analysis of the Resilience Scale for Brazilian caregivers of people with Alzheimer's disease.

INTRODUCTION: Resilience is a dynamic process that acts to modify the effects of an adverse life event. In this study, we aimed to test the construct validity of the Resilience Scale by employing exploratory and confirmatory procedures, and to investigate the relationship between caregiver's resilience and clinical status of people with Alzheimer's disease. METHODS: A sample of 143 dyads of people with Alzheimer's disease and their primary caregivers were included. RESULTS: The total Resilience Scale mean score was 140.3 (standard deviation [SD] = 16.289), ranging from 25 to 175, indicating a high level of resilience. Cronbach's alpha was high (α = 0.77), indicating excellent internal consistency. The mean of corrected item-total correlation coefficients was moderate. The Resilience Scale presented a four-factor solution with a well-defined structure: sense of life and self-sufficiency, perseverance, self-confidence and equanimity, and meaningfulness. CONCLUSION: The findings indicate excellent internal consistency of the Resilience Scale when used to evaluate psychological and emotional difficulties of caregivers, even though the correlations observed between the Resilience Scale and clinical variables were not significant for functionality, mood, awareness, neuropsychiatric symptoms, or burden.

Latent tuberculosis screening before kidney transplantation in the South of Brazil.

BACKGROUND: Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral. METHODS: We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019. RESULTS: There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402). CONCLUSION: In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.

Necrotising fasciitis of the thoracic wall: a rare case with favourable outcome.

Necrotising fasciitis (NF) is a severe infection of the subcutaneous tissue and fascia that can rapidly lead to sepsis and shock with high mortality rates. Its initial signs are often non-specific making it difficult for an early diagnosis to be reached. Nevertheless it is of the utmost importance to begin proper treatment including wide surgical debridement as soon as possible in order to avoid death. We present the case of a patient with NF of the thoracic wall which is a rare location for this disease but often associated with worse prognosis. Even though he progressed to septic shock within less than 24 hours of its presentation, due to early surgical management, aggressive resuscitation and intensive care support, he reached a favourable outcome. After three surgical revisions and 2 weeks in an intensive care unit, the patient was discharged from hospital 35 days after admission.

COVID-19: challenges for dementia care and research.

The COVID-19 pandemic has raised significant concerns about the management and care for people with dementia and their caregivers. In this context, this work will discuss how social isolation or social distancing caused by the pandemic may impact the clinical management of people with dementia, caregivers' health, and dementia research. The pandemic disrupts all forms of social interaction and may increase the behavioral impairment of people with dementia. Regarding pharmacological treatment, telemedicine is an option, but the context of social isolation raises questions about how to manage people with dementia with lack of cognitive stimulation and non-pharmacological treatment. In addition, the impact of the pandemic on caregivers should be considered. There is some evidence that telephone counseling can reduce depressive symptoms of caregivers of people with dementia. In dementia research, social isolation imposes researchers to modify their study protocols in order to continue collecting data by developing remote tools to assess the participants such as electronic informed consent and online questionnaires and tests. Thus, there is an urgent need for the evaluation and refinement of interventions to address several cognitive, behavioral, and clinical aspects of the long-term impact of the pandemic in dementia.

A pandemia causada pelo COVID-19 desencadeia grandes preocupações sobre o manejo e cuidados com as pessoas com demência e seus cuidadores. Neste contexto, discutiremos como o isolamento social causado pela pandemia pode impactar o manejo clínico de pessoas com demência, a saúde do cuidador e a pesquisa sobre demência. A pandemia interrompe todas as formas de interação social e pode causar aumento do comprometimento dos sintomas neuropsiquiátricos nas pessoas com demência. Em relação ao tratamento farmacológico, a telemedicina é uma opção, mas o contexto de isolamento social levanta questões sobre como manejar as pessoas com demência com falta de estimulação cognitiva ou intervenções nãofarmacológicas. Além disso, o impacto da pandemia sobre os cuidadores deve ser considerado. Existem evidências de que o aconselhamento telefônico pode reduzir os sintomas depressivos dos cuidadores. Além disso, o isolamento social impõe que pesquisadores modifiquem seus protocolos de pesquisa com o objetivo de continuar coletando dados, através do desenvolvimento de ferramentas remotas para avaliar os participantes, como o consentimento livre e esclarecido eletrônico e questionários e testes online. Assim, há uma necessidade urgente de avaliação e refinamento das intervenções para abordar aspectos cognitivos, comportamentais e clínicos do impacto de longo prazo da pandemia na demência.

