Rare Combination of Chyloperitoneum Secondary to Primary Small-Bowel Volvulus.

Chylous ascites is the exudation from lymphatic content to the peritoneum and is a rare situation that mostly occurs following medical causes like neoplasms or cirrhosis. However, trauma to the lymphatic system due to compression by masses or altered anatomy can be a trigger too. We describe a rare combination of a primary small bowel volvulus in a young healthy adult causing chylous ascites. Obstruction caused by a primary small bowell volvulus can re-arrange the lymphatics anatomy increasing their flow pressure which can lead to rupture and leak. This is an emergent scenario that needs to be addressed quickly because of bowel ischaemia. CT scan is the gold standard to expedite diagnosis and go to surgical treatment. Although it can be an impactful finding, treatment of the cause behind chylous ascites results in complete resolution without any bowel resection.

Written narrative of students with and without difficulty in syntactic awareness / Narrativa escrita de escolares com e sem dificuldade de consciência sintática

INTRODUCTION: Syntactic awareness is a metalinguistic ability defined as the child's ability to reflect on formal processes relating to the organization of words in sentences and to manipulate them. This skill is still little explored in the context of school learning, and its importance in the school learning process of Portuguese-speaking children is poorly describedOBJECTIVE: To compare written narrative between children with and without difficulty in syntactic awarenessMETHODS: The study was conducted on 60 children (mean age 9.4 years; SD: 0.9) enrolled in the 4th and 5th years of elementary school in a municipal school. The subjects were divided into two groups according to their performance in the task of syntactic awareness - G1 (children with medium/high performance in syntactic awareness) and G2 (lower performance). After the assessment of syntactic awareness each child elaborated a written narrative text based on a stimulus figure. This text was analyzed by judges in terms of spelling, grammatical errors, use of grammatical classes, and content. The Student t-test (α = 0.05) was used to compare the groupsRESULTS: G2 children showed altered handwriting; greater occurrence of spelling mistakes, mainly of irregular phonographic relation type; oral support and difficulty with nasal markers; short texts with preference for the use of nouns and verbs, as well as difficulties with text structuring, use of punctuation and vocabulary, while G1 used more verbs and pronouns instead of nounsCONCLUSIONS: Children with adequate syntactic awareness were able to elaborate written narratives with greater competence, demonstrating acquisition of orthographic aspects and development of textual coherence

INTRODUÇÃO: A consciência sintática é uma habilidade metalinguística e é definida como a capacidade da criança em refletir sobre os processos formais relativos à organização das palavras em frases e manipulá-los. Esta é uma habilidade ainda pouco explorada no contexto de aprendizagem escolar, sendo pouco descrito a sua importância no processo de aprendizagem escolar de crianças falantes do portuguêsOBJETIVO: Comparar a narrativa escrita entre crianças com e sem dificuldade em consciência sintáticaMÉTODO: Participaram 60 crianças (idade média 9,4 anos; DP: 0,9) matriculadas no 4º e 5º ano do ensino fundamental de uma escola municipal, divididas em dois grupos, de acordo com seu o desempenho na tarefa de consciência sintática - G1 (crianças com desempenho médio/elevado em consciência sintática) e G2 (desempenho rebaixado). Após a avaliação da habilidade de consciência sintática, cada criança elaborou um texto narrativo escrito baseado em uma figura estímulo que foi analisado nos aspectos grafia, erros ortográficos, uso das classes gramaticais e o conteúdo. Para comparação entre os grupos usou-se o teste T - student (α = 0,05RESULTADOS: As crianças do G2 apresentaram grafia alterada; maior ocorrência de erros ortográficos, sendo estes principalmente do tipo relação fonografêmica irregular; apoio na oralidade e dificuldade com marcadores de nasalização; textos curtos com preferência do uso de substantivos e verbos, além de dificuldades com a estruturação do texto, uso de pontuação e vocabulário, enquanto que o G1 utilizou mais verbos e pronomes no lugar dos substantivosCONCLUSÃO: Crianças que apresentam adequada habilidade de consciência sintática conseguiram elaborar narrativas escritas com maior competência, demonstrando aquisição de aspectos ortográficos e desenvolvimento da coerência textual

Cardiovascular diseases: a therapeutic perspective around the clock.

