A pediatric case of disseminated American cutaneous leishmaniasis in Rio de Janeiro