Cystoid Macular Edema: A Rare Adverse Reaction to Rituximab.

Membranous glomerulonephritis is the leading cause of nephrotic syndrome in non-diabetic Caucasian adults. For patients at risk of progressing to end-stage renal disease, immunosuppression, particularly rituximab, is the recommended treatment. While extremely rare, cases of cystoid macular edema associated with rituximab have been documented in the literature. In this report, we present the case of a 54-year-old male with membranous glomerulonephritis at a high risk of progressing to end-stage renal disease who experienced cystoid macular edema hours after receiving rituximab infusion. Following the discontinuation of the medication, the patient spontaneously recovered visual acuity without the need for any targeted therapy.

Functional limitation in the older Brazilian adults: Association with multimorbidity and socioeconomic conditions.

The aim of this study was to assess the association between multimorbidity and the presence of functional limitation in basic (BADL) and instrumental activities of daily living (IADL) among Brazilian older adults and to verify whether this association is moderated by socioeconomic conditions. Cross-sectional study with data from the Brazilian National Health Survey (PNS) (2019) for the Brazilian population aged 60 years and over. The dependent variables were functional limitation, based on self-reported difficulty in performing one or more activities of daily living, including six BADL (feeding, bathing, using the toilet, dressing, crossing a room on the same floor and getting out of bed) and four IADL (shopping, managing money, taking medication and using transportation). The independent variables were multimorbidity (presence of two or more self-reported chronic diseases) and socioeconomic measures (per capita household income, asset score, and education level). The association between multimorbidity and outcomes was assessed using adjusted logistic regression models. The moderating effect of socioeconomic conditions on the association between multimorbidity and functional limitations was assessed by including an interaction term. The final sample consisted of 22,725 individuals. The prevalence of functional limitation was 8.5% (95%CI: 7.9-9.2) and 18.6% (95%CI: 17.8-19.5) in BADL and IADL, respectively. Multimorbidity was associated with BADL [OR: 2.30 (95%CI: 1.93-2.74)] and IADL [OR: 2.26 (95%CI: 1.98-2.57)]. The odds of functional limitation were higher among individuals with lower levels of education and income, but there was no interaction between multimorbidity and socioeconomic position measures. Multimorbidity was associated with functional limitation (BADL and IADL) and socioeconomic conditions, and this association was constant across socioeconomic position levels.

Towards an Efficient Method for Large-Scale Wi-SUN-Enabled AMI Network Planning.

In a smart grid communication network, positioning key devices (routers and gateways) is an NP-Hard problem as the number of candidate topologies grows exponentially according to the number of poles and smart meters. The different terrain profiles impose distinct communication losses between a smart meter and a key device position. Additionally, the communication topology must consider the position of previously installed distribution automation devices (DAs) to support the power grid remote operation. We introduce the heuristic method AIDA (AI-driven AMI network planning with DA-based information and a link-specific propagation model) to evaluate the connectivity condition between the meters and key devices. It also uses the link-received power calculated for the edges of a Minimum Spanning Tree to propose a simplified multihop analysis. The AIDA method proposes a balance between complexity and efficiency, eliminating the need for empirical terrain characterization. Using a spanning tree to characterize the connectivity topology between meters and routers, we suggest a heuristic approach capable of alleviating complexity and facilitating scalability. In our research, the interest is in proposing a method for positioning communication devices that presents a good trade-off between network coverage and the number of communication devices. The existing literature explores the theme by presenting different techniques for ideal device placement. Still rare are the references that meticulously explore real large-scale scenarios or the communication feasibility between meters and key devices, considering the detailed topography between the devices. The main contributions of this work include: (1) The presentation of an efficient AMI planning method with a large-scale focus; (2) The use of a propagation model that does not depend on an empirical terrain classification; and (3) The use of a heuristic approach based on a spanning tree, capable of evaluating a smaller number of connections and, even so, proposing a topology that uses fewer router and gateway positions compared to an approach that makes general terrain classification. Experiments in four real large-scale scenarios, totaling over 230,000 smart meters, demonstrate that AIDA can efficiently provide high-quality connectivity demanding a reduced number of devices. Additional experiments comparing AIDA's detailed terrain-based propagation model to the Erceg-SUI Path Loss model suggest that AIDA can reach the smart meter's coverage with a fewer router positions.

Corrigendum: Possible Involvement of Hsp90 in the Regulation of Telomere Length and Telomerase Activity During the Leishmania Amazonensis Developmental Cycle and Population Proliferation.

[This corrects the article DOI: 10.3389/fcell.2021.713415.].

Possible Involvement of Hsp90 in the Regulation of Telomere Length and Telomerase Activity During the Leishmania amazonensis Developmental Cycle and Population Proliferation.