Biological rhythms are a ubiquitous feature of life. Most bodily functions, including physiological, biochemical, and behavioral processes, are coupled by the circadian rhythm. In the cardiovascular system, circadian fluctuations regulate several functions, namely heart rate, blood pressure, cardiac contractility, and metabolism. In fact, current lifestyles impose external timing constraints that clash with our internal circadian physiology, often increasing the risk of cardiovascular disease (CVD). Still, the mechanisms of dysregulation are not fully understood because this is a growing area of research. In this review, we explore the modulatory role of the circadian rhythms on cardiovascular function and disease as well as the role of chronotherapy in the context of CVD and how such an approach could improve existing therapies and assist in the development of new ones.

Anthelmintic efficacy of trichlorfon and blood parameters of young lambs infected with Haemonchus contortus.

In this study we evaluated the efficacy of trichlorfon against Haemonchus contortus, monitoring its influence on blood parameters and plasma enzymes of lambs with haemonchosis. A lamb group was orally treated with trichlorfon at 100 mg kg-1 while the other group was untreated. Split-plot design analysis was performed with the lamb groups defined as plots while the subplots were the four periods (weeks) of collection. The trichlorfon treatment promoted a significant and effective reduction of fecal egg counts after one week, with efficacies > 99%. After 21 days of treatment, detected blood parameters and serum levels of plasma enzymes were normal. Additionally, serum albumin and urea concentrations increased to normal values, which were not observed in untreated lambs. The treatment with this organophosphate, using a correct oral administration, may represent an effective therapeutic alternative for sheep infected with multi resistant strain of H. contortus.

Variáveis de risco para o desenvolvimento da linguagem associadas à prematuridade / Risk factors for language development associated with prematurity

RESUMO Introdução Estudos relacionam a prematuridade a alterações linguísticas. Objetivo Analisar as diversas variáveis relacionadas à prematuridade, identificando os fatores de risco para alteração no desenvolvimento linguístico. Métodos Foram analisados 98 prontuários de crianças nascidas pré-termo (1 a 6 anos). Coletaram-se dados referentes ao desenvolvimento de linguagem (teste Denver II) e dados referentes a diversas variáveis, tais como idade gestacional, tempo de internação e intercorrências pós-natal. A partir do resultado no teste Denver II, dividiu-se a amostra em dois grupos: G1: 28 crianças com risco para alteração linguística; G2: 70 crianças sem risco para alteração linguística. Para as inferências estatísticas, utilizou-se modelos de regressão logística e teste Fisher (α=0,05). Resultados Foram identificadas como fatores de risco para o desenvolvimento da linguagem as variáveis presença de hemorragia peri-intraventricular (HPIV) ou broncodisplasia pulmonar (DPB), idade materna inferior a 18 anos, peso ao nascimento inferior a 1000g e longo tempo de internação. Também houve associação entre risco para alterações de linguagem com a presença de risco nas áreas motoras e social. Conclusão A prematuridade, por si só, não constitui um fator de risco para o desenvolvimento de linguagem. Nesses casos, é necessário investigar melhor as variáveis envolvidas na prematuridade, delimitando os fatores de risco envolvidos. Neste estudo, a presença de HPIV e peso inferior a 1000 gramas, ao nascer, foram identificados como principais fatores de risco para o desenvolvimento de linguagem, seguidos pelas variáveis DPB, longo tempo de internação e idade materna inferior a 18 anos, no momento da gestação.