COVID-19: challenges for dementia care and research / Covid-19: desafios para os cuidados e a pesquisa na demência

ABSTRACT. The COVID-19 pandemic has raised significant concerns about the management and care for people with dementia and their caregivers. In this context, this work will discuss how social isolation or social distancing caused by the pandemic may impact the clinical management of people with dementia, caregivers' health, and dementia research. The pandemic disrupts all forms of social interaction and may increase the behavioral impairment of people with dementia. Regarding pharmacological treatment, telemedicine is an option, but the context of social isolation raises questions about how to manage people with dementia with lack of cognitive stimulation and non-pharmacological treatment. In addition, the impact of the pandemic on caregivers should be considered. There is some evidence that telephone counseling can reduce depressive symptoms of caregivers of people with dementia. In dementia research, social isolation imposes researchers to modify their study protocols in order to continue collecting data by developing remote tools to assess the participants such as electronic informed consent and online questionnaires and tests. Thus, there is an urgent need for the evaluation and refinement of interventions to address several cognitive, behavioral, and clinical aspects of the long-term impact of the pandemic in dementia.

RESUMO. A pandemia causada pelo COVID-19 desencadeia grandes preocupações sobre o manejo e cuidados com as pessoas com demência e seus cuidadores. Neste contexto, discutiremos como o isolamento social causado pela pandemia pode impactar o manejo clínico de pessoas com demência, a saúde do cuidador e a pesquisa sobre demência. A pandemia interrompe todas as formas de interação social e pode causar aumento do comprometimento dos sintomas neuropsiquiátricos nas pessoas com demência. Em relação ao tratamento farmacológico, a telemedicina é uma opção, mas o contexto de isolamento social levanta questões sobre como manejar as pessoas com demência com falta de estimulação cognitiva ou intervenções nãofarmacológicas. Além disso, o impacto da pandemia sobre os cuidadores deve ser considerado. Existem evidências de que o aconselhamento telefônico pode reduzir os sintomas depressivos dos cuidadores. Além disso, o isolamento social impõe que pesquisadores modifiquem seus protocolos de pesquisa com o objetivo de continuar coletando dados, através do desenvolvimento de ferramentas remotas para avaliar os participantes, como o consentimento livre e esclarecido eletrônico e questionários e testes online. Assim, há uma necessidade urgente de avaliação e refinamento das intervenções para abordar aspectos cognitivos, comportamentais e clínicos do impacto de longo prazo da pandemia na demência.

Histoplasmosis, An Underdiagnosed Disease Affecting People Living With HIV/AIDS in Brazil: Results of a Multicenter Prospective Cohort Study Using Both Classical Mycology Tests and Histoplasma Urine Antigen Detection.

BACKGROUND: Histoplasmosis is highly endemic in the American continent. This condition is associated with a high mortality, particularly in people living with HIV/AIDS (PLWHA). Diagnosis of histoplasmosis is usually late in South America, as Histoplasma antigen detection is rarely available. Here we determined the prevalence, risk factors, and outcome of histoplasmosis in PLWHA in Brazilian hospitals. METHODS: This was a prospective cohort study (2016-2018) involving 14 tertiary medical centers in Brazil. We included hospitalized PLWHA presenting with fever and additional clinical findings. Patients were investigated at each participant center with classical mycology methods. Also, Histoplasma antigen detection was performed in urine samples (IMMY). Probable/proven histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. RESULTS: From 616 eligible patients, 570 were included. Histoplasmosis was identified in 21.6% (123/570) of patients. Urine antigen testing increased the diagnostic yield in 53.8%, in comparison with standard mycology methods. Variables independently associated with histoplasmosis were CD4+ count <50 cells/mm3, use of an antiretroviral (protective effect), and sample collection in the Northeast region of Brazil. Dyspnea at presentation was independently associated with death. Histoplasmosis was more frequent than tuberculosis in patients with low CD4+ counts. Overall 30-day mortality was 22.1%, decreasing to 14.3% in patients with antigen-based diagnosis. CONCLUSIONS: Histoplasmosis is a very frequent condition affecting PLWHA in Brazil, particularly when CD4+ counts are lower than 50 cells/mm3. Antigen detection may detect earlier disease, with a probable impact on outcomes. Access to this diagnostic tool is needed to improve clinical management of PLWHA in endemic countries.