The Leishmania developmental cycle comprises three main life forms in two hosts, indicating that the parasite is continually challenged due to drastic environmental changes. The disruption of this cycle is critical for discovering new therapies to eradicate leishmaniasis, a neglected disease that affects millions worldwide. Telomeres, the physical ends of chromosomes, maintain genome stability and cell proliferation and are potential antiparasitic drug targets. Therefore, understanding how telomere length is regulated during parasite development is vital. Here, we show that telomeres form clusters spread in the nucleoplasm of the three parasite life forms. We also observed that amastigotes telomeres are shorter than metacyclic and procyclic promastigotes and that in parasites with continuous in vitro passages, telomere length increases over time. These observed differences in telomere length among parasite's life stages were not due to lack/inhibition of telomerase since enzyme activity was detected in all parasite life stages, although the catalysis was temperature-dependent. These data led us to test if, similar to other eukaryotes, parasite telomere length maintenance could be regulated by Hsp83, the ortholog of Hsp90 in trypanosomatids, and Leishmania (LHsp90). Parasites were then treated with the Hsp90 inhibitor 17AAG. The results showed that 17AAG disturbed parasite growth, induced accumulation into G2/M phases, and telomere shortening in a time-dependent manner. It has also inhibited procyclic promastigote's telomerase activity. Besides, LHsp90 interacts with the telomerase TERT component as shown by immunoprecipitation, strongly suggesting a new role for LHsp90 as a parasite telomerase component involved in controlling telomere length maintenance and parasite life span.

Serum potassium level used as trigger doubled the detection of adverse drug events when compared with calcium polystyrene sulfonate trigger: a cross-sectional study

Background: Prescription of calcium polystyrene sulfonate (CPS) has been considered a trigger with good performance to detect hyperkalemia related to adverse drug events (ADE). However, CPS prescription may underestimate the rate of ADE. Objective: To compare the performance of the serum potassium level (SPL) >5.0mEq/L and CPS triggers in detecting hyperkalemia related to ADE. Design and setting: A six-month cross-sectional study was conducted in a Brazilian medium-complexity public hospital. Methods: SPL Tests with results >5.0mEq/L and the prescriptions of CPS of all patients hospitalized in the internal medicine and infectious diseases wards were used as trigger tools to detect potential ADE. Primary outcome: patients with hyperkalemia related to ADE. Secondary outcomes: effectiveness of treatments and ADE. Variables analyzed were SPL tests, CPS prescriptions, treatments of hyperkalemia and comorbidities. Positive predictive values (PPV) of CPS and SPL triggers were calculated and compared. Results: In total 2,466 SPL tests were assessed, of which 513 were triggered (>5.0mEq/L). The tests triggered 198 patients with hyperkalemia, of whom 121 had hyperkalemia related to ADE (PPV=0.61). In total, 101 CPS prescriptions triggered tests in 35 patients with hyperkalemia, among whom 21 cases were related to ADE (PPV=0.60). SPL detected 204 ADE (PPV=0.40), while CPS prescription detected 22 (PPV=0.21). Seven pharmacological and four non-pharmacological treatments were identified. CPS showed the lowest effectiveness (PPV=0.71). Conclusion: SPL>5.0mEq/L increased the detection of ADE by 9.3-fold, the number of patients tracked with hyperkalemia related to ADE by 5.8-fold, and doubled the performance in detection of ADE in comparison with the prescription of the CPS trigger.

A multi-approach analysis highlights the relevance of RPA-1 as a telomere end-binding protein (TEBP) in Leishmania amazonensis.

BACKGROUND: Telomeres are chromosome end structures important in the maintenance of genome homeostasis. They are replenished by the action of telomerase and associated proteins, such as the OB (oligonucleotide/oligosaccharide-binding)-fold containing telomere-end binding proteins (TEBP) which plays an essential role in telomere maintenance and protection. The nature of TEBPs is well known in higher and some primitive eukaryotes, but it remains undetermined in trypanosomatids. Previous in silico searches have shown that there are no homologs of the classical TEPBs in trypanosomatids, including Leishmania sp. However, Replication Protein A subunit 1 (RPA-1), an OB-fold containing DNA-binding protein, was found co-localized with trypanosomatids telomeres and showed a high preference for the telomeric G-rich strand. METHODS AND RESULTS: We predicted the absence of structural homologs of OB-fold containing TEBPs in the Leishmania sp. genome using structural comparisons. We demonstrated by molecular docking that the ssDNA binding mode of LaRPA-1 shares features with the higher eukaryotes POT1 and RPA-1 crystal structures ssDNA binding mode. Using fluorescence spectroscopy, protein-DNA interaction assays, and FRET, we respectively show that LaRPA-1 shares some telomeric functions with the classical TEBPs since it can bind at least one telomeric repeat, protect the telomeric G-rich DNA from 3'-5' Exonuclease I digestion, and unfold telomeric G-quadruplex. CONCLUSIONS: Our results suggest that RPA-1 emerges as a TEBP in trypanosomatids, and in this context, we present two possible evolutionary landscapes of trypanosomatids RPA-1 that could reflect upon the evolution of OB-fold containing TEBPs from all eukaryotes.