ABSTRACT Introduction This study relates prematurity to linguistic impairments. Purpose To analyze several variables related to prematurity, identifying the risk factors for language development disorders. Methods Medical records of 98 preterm-born children (1 to 6 years) were analyzed. Data on language development (DENVER II test) and several variables, such as gestational age, length of hospital stay and postnatal complications were collected. From the Denver II test results, the sample was divided into two groups: G1: 28 children with risk factors for linguistic impairment; G2: 70 children without risk factors for linguistic impairment. Regression models and Fisher test (α=0,05) were used for statistical inferences. Results The presence of peri-intraventricular hemorrhage (PIVH) or bronchopulmonary dysplasia (BPD), maternal age less than 18 years, birth weight less than 1000g and long hospital stay were identified as risk factors for language development. There was also an association between risk for language disorders and the presence of risk in motor and social areas. Conclusion Prematurity itself cannot be assigned as a risk factor for language development. In such cases, the variables associated with prematurity must be further assessed, limiting the involved risk factors. In this study, the presence of PIVH, BPD, maternal age less than 18 years, birth weight less than 1000 grams and long hospital stay were identified as risk factors for language development.

A errância: para além de um sintoma patológico / Wandering: beyond a pathological symptom / L’errance: par ailleurs d’um syntôpme patologique / La errancia: más allá de un síntoma patológico / Die Irrfahrt: jenseits eines pathologisches Symptom

Este artigo discute a questão da errância de forma transestrutural, como uma vicissitude presente nas diferentes estruturas clínicas, e verifica sua positividade: a possibilidade de, a partir do errar, construir--se algo novo. Com base na conexão entre psicanálise e arte, o trabalho recorre à escrita de James Joyce para investigar a errância e analisar o percurso realizado pelo escritor, inicialmente na posição de vagabundo, errante, até com sua arte inventar um lugar para si no mundo.

This paper discusses the issue of wandering in a transtructural form, as a vicissitude that occurs in different clinical structures, and verifies its positivity: the possibility, from erring, to building up something new. Based on the connection between psychoanalysis and art, the paper refers to the writing of James Joyce to investigate the wandering and analyze the path taken by the writer, initially in a vagabond position, wandering, until he invented with his art a place for himself in the world.

Cet article discute la question de l’errance de façon transestructurel, tel qu’une vicissitude présente dans les différentes estructures cliniques, et verifie sa positivité: la possibilité d’à travers de l’erreur, construire à soi même quelque chose nouvelle. À travers la connexion entre la psychanalyse et l’art, le travaille rapport à l’écrite de James Joyce pour enquêter l’errance et analyser le trajet realisé par l’écrivain, d’abord dans le rôle de vagabond, mais même avec son art créer un lieu pour soi-même.

Este artículo discute la cuestión de la errancia de forma transestructural, como una vicisitud presente en las diferentes estructuras clínicas, y verifica su positividad: la posibilidad de, a partir del errar, construirse algo nuevo. Basado en la conexión entre el psicoanálisis y el arte, el trabajo se refiere a la escritura de James Joyce para investigar la errancia y analizar el recurrido del escritor, inicialmente en la posición de vagabundo, errante, para después con su arte inventar un lugar para sí en el mundo.

Dieser Artikel untersucht das Problem des Irrens vom transstrukturalen Typ, als einen in verschiedenen klinischen Strukturen präsenten Wandel, und überprüft seinen positiven Charakter: die Möglichkeit, ausgehend von der Tatsache des Irrens, etwas Neues zu konstruieren. Auf der Grundlage einer Verbindung von Psychoanalyse und Kunst, stützt sich die Arbeit auf das Schreiben von James Joyce, um das Irren zu erforschen und den von diesem Schriftsteller durchlaufenen Weg zu analysieren, zunächst in der Position eines Vagabunden, eines Irrenden, um schließlich mit seiner Kunst einen Platz für sich in der Welt zu erfinden.

Plants of the Cerrado naturally selected by grazing sheep may have potential for inhibiting development of Haemonchus contortus larva.