Histoplasmosis, an underdiagnosed disease affecting people living with HIV/AIDS in Brazil: Results of a multicenter prospective cohort study using both classical mycology tests and histoplasma urine antigen detection

BACKGROUND: Histoplasmosis is highly endemic in the American continent. This condition is associated with a high mortality, particularly in people living with HIV/AIDS (PLWHA). Diagnosis of histoplasmosis is usually late in South America, as Histoplasma antigen detection is rarely available. Here we determined the prevalence, risk factors, and outcome of histoplasmosis in PLWHA in Brazilian hospitals. METHODS: This was a prospective cohort study (2016­2018) involving 14 tertiary medical centers in Brazil. We included hospitalized PLWHA presenting with fever and additional clinical findings. Patients were investigated at each participant center with classical mycology methods. Also, Histoplasma antigen detection was performed in urine samples (IMMY). Probable/proven histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. RESULTS: From 616 eligible patients, 570 were included. Histoplasmosis was identified in 21.6% (123/570) of patients. Urine antigen testing increased the diagnostic yield in 53.8%, in comparison with standard mycology methods. Variables independently associated with histoplasmosis were CD4+ count <50 cells/mm3, use of an antiretroviral (protective effect), and sample collection in the Northeast region of Brazil. Dyspnea at presentation was independently associated with death. Histoplasmosis was more frequent than tuberculosis in patients with low CD4+ counts. Overall 30-day mortality was 22.1%, decreasing to 14.3% in patients with antigen-based diagnosis. CONCLUSIONS: Histoplasmosis is a very frequent condition affecting PLWHA in Brazil, particularly when CD4+ counts are lower than 50 cells/mm3. Antigen detection may detect earlier disease, with a probable impact on outcomes. Access to this diagnostic tool is needed to improve clinical management of PLWHA in endemic countries

Coping strategies among caregivers of people with Alzheimer disease: a systematic review.

INTRODUCTION: Caregivers of people with Alzheimer disease (PwAD) report significant stress, burden and depression compared to caregivers of people with other dementias, especially when neuropsychiatric symptoms are prominent. Adequate coping strategies can modify the impact of stressful situations and increase the caregivers' quality of life. OBJECTIVE: To systematically review the different coping strategies used by caregivers of PwAD to manage neuropsychiatric symptoms. METHOD: We carried out electronic searches using MEDLINE (PubMed), SciELO, Web of Knowledge Cross Search (Thomson Scientific/ISI Web Services) and PsycINFO databases to select studies on coping in PwAD caregivers published from January 2005 to July 2017. The search terms were coping, caregivers, strategy, onset, adaptation, family, behavior, dementia and Alzheimer. The studies were organized in three categories: problem-focused, emotion-focused and dysfunctional coping strategies. RESULTS: We found 2,277 articles. After application of exclusion criteria and exclusion of redundant references, 24 articles were analyzed. Emotion-focused coping was the most commonly used strategy among PwAD caregivers. The use of this strategy associated with religion and spirituality may help reduce symptoms of depression and anxiety. Problem-focused coping strategies were mostly used with active coping interventions. Problem-solving coping may have buffered the impact of acute psychological stressors on procoagulant activity. Dysfunctional coping strategies were associated with increase of caregiver burden. CONCLUSION: The evaluated studies showed that the use and development of coping strategies may have ameliorated the depressive symptoms, anxiety and burden of caregivers. However, longitudinal studies are still needed that clearly describe the type of coping strategy used in relation to the presented results.