Relato de uma experiência de estágio em psicodiagnóstico com crianças provenientes de famílias de baixa renda / Report of an internship experience in psychodiagnosis with children from low income families

O presente trabalho teve como objetivo apresentar a experiência de alunos e duas supervisoras no atendimento a crianças provenientes de famílias de baixa renda, no estágio em Psicodiagnóstico Interventivo. Apresentamos a relevância desta prática tanto para os futuros profissionais quanto para os clientes que participam do processo. Para ser realizado, o psicodiagnóstico em questão, seguiu-se a linha teórica fenomenológico-existencial e se desenvolveu a partir das entrevistas iniciais (realizadas com os pais ou responsáveis), horas lúdicas (realizadas com as crianças), até as entrevistas devolutivas (realizadas também com os pais e com as crianças). Pode-se notar, ao longo de nossa prática como supervisoras deste estágio os benefícios que sua prática pode trazer, pois do lado do cliente, recebeu-se feedback das escolas e da família sobre mudanças significativas no comportamento das crianças. Pelo lado das crianças, observou-se o desenvolvimento do exercício da autorreflexão sobre os sentimentos e resolução de conflitos de modo mais assertivo que no início do processo. Do ponto de vista dos estagiários, pudemos observar, também, o crescimento profissional destes, a partir desta experiência.

The present study aimed to present the experience of students and two supervisors in the care of children from low income families, in the Interventive Psychodiagnosis internship. We present the relevance of this practice to both future professionals and for clients participating in the process. To be performed, the psychodiagnosis in question, followed the existential phenomenological theoretical line and developed from the initial interviews (conducted with parents or guardians), playful hours (conducted with the children) and the devolutive interviews (conducted also with parents and children). It can be noted our practice as supervisors of this stage the benefits that their practice can bring, because from the client side, we received feedback from schools and family about significant changes in children's behavior. On the children's side, the self-reflection exercise on feelings and conflict resolution was more assertively developed than at the beginning of the process. From the trainees' point of view, we could also observe their professional growth from this experience.

Precordial pain, leukocytosis and bicytopenia in a teenager with systemic juvenile idiopathic arthritis under immunosuppressive therapy / Dor precordial, leucocitose e bicitopenia em adolescente com artrite idiopática juvenil sistêmica em terapia imunossupressora

ABSTRACT Objective: To highlight the importance of the new classification criteria for the macrophage activation syndrome (MAS) in systemic juvenile idiopathic arthritis in order to reduce morbidity and mortality outcome related to this disease. Case description: A 12-year-old female patient with diagnosis of systemic juvenile idiopathic arthritis under immunosuppression therapy for two years developed cough, acute precordial chest pain, tachypnea, tachycardia and hypoxemia for two days. Chest tomography showed bilateral laminar pleural effusion with bibasilar consolidation. The electrocardiogram was consistent with acute pericarditis and the echocardiogram showed no abnormalities. Laboratory exams revealed anemia, leukocytosis and increased erythrocyte sedimentation rate, as well as C-reactive protein rate and serum biomarkers indicative of myocardial injury. Systemic infection and/or active systemic juvenile idiopathic arthritis were considered. She was treated with antibiotics and glucocorticoids. However, 10 days later she developed active systemic disease (fever, evanescent rash and myopericarditis with signs of heart failure) associated with macrophage activation syndrome, according to the 2016 Classification Criteria for Macrophage Activation Syndrome in Systemic Juvenile Idiopathic Arthritis. She was treated for five days with pulse therapy, using glucocorticoids, immunoglobulin and cyclosporine A, with improvement of all clinical signs and laboratory tests. Comments: Myopericarditis with signs of heart failure associated with MAS is a rare clinical presentation of systemic juvenile idiopathic arthritis. Macrophage activation syndrome occurs mainly during periods of active systemic juvenile idiopathic arthritis and may be triggered by infection. Knowledge about this syndrome is crucial to reduce morbidity and mortality.