Plant species naturally selected by sheep grazing in the Cerrado region of Brazil were assessed in vitro for activity against Haemonchus contortus. One year of observations showed the plant families in the region exhibiting greatest richness to be Fabaceae, Rubiaceae, Malpighiaceae, Bignoniaceae, Myrtaceae, and Annonaceae. Nine species commonly selected by grazing sheep showed variation in the selectivity index with respect to the dry and rainy seasons. Coproculture was conducted in five replicates of 11 treatments: ivermectin, distilled water, or dehydrated leaves of nine selected plant species administered at 333.3 mg g(-1) fecal culture. The dried powder of Piptadenia viridiflora and Ximenia americana leaves significantly reduced the number of infective larvae compared to the distilled water control. These species showed efficacy of over 85 % despite low concentrations of proanthocyanidin. High-performance liquid chromatography analyses of extracts of these plants showed major peaks of UV spectra characteristic of flavonoids. Those naturally selected plant species with high antihelminthic efficacy show promise for use in diet as an alternative control of H. contortus in sheep.

Perfil sanguíneo e peso de órgãos internos de bezerros leiteiros criados em diferentes sistemas de aleitamento / Blood profile and weight of internal organs of dairy calves in different nursing systems

Objetivou-se avaliar o perfil sanguíneo e o tamanho absoluto e relativo dos órgãos internos de bezerros em sistema de aleitamento convencional ou fracionado. Foram utilizadas 10 fêmeas, com peso corporal inicial médio de 37,53 kg (±2,36) e 12 machos com peso corporal médio de 81,6 kg (±8,6), ambos da raça Holandesa. O aleitamento convencional constituiu-se de quatro litros de leite fornecidos diariamente durante 54 dias de avaliação e o fracionado, de seis litros do 6º ao 25º dias de idade, quatro litros do 26º ao 45º dias de idade e dois litros do 46º ao 59º dias de idade, além de concentrado, feno de Cynodon sp., água e suplemento mineral fornecidos ad libitum. O delineamento experimental foi inteiramente ao acaso, com cinco repetições para os parâmetros sanguíneos e seis repetições para o desenvolvimento dos órgãos internos. As coletas de sangue foram realizadas nas fêmeas nos dias sete, 21, 28, 42, 49 e 56 de idade. Para a avaliação dos órgãos internos os machos foram abatidos aos dois meses de idade, após jejum de 16 horas. Não foram observadas diferenças para os valores de proteínas totais, albumina, globulina, creatinina, ureia, colesterol e β-hidroxibutirato nas idades avaliadas (p>0,05). Entretanto, para a concentração de glicose houve interação entre os sistemas de aleitamento e os períodos avaliados, podendo ser observado que com 21 dias de idade a concentração foi maior nas bezerras mantidas em sistema fracionado, quando comparadas aos animais do grupo convencional. O sistema de aleitamento não alterou o peso corporal final, peso corporal final vazio e o peso dos órgãos internos, exceto para o coração, demonstrando que o sistema de aleitamento fracionado não altera as avaliações dos órgãos internos...

The objective was to evaluate the blood profile together with the relative and absolute size of the internal organs of calves in conventional or fractionated feeding system. Ten females were used, with an average initial body weight of 37.53 kg (±2.36), and 12 males with a mean body weight of 81.6 kg (±8.6), both Holstein breed. The conventional feeding consisted of four liter milk supplied daily for 54 days of evaluation, and fractioned six liter milk was given from 6 to 25 days of age, four liter from 26 to 45 days of ager, and two liter from 46 to 59 days of age. Cynodon sp. hay, water and mineral supplement was provided ad libitum. The experimental design was completely randomized with five replicates for blood parameters and six replicates for the development of internal organs. Blood collections were performed in females on days seven, 21, 28, 42, 49 and 56 of age. For the evaluation of internal organs males were slaughtered at two months of age, after 16 hours of fasting. No differences occurred in the values of total protein, albumin, globulin, creatinine, urea, cholesterol and β-hydroxybutyrate in ages evaluated (p>0.05). However, for the concentration of glucose no interaction was found between lactation systems and periods evaluated. It can be noted that at 21 days of age the concentration was higher in calves kept in the fractionated system, when compared with animals of the conventional group. The feeding system did not affect the final body weight, the empty body weight or the weight of the internal organs, except for the heart, demonstrating that the fractional feeding system does not alter the assessment of the internal organs...