Coping strategies among caregivers of people with Alzheimer disease: a systematic review / Estratégias de coping entre cuidadores de pessoas com doença de Alzheimer: uma revisão sistemática

Abstract Introduction Caregivers of people with Alzheimer disease (PwAD) report significant stress, burden and depression compared to caregivers of people with other dementias, especially when neuropsychiatric symptoms are prominent. Adequate coping strategies can modify the impact of stressful situations and increase the caregivers' quality of life. Objective To systematically review the different coping strategies used by caregivers of PwAD to manage neuropsychiatric symptoms. Method We carried out electronic searches using MEDLINE (PubMed), SciELO, Web of Knowledge Cross Search (Thomson Scientific/ISI Web Services) and PsycINFO databases to select studies on coping in PwAD caregivers published from January 2005 to July 2017. The search terms were coping, caregivers, strategy, onset, adaptation, family, behavior, dementia and Alzheimer. The studies were organized in three categories: problem-focused, emotion-focused and dysfunctional coping strategies. Results We found 2,277 articles. After application of exclusion criteria and exclusion of redundant references, 24 articles were analyzed. Emotion-focused coping was the most commonly used strategy among PwAD caregivers. The use of this strategy associated with religion and spirituality may help reduce symptoms of depression and anxiety. Problem-focused coping strategies were mostly used with active coping interventions. Problem-solving coping may have buffered the impact of acute psychological stressors on procoagulant activity. Dysfunctional coping strategies were associated with increase of caregiver burden. Conclusion The evaluated studies showed that the use and development of coping strategies may have ameliorated the depressive symptoms, anxiety and burden of caregivers. However, longitudinal studies are still needed that clearly describe the type of coping strategy used in relation to the presented results.

Resumo Introdução Cuidadores de pessoas com doença de Alzheimer relatam mais estresse, sobrecarga e depressão em comparação com cuidadores de pessoas com outras patologias, especialmente quando os sintomas neuropsiquiátricos são proeminentes. Estratégias adequadas de enfrentamento podem modificar o impacto de situações estressantes e aumentar a qualidade de vida do cuidador. Objetivo Revisar sistematicamente as diferentes estratégias de enfrentamento utilizadas pelos cuidadores para lidar com sintomas neuropsiquiátricos. Método Foi realizada busca eletrônica em artigos publicados entre janeiro de 2005 e julho de 2017 nos bancos de dados MEDLINE (PubMed), SciELO, Web of Knowledge Cross Search (Thomson Scientific/ISI Web Services) e PsycINFO. Os termos utilizados foram coping, caregivers, strategy, onset, adaptation, family, behavior, dementia and Alzheimer. Os artigos avaliados foram categorizados em estratégias de enfrentamento focadas na resolução do problema, na emoção e estratégias disfuncionais. Resultados Foram encontrados 2.277 artigos. Após aplicação dos critérios de exclusão, foram incluídos 24 artigos. A estratégia de enfrentamento mais utilizada foi a focada na emoção. O uso desta estratégia associada a religião e espiritualidade pode reduzir sintomas de depressão e ansiedade dos cuidadores. As estratégias de enfrentamento focadas na resolução do problema utilizaram principalmente intervenções baseadas no enfrentamento ativo. A resolução de problemas reduz o impacto dos estressores psicológicos agudos sobre a atividade procoagulante. As estratégias disfuncionais estavam associadas ao aumento da sobrecarga dos cuidadores. Conclusão Os estudos mostraram que o desenvolvimento e uso de estratégias de enfrentamento pode aliviar sintomas depressivos, ansiosos e sobrecarga do cuidador. No entanto, ainda são necessários estudos longitudinais que descrevam claramente o tipo de estratégia de enfrentamento utilizada em relação aos desfechos das pesquisas.

Endoscopic Management of Colonic Perforation due to Ventriculoperitoneal Shunt: Case Report and Literature Review.

The authors report the case of a 41-year-old woman with a colonic perforation due to a ventriculoperitoneal shunt (VPS) catheter. Left-sided colonic perforation was diagnosed by abdominal computed tomography 28 years after shunt placement, following acute meningitis caused by Escherichia coli. The proximal end of the VPS was exteriorized and it was decided to remove the distal end by colonoscopy. After pulling out the catheter with a polypectomy snare, it broke at the site where it was entering the colon, leaving a small perforation in the colonic wall which was closed with 2 endoclips. The endoluminal fragment of the catheter, being 20 cm in length, was removed through the rectum. The patient is asymptomatic at the 12-month follow-up. A review of the literature regarding 9 endoscopically managed cases of digestive tract perforation caused by VPS is presented.

Os autores descrevem o caso de uma mulher de 42 anos com perfuração do cólon por cateter de derivação ventrículo-peritoneal (DVP) colocado 28 anos antes. No contexto de meningite aguda a Escherichia coli, o estudo complementar com tomografia computadorizada abdominal identificou a extremidade distal do cateter de DVP no interior do lúmen do cólon esquerdo. Após remoção da extremidade ventricular do cateter, optou-se pela tentativa de extração da extremidade intra-cólica por colonoscopia. Durante a extração do cateter com ansa de polipectomia, constatou-se secção do mesmo no local de entrada na parede cólica, observando-se um pequeno orifício. Procedeu-se ao encerramento da perfuração com 2 endoclips e extração do fragmento livre endoluminal do cateter, com cerca de 20 cm, pelo reto. A doente permanece assintomática após 12 meses de seguimento. Uma revisão da literatura identificou 9 casos de perfuração do tubo digestivo por cateter de DVP tratados com endoscopia.

Impact of pre-analytical variables in the determination of serum galactomannan.

Invasive aspergillosis (IA) is associated with a high morbidity and mortality. Since Aspergillus species are usually not cultured in these patients, presumptive diagnosis of IA is more commonly based on galactomannan (GM) detection. Several factors are known to cause false-positive results in the GM test, but little is known on the influence of pre-analytical variables interfering on the test. Here we studied the influence of temperature and sample storage duration in GM results, using samples known to be negative and positive (spiked) for GM. We also evaluated the effect of hemolysis and hyperbilirubinemia on GM optical indexes. We found no influence of storage time (up to 96 h) and temperatures (refrigerated vs. RT) on GM results. However, bilirubin (P = .022) and haemoglobin (P = .003) content influenced GM readings in samples known for being GM positive and negative at baseline, respectively. We conclude that the Platelia GM test does not suffer major influence of pre-analytical variables such as storage conditions, and low levels of hemolysis and hyperbilirubinemia. Nonetheless, massive haemolysis seems to interfere with GM readings in GM-negative samples, and high levels of bilirubin can affect GM readings in samples that are positive for GM at baseline. These findings may facilitate logistics and the implementation of standard operational procedures in clinical laboratories.

Klebsiella pneumoniae ESBL forming spheroplasts in the fresh and unstained urine sediment. / Klebsiella pneumoniae ESBL formando esferoplastos em sedimento urinário a fresco sem coloração.

A 60 year-old man was submitted to kidney transplantation in 2013 due to chronic renal insufficiency caused by hypertension. He had recurrent episodes of urinary tract infection and came to the hospital due to a 4 day-long fever, abdominal pain, burning urination and nausea. Routine urinalysis revealed a picture of infection (> 50 leucocytes/high power field associated to massive bacteriuria). The urine sediment revealed elongated like elements with an enlarged part in the middle of the structure body.

Klebsiella pneumoniae ESBL formando esferoplastos em sedimento urinário a fresco sem coloração / Klebsiella pneumoniae ESBL forming spheroplasts in the fresh and unstained urine sediment

Resumo Um homem de 60 anos de idade foi submetido a transplante renal em 2013 devido à insuficiência renal crônica causada por hipertensão. Ele teve episódios recorrentes de infecção do trato urinário e veio para o hospital devido a 4 dias de febre, dor abdominal, ardência para urinar e náusea. Análise do sedimento urinário revelou um quadro de infecção (> 50 leucócitos/campo de grande aumento associado à bacteriúria maciça). O sedimento urinário revelou elementos alongados com um alargamento na parte central do corpo da estrutura.

Abstract A 60 year-old man was submitted to kidney transplantation in 2013 due to chronic renal insufficiency caused by hypertension. He had recurrent episodes of urinary tract infection and came to the hospital due to a 4 day-long fever, abdominal pain, burning urination and nausea. Routine urinalysis revealed a picture of infection (> 50 leucocytes/high power field associated to massive bacteriuria). The urine sediment revealed elongated like elements with an enlarged part in the middle of the structure body.