RESUMO Objetivo: Destacar a importância do conhecimento sobre os novos critérios de classificação para síndrome de ativação macrofágica (SAM) na artrite idiopática juvenil sistêmica para reduzir a morbidade e mortalidade desse desfecho. Descrição do caso: Adolescente do sexo feminino de 12 anos de idade, em terapia imunossupressora por diagnóstico de artrite idiopática juvenil sistêmica há 2 anos, com quadro de tosse, dor precordial aguda, taquipneia, taquicardia e hipoxemia há 2 dias. A tomografia de tórax evidenciou efusão pleural laminar bilateral com consolidação bibasal. O eletrocardiograma foi compatível com pericardite aguda, e o ecocardiograma foi normal. Os exames laboratoriais revelaram anemia, leucocitose e aumento da velocidade de hemossedimentação, proteína C-reativa e marcadores séricos de lesão miocárdica. Infecção sistêmica e/ou doença sistêmica em atividade foram consideradas. A paciente foi tratada com antibióticos e glicocorticoide. Entretanto, dez dias depois, evoluiu com doença sistêmica em atividade (febre, exantema e miopericardite com insuficiência cardíaca) associada à SAM, de acordo com o 2016 Classification Criteria for Macrophage Activation Syndrome in Systemic Juvenile Idiopathic Arthritis, e necessitou de cinco dias de pulsoterapia com glicocorticoide, imunoglobulina e ciclosporina A, com melhora de todos os parâmetros clínicos e laboratoriais. Comentários: A miopericardite com sinais de insuficiência cardíaca associada à SAM é uma apresentação clínica rara da artrite idiopática juvenil sistêmica, que ocorre principalmente em períodos de atividade sistêmica da doença e pode ser deflagrada por infecções. O conhecimento sobre essa síndrome é fundamental para reduzir morbidade e mortalidade desse grave desfecho.

PRECORDIAL PAIN, LEUKOCYTOSIS AND BICYTOPENIA IN A TEENAGER WITH SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS UNDER IMMUNOSUPPRESSIVE THERAPY.

OBJECTIVE: To highlight the importance of the new classification criteria for the macrophage activation syndrome (MAS) in systemic juvenile idiopathic arthritis in order to reduce morbidity and mortality outcome related to this disease. CASE DESCRIPTION: A 12-year-old female patient with diagnosis of systemic juvenile idiopathic arthritis under immunosuppression therapy for two years developed cough, acute precordial chest pain, tachypnea, tachycardia and hypoxemia for two days. Chest tomography showed bilateral laminar pleural effusion with bibasilar consolidation. The electrocardiogram was consistent with acute pericarditis and the echocardiogram showed no abnormalities. Laboratory exams revealed anemia, leukocytosis and increased erythrocyte sedimentation rate, as well as C-reactive protein rate and serum biomarkers indicative of myocardial injury. Systemic infection and/or active systemic juvenile idiopathic arthritis were considered. She was treated with antibiotics and glucocorticoids. However, 10 days later she developed active systemic disease (fever, evanescent rash and myopericarditis with signs of heart failure) associated with macrophage activation syndrome, according to the 2016 Classification Criteria for Macrophage Activation Syndrome in Systemic Juvenile Idiopathic Arthritis. She was treated for five days with pulse therapy, using glucocorticoids, immunoglobulin and cyclosporine A, with improvement of all clinical signs and laboratory tests. COMMENTS: Myopericarditis with signs of heart failure associated with MAS is a rare clinical presentation of systemic juvenile idiopathic arthritis. Macrophage activation syndrome occurs mainly during periods of active systemic juvenile idiopathic arthritis and may be triggered by infection. Knowledge about this syndrome is crucial to reduce morbidity and mortality.

Análise dos parceiros sorodiferentes no serviço de referência para HIV / Analysis of serodifferent partners in the HIV reference service

Objetivo: levantar as informações pelo formulário de atendimento acerca dos parceiros sorodiscordantes, com status sorológico negativo para o vírus, cadastrados em um serviço escola de referência regional para HIV/Aids. Método: trata-se de estudo quantitativo, descritivo, documental, com 145 casais em relação sorodiferente. Analisaram-se prontuários de todas as parcerias sexuais sorodiferentes cadastradas de 1992 até 2017. Apresentaram-se os resultados em forma de figuras. Resultados: verificou-se que 63,45% (n = 92) homens são soronegativos e estão em relação sorodiferente e, no que diz respeito à orientação sexual, notou-se que 91,03% (n = 132) parcerias são heterossexuais. Mencionou-se, em 62,06% (n = 90) dos formulários, a periodicidade de realização dos testes rápidos e, destes, 20% (n = 29) o realizam anualmente. Notou-se que 39,31% (n = 57) dos indivíduos soronegativos relataram usar preservativo em todas as relações com o parceiro soropositivo e, dentre todos os soronegativos cadastrados, 86,90% (n = 126) afirmaram estar em uma relação estável com o parceiro. Conclusão: pode-se concluir que o formulário não é preenchido adequadamente e que os casais soronegativos necessitam de maior atenção de profissionais de saúde e da população.(AU)