Clinical features of 121 patients with diffuse unilateral subacute neuroretinitis.

PURPOSE: To describe the determinant clinical signs to diagnose diffuse unilateral subacute neuroretinitis (DUSN) and the main features related to identification of the live worm. DESIGN: Retrospective study performed at the Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil, between 2003 and 2008. METHODS: Patients with early- or late-stage diffuse unilateral subacute neuroretinitis were included. All patients underwent complete ophthalmologic examination and had a minimum of 6 months of follow-up. RESULTS: A total of 121 patients were included. Most patients were younger than 20 years (69.42%). Visual acuity was 20/400 or worse in 86 patients (71.7%). Nine patients (7.43%) presented in the early stage and 112 (92.57%) patients presented in the late stage. Subretinal tracks (91.7%), focal alterations of the retinal pigment epithelium (89.3%), small white spots (80.2%), and optic nerve atrophy (76.9%) were the most frequent clinical features. The subretinal worm was identified in 48 patients (39.66%), and laser treatment to destroy it was performed in all cases. The most common location of the nematode was the posterior pole (21 patients). It was observed that the younger the age, the higher the indices of larvae identification (P=.022). Multifocal yellow-white lesions and vitritis were correlated with identification of the worm (P=.001). Mean logarithm of the minimal angle of resolution visual acuity was 1.466 (20/600) and 1.281 (20/400) before and after laser treatment, respectively (P<.005). CONCLUSIONS: Identification of clinical signs and diagnosis of diffuse unilateral subacute neuroretinitis in its early stage, followed by prompt location and destruction of the worm by photocoagulation, may improve the vision of affected patients.

Amor cortês: um exemplo de sublimação através da arte

Esse trabalho procede uma articulação entre psicanálise e arte, destacando a literatura de Lewis Carroll, para examinar a importância do laço transferencial para a criação. Observamos na relação entre Carroll e Alice algo da dimensão do amor cortês.(AU)

Spectral domain optical coherence tomography in diffuse unilateral subacute neuroretinitis.

Purpose. To describe the SD-OCT findings in patients with diffuse unilateral subacute neuroretinitis (DUSN) and evaluate CRT and RNFL thickness. Methods. Patients with clinical diagnosis of DUSN who were submitted to SD-OCT were included in the study. Complete ophthalmologic examination and SD-OCT were performed. Cirrus scan strategy protocols used were 200 × 200 macular cube, optic nerve head cube, and HD-5 line raster. Results. Eight patients with DUSN were included. Mean RNFL thickness was 80.25 µm and 104.75 µm for affected and normal eyes, respectively. Late stage had mean RNFL thickness of 74.83 µm compared to 96.5 µm in early stage. Mean CMT was 205.5 µm for affected eyes and 255.13 µm for normal fellow eyes. Conclusion. RNFL and CMT were thinner in DUSN eyes compared to normal eyes. Late-stage disease had more pronounced thinning compared to early-stage patients. This thinning in RNFL and CMT may reflect the low visual acuity in patients with DUSN.

Mycetoma caused by Nocardia caviae in the first Brazilian patient.

BACKGROUND: Mycetoma is a chronic subcutaneous mycosis caused by exogenous fungi or actinomycetes. This infection has a progressive course and shows a typical clinical characteristic of tumefaction, draining sinuses, and grains. Infection initiation is related to local trauma and can spread to muscle, underlying bone, and adjacent organs. Nocardia brasiliensis is the most frequent actinomycete isolated, while N. caviae is a rare agent. METHODS: We present a case of mycetoma in a 37-year-old African-American man on the right hand. The infection had been apparent for four years prior to the consultation. When the infection did not respond to antibiotic therapy, the patient was referred to the Dermatology department. Routine laboratory studies were normal. X-ray examination of the hand showed an osteolytic lesion on the hand bones. On skin biopsy culture, on Sabouraud Dextrose Agar at 28 degrees C, a colony was isolated which was further identified as N. caviae by biochemical and hydrolysis testing. RESULTS: The patient was treated with oral trimethoprim/sulfamethoxazole (TMP/SMZ) 160/800 mg twice a day for 10 months. Four months after the beginning of the therapy, the subject exhibited clinical improvement and functional recovery of the hand. Five-year follow-up X-ray examination of the hand showed no osteolytic lesion on the hand bones. CONCLUSION: We report the first mycetoma case caused by N. caviae in our country with an unusual location on the hand. The patient showed clinical improvement with oral TMP/SMZ.

Cárie oculta: a importância de um diagnóstico precoce / Hidden caries: the importance of a precocious diagnosis

O diagnóstico de lesões cariosas através do exame clínico visual tem-se tornado extremamente difícil ou até mesmo impossível, uma vez que mesmo sem defeito aparente no esmalte, uma lesão cariosa pode estar presente em dentina. Atualmente, o termo cárie oculta tem sido usado para descrever lesões de cáries desenvolvidas em dentina sob esmalte superficial aparentemente hígido ou minimamente desmineralizado, podendo ocorrer tanto na superfície oclusal como na proximal dos dentes que, quando abertos, encontram-se com aspecto amolecido e com grande destruição do tecido dentinário. Considerando a freqüência com que este tipo de lesões tem sido observadas na Clínica de Dentística da Faculdade de Odontologia das Faculdades Federais Integradas de Diamantina, MG, torna-se imprescindível destacar a importância das radiografias interproximais aplicadas como rotina em associação a uma criteriosa inspeção visual para a detecção de cáries oclusais, procurando minimizar as dificuldades no diagnóstico de cáries oclusais, uma vez que as mesmas, quando não detectadas precocemente, são capazes de promover extensa destruição dentinária, podendo até mesmo resultar em um envolvimento pulpar

Atuação da fisioterapia na paralisia facial periférica: relato de caso / Action of physiotherapy in peripheral facial paralysis case report

A Paralisia Facial Periférica, resultante da lesão do VII par de nervo craniano, ocorre igualmente em ambos os sexos e independentemente da faixa etária. A instalação desta paralisia costuma ser rápida e unilateral. Possui diagnóstico simples, porém ressalta-se a necessidade de afastar-se todas as outras possibilidades da Paralisia Facial Periférica. Com o objetivo de demonstrar os benefícios da fisioterapia em uma paciente com Paralisia Facial Periférica Idiopática realizou-se este trabalho. Trata-se de uma pesquisa de coletas de dados que contou com a participação da paciente R.M.M . A paciente foi submetida a dez sessões de fisioterapia diárias com duração de aproximadamente 45 minutos, após o terceiro dia de instalação do quadro da paralisia . O tratamento baseou-se em Corrente Diadinâmica e Russa nos três primeiros dias e após exercícios de alongamento de fáscias da musculatura facial e massoterapia. Os parâmetros utilizados para avaliar a evolução foram provas de força para músculos da expressão facial. Resultados satisfatórios com as técnicas utilizadas foram observados no sétimo dia de tratamento. No estudo de caso apresentado ficou comprovado o benefício da fisioterapia na Paralisia Facial Periférica que foi demonstrado através da rápida recuperação da paciente, o que preveniu a instalação de possíveis deformidades. Para concluir gostaríamos de chamar a atenção para a importância da intervenção precoce da fisioterapia

Acidente vascular cerebral em criança portadora de origem anômala da artéria coronária esquerda / Cerebrovascular Accident in Child with Anomalous Origin of the Left Coronary

A two-year-old male child presenting anomalous origin of the left coronary artery diagnosed by Doppler echocardiography and confirmed by angiography developed an ischemic stroke, which is a rare event in this situation. He [correction of She] had good recovery of the neurological deficit and his anomalous artery was successfully reimplanted