Objective: to gather information through the form of care about serodiscordant partners, with negative serological status for the virus, registered in a regional reference school service for HIV / AIDS. Method: this is a quantitative, descriptive, documentary study with 145 couples in a serodifferent relationship. Medical records of all registered serodifferent sexual partnerships from 1992 to 2017 were analyzed. Results were presented as figures. Results: it was found that 63.45% (n = 92) men are seronegative and are in a serodifferent relationship and, regarding sexual orientation, it was noted that 91.03% (n = 132) partnerships are heterosexual. It was mentioned in 62.06% (n = 90) of the forms, the periodicity of the quick tests and, of these, 20% (n = 29) do it annually. It was noted that 39.31% (n = 57) of seronegative individuals reported using condoms in all relationships with the seropositive partner and, among all registered seronegatives, 86.90% (n = 126) reported being in a stable relationship with the partner. Conclusion: it can be concluded that the form is not completed properly and that seronegative couples need more attention from health professionals and the population.(AU)

Objetivo: recopilar informaciones a través del formulario de atención sobre parejas serodiscordantes, con estado serológico negativo para el virus, registrados en un servicio escolar regional de referencia para el VIH / SIDA. Método: este es un estudio documental cuantitativo, descriptivo con 145 parejas en una relación serodiscordantes. Se analizaron los registros médicos de todas las parejas sexuales serodiscordantes registradas de 1992 a 2017. Los resultados se presentaron en forma de figuras. Resultados: se encontró que el 63.45% (n = 92) hombres son seronegativos y están en una relación serodiscordante y, con respecto a la orientación sexual, se observó que el 91.03% (n = 132) parejas son heterosexuales. Se mencionó en 62.06% (n = 90) de los formularios, la periodicidad de las pruebas rápidas y, de estos, 20% (n = 29) lo hacen anualmente. Se observó que el 39.31% (n = 57) de los individuos seronegativos informaron haber usado condones en todas las relaciones con la pareja seropositiva y, entre todos los seronegativos registrados, el 86.90% (n = 126) declaró estar en una relación estable con la pareja. Conclusión: se puede concluir que el formulario no se completa correctamente y que las parejas seronegativas necesitan más atención de los profesionales de la salud y la población.(AU)

Cosmesis in patients with breast neoplasia submitted to the hypofractionated radiotherapy with of intensity-modulated beam.

OBJECTIVE: To assess the cosmetic satisfaction of patients diagnosed with breast cancer submitted to the hypofractionated radiotherapy with IMRT (hIMRT) technique and its correlation with dosimetric data of the radiotherapy planning. METHODS: The retrospective cohort study that assessed women with a diagnosis of malignant breast neoplasia submitted to the conservative treatment or radical mastectomy and treated with hIMRT. In the period between August 2007 to December 2014, in a philanthropic / private institution, 170 records were selected. The cosmetic assessment was carried out by means of the Harvard/RTOG/NSABP scale with one-year minimum range after treatment. The collected dosimetric data were: breast / chest wall volume, volume that received 95% (V95%) and 107% (V107%) of the prescribed dose. RESULTS: The volume of the treated breasts ranged from 169 to 2.103 ml (median = 702; IQR: 535 to 914 ml). Median V95% was 86.7% (54.6-96.6%; IQR: 80.0% to 90.6%); eight (5.7%) patients had V95% higher than 95%. Median V107% was 0% (0%-16.3%; IQR: 0.0% to 0.3% and 13); 9.3% patients had V107% higher than 2%. One hundred and thirty-three (78.2%) patients responded to the cosmetic assessment: 99 (74.4%) considered the cosmetic results excellent. Significant associations between cosmetic assessment and breast volume (p=0.875), V95% (p=0.294) e V107% (p=0.301) were not found. CONCLUSION: The cosmetic results showed favorable when using hIMRT, and the lack of correlation with usual the dosimetric data illustrates the capacity of hIMRT to minimize the heterogeneity of the dose in this endpoint, even in voluminous breasts.

Cosmesis in patients with breast neoplasia submitted to the hypofractionated radiotherapy with of intensity-modulated beam

SUMMARY OBJECTIVE: To assess the cosmetic satisfaction of patients diagnosed with breast cancer submitted to the hypofractionated radiotherapy with IMRT (hIMRT) technique and its correlation with dosimetric data of the radiotherapy planning. MATERIALS AND METHODS: The retrospective cohort study that assessed women with a diagnosis of malignant breast neoplasia submitted to the conservative treatment or radical mastectomy and treated with hIMRT. In the period between August 2007 to December 2014, in a philanthropic / private institution, 170 records were selected. The cosmetic assessment was carried out by means of the Harvard/RTOG/NSABP scale with one-year minimum range after treatment. The collected dosimetric data were: breast / chest wall volume, volume that received 95% (V95%) and 107% (V107%) of the prescribed dose. RESULTS: The volume of the treated breasts ranged from 169 to 2.103 ml (median = 702; IQR: 535 to 914 ml). Median V95% was 86.7% (54.6-96.6%; IQR: 80.0% to 90.6%); eight (5.7%) patients had V95% higher than 95%. Median V107% was 0% (0%-16.3%; IQR: 0.0% to 0.3% and 13); 9.3% patients had V107% higher than 2%. One hundred and thirty-three (78.2%) patients responded to the cosmetic assessment: 99 (74.4%) considered the cosmetic results excellent. Significant associations between cosmetic assessment and breast volume (p=0.875), V95% (p=0.294) e V107% (p=0.301) were not found. CONCLUSION: The cosmetic results showed favorable when using hIMRT, and the lack of correlation with usual the dosimetric data illustrates the capacity of hIMRT to minimize the heterogeneity of the dose in this endpoint, even in voluminous breasts.

RESUMO OBJETIVO: Avaliar a satisfação cosmética de pacientes diagnosticadas com câncer de mama submetidas à radioterapia hipofracionada com técnica IMRT (hIMRT) e sua correlação com dados dosimétricos do planejamento radioterápico. MATERIAIS E MÉTODOS: Estudo de coorte retrospectivo que avaliou mulheres com diagnóstico de neoplasia maligna de mama submetidas a tratamento conservador ou mastectomia radical e tratadas com hIMRT. No período de agosto de 2007 a dezembro de 2014, em uma instituição filantrópica/particular, foram selecionados 170 prontuários. A avaliação cosmética foi feita por meio da escala de Harvard/RTOG/NSABP com um intervalo mínimo de um ano após o tratamento. Dados dosimétricos coletados foram: volume da mama/plastrão, volume que recebeu 95% (V95%) e 107% (V107%) da dose prescrita. RESULTADOS: O volume das mamas tratadas variou de 169 a 2.103 ml (mediana = 702; IQR: 535 a 914 ml). O V95% mediano foi 86,7% (54,6-96,6%; IQR: 80,0% a 90,6%); oito (5,7%) pacientes tiveram o V95% superior a 95%. O V107% mediano foi 0% (0%-16,3%; IQR: 0,0% a 0,3% e 13); 9,3% pacientes tiveram o V107% superior a 2%. Cento e trinta e três (78,2%) pacientes responderam à avaliação cosmética: 99 (74,4%) consideraram o resultado cosmético excelente. Não foram encontradas associações significativas entre a avaliação cosmética e o volume da mama (p=0,875), V95% (p=0,294) e V107% (p=0,301). CONCLUSÕES: Os resultados cosméticos mostraram-se favoráveis com o uso de hIMRT, e a ausência de correlação com os dados dosimétricos usuais ilustra a capacidade do hIMRT em minimizar a heterogeneidade da dose neste desfecho, mesmo em mamas volumosas.

Association between gestational weight gain, birth weight classification, and type of treatment in diabetic mothers / Associação entre ganho de peso gestacional, classificação de peso ao nascer e tipo de tratamento em mães diabéticas

The objective of the study was to identify the relationship between gestational weight gain, type of treatment used, and the weight of the baby at birth. This being an observational retrospective study, the primary outcomes evaluated were: the type of treatment used and the classification of the baby's weight at birth. Collection occurred from January 2013 to May 2015. Multivariate multinomial logistic regression models were used to calculate odds ratios. Of the 682 pregnant women, 393 (57.6%) had a weight gain that was less than adequate, 140 (20.5%) showed adequate weight gain, and 149 (21.9%) had a weight gain that was higher than adequate. Weight gain that was less than adequate did not correlate with treatment used or with birth weight classification; higher-than-adequate weight gain was also not associated with the type of treatment used but decreased the chance of having a child considered normal for its gestational age by 50% and doubled the chance of having child considered large for gestational age. Comparing the groups according to the weight gain by means of the odds ratio, no difference was found in the therapy used

O objetivo do estudo foi o de identificar qual a relação entre o ganho de peso gestacional, tipo de tratamento utilizado e peso do bebê ao nascer. Estudo retrospectivo observacional, os desfechos primários avaliados foram: tipo de tratamento utilizado e classificação de peso do bebê ao nascer. Coleta: janeiro de 2013 a maio de 2015. Modelos de regressão logística multivariada multinomial para cálculo de razão de chance. Das 682 gestantes, 393 (57.6%) tiveram um ganho de peso abaixo do adequado, 140 (20.5%) tiveram um ganho de peso adequado e 149 (21.9%) tiveram um ganho de peso acima. O ganho de peso abaixo do adequado não apresentou relação com tratamento utilizado ou na classificação de peso do bebê ao nascer, o ganho de peso acima do adequado também não apresentou associação com o tratamento utilizado, porém diminuiu a chance de ter um filho adequado para a idade gestacional em 50% e dobrou a de ter um filho grande para a idade gestacional. Comparando os grupos, conforme o ganho de peso através da razão de chance, não foi encontrada diferença na terapêutica utilizada

Câncer de mama: Reprogramação do metabolismo tumoral / Breast Cancer: tumoral metabolism reprogramming

O câncer de mama é a neoplasia de maior incidência em mulheres de todo o mundo, cuja mortalidade se deve principalmente ao desenvolvimento de metástases (condição patológica em que as células tumorais conseguem atravessar a matriz extracelular e se estabelecer em outros tecidos). Devido à importância epidemiológica dessa doença, estudos têm sido realizados em busca de uma melhor compreensão dos processos que atuam na carcinogênese e/ou tumorigênese e que, consequentemente, levam ao desenvolvimento de novas formas de diagnóstico e tratamento que sejam cada vez mais efetivos. Para manter a alta taxa de proliferação e desenvolver um perfil agressivo, características que são observadas em células tumorais, diversas alterações no metabolismo celular se tornam necessárias. O metabolismo tumoral começou a ser descrito por Otto Warburg em 1920, onde afirma que células cancerosas metabolizam glicose de forma diferente das células normais através da glicólise aeróbica. Dados recentes mostram que as alterações também ocorrem no metabolismo lipídico, apontando para uma reprogramação celular. A possibilidade de novos alvos farmacológicos inseriu o metabolismo como alvo das pesquisas recentes. Entretanto, e apesar do avanço, 90 anos depois da descoberta feita por Warburg, os estudos ainda não conseguiram esclarecer por completo como o metabolismo tumoral funciona, demonstrando assim a necessidade de mais pesquisas. Tendo em vista este cenário, essa revisão tem como objetivo documentar e discutir os principais resultados obtidos até o momento, como apontar e sugerir áreas de investigação. (AU)

Breast cancer is the most prevalent neoplasm in women worldwide, whose mortality is mainly due to the development of metastasis (pathological condition in which cancer cells can cross the extracellular matrix and settle in other tissues). Due to the epidemiological importance of this disease, studies have been carried out in order to better understand the processes involved in carcinogenesis and/or tumorigenesis and, consequently, allow the development of new forms of diagnosis and treatment that are increasingly effective. To maintain the high proliferation rate and develop an aggressive profile, features that are observed in tumor cells, several changes in cellular metabolism become necessary. Tumor metabolism began to be described by Otto Warburg in 1920, where he states that cancer cells metabolize glucose differently from normal cells through aerobic glycolysis. Recent data show that changes also occur in lipid metabolism, pointing to cellular reprogramming. The possibility of new pharmacological targets, inserted the metabolism as a target of recent research. However, despite the breakthrough, 90 years after Warburg discovery, studies have not yet been able to fully clarify how tumor metabolism works, demonstrating the need for more research. In view of this scenario, this review aims to document the main results obtained so far and to discuss those aspects that are not yet well understood. (AU)

Tratamento de verrugas virais com bleomicina intralesional / Treatment of viral warts with intralesional bleomycin

A verruga viral representa uma das dermatoses mais prevalentes. O quadro clínico varia de lesão única com cura espontânea até múltiplas lesões recalcitrantes. O sulfato de bleomicina é uma droga de ação citotóxica, aprovada para o tratamento quimioterápico de algumas malignidades. Há mais de 45 anos existem trabalhos demonstrando sua utilidade na dermatologia, em especial na terapia intralesional para verrugas virais, que constitui excelente opção para as lesões em topografias de difícil manejo e para os casos não responsivos a outras abordagens.

Viral warts are one of the most prevalent dermatoses. The clinical picture varies from a single lesion with spontaneous cure to multiple recalcitrant lesions. Bleomycin sulfate is a cytotoxic action drug approved for the chemotherapeutic treatment of some malignancies. There are a number of studies that have been carried out during the last 45 years demonstrating its usefulness in dermatology, especially in intralesional therapy for viral warts, meaning it is an excellent option for lesions in difficult-to-handle topographies and for cases that do not respond to other approaches.

Percepção de homens após infarto agudo do miocárdio / Men's perception after acute myocardial infarction / Percepción de los hombres después del infarto agudo de miocardio

Objetivo: Compreender a percepção de homens sobre seus próprios sentimentos, as repercussões das mudanças no estilo de vida e a participação familiar após infarto agudo do miocárdio (IAM). Métodos: Estudo descritivo com abordagem qualitativa, realizado entre março e junho de 2016, em Goiânia, Goiás, Brasil, no qual se aplicaram entrevistas semi-estruturadas a homens adultos que tiveram episódio de infarto. A análise das entrevistas se baseou na Teoria Fundamentada nos Dados (Grounded Theory), de onde emergiram as categorias explicativas: Sentimentos vivenciados pelos pacientes após diagnóstico de IAM; Repercussão da mudança no estilo de vida com enfoque na alimentação e atividade física; Envolvimento e suporte familiar. Resultados: Em meio aos diversos sentimentos que acompanham o diagnóstico de IAM, destacaram-se o medo da finitude e de desamparar a família. As mudanças no estilo de vida, como elemento essencial do tratamento não medicamentoso, eram iniciadas. Quanto à alimentação, porém, foram insuficientes, em parte, devido à falta de orientações nutricionais adequadas. No que se refere à prática de atividade física, havia conscientização adequada, mas prevaleceu a dificuldade de manutenção do novo hábito. As famílias se revelaram a fonte majoritária de apoio social, sendo decisivas nesse processo. A adesão demonstrou-se parcial, tendo a falta de continuidade como entrave principal. Conclusão: O sucesso do planejamento terapêutico contínuo depende da adesão dos usuários, com existência de dificuldades nesse aspecto, mesmo com suporte social adequado. Torna-se clara a necessidade da conscientização sobre prevenção secundária e seus benefícios, de educação alimentar e da manutenção da mudança de hábitos.

Objective: To understand men's perception about their feelings, repercussions of lifestyle change and family participation after acute myocardial infarction (AMI). Methods: Qualitative descriptive study conducted between March and June 2016 in Goiânia, Goiás, Brazil, using semi-structured interviews with adult men who had an episode of infarction. The analysis of the interviews was based on Grounded Theory, from which the following explanatory categories emerged: Feelings experienced by the patients after diagnosis of AMI; Repercussion of lifestyle change with focus on feeding and physical activity; Family involvement and support. Results: In the midst of the whirlwind of feelings that accompanied the diagnosis of AMI, the fear of finitude and of abandoning the family stood out. Lifestyle change, as an essential element of non-drug treatment, was initiated. However, with regard to feeding, they were partially insufficient due to the lack of adequate nutritional guidelines. As for physical activity, there was adequate awareness, but the difficulty of maintaining the new habit prevailed. Families have proved to be the main source of social support, being decisive in this process. The adherence was partial and the lack of continuity was the main obstacle. Conclusion: The success of continuous therapeutic planning depends on users' adherence, who experience difficulties in this aspect, even in the face of adequate social support. There is a clear need for raising awareness of secondary prevention and its benefits, of food education and of maintaining habit changes.

Objetivo: Comprender la percepción de los hombres sobre sus propios sentimientos, las repercusiones de los cambios del estilo de vida y la participación familiar después del infarto agudo de miocardio (IAM). Métodos: Estudio descriptivo de abordaje cualitativo realizado entre marzo y junio de 2016 en Goiânia, Goiás, Brasil en el cual se aplicaron entrevistas semi-estructuradas a los hombres adultos que tuvieron algún episodio de infarto. El análisis de las entrevistas se dio a través de la Teoría Fundamentada de los Datos (Grounded Theory) de lo cual emergieron las categorías explicativas: Sentimientos vividos por los pacientes después del diagnóstico de IAM; Repercusión del cambio del estilo de vida basado en la alimentación y actividad física; Envolvimiento y apoyo familiar. Resultados: Entre los diversos sentimientos que acompañan el diagnóstico de IAM se destacaron el miedo de la finitud y de abandonar a la familia. Se iniciaban los cambios del estilo de vida como elemento esencial del tratamiento sin medicación. Sin embargo, los cambios respecto la alimentación fueron insuficientes, en parte, debido la falta de orientaciones nutricionales adecuadas. Había concienciación adecuada sobre la práctica de actividad física pero prevaleció la dificultad para la manutención del nuevo hábito. Las familias se revelaron la principal fuente de apoyo social, siendo decisivas en el proceso. La adhesión ha sido parcial y la falta de seguimiento ha sido la principal traba. Conclusión: El éxito del planeamiento terapéutico continuo depende de la adhesión de los usuarios, con dificultades en ese aspecto, aunque con apoyo adecuado. Es evidente la necesidad de la concienciación de la prevención secundaria y sus beneficios, de la educación alimentaria y de la manutención de los cambios de hábitos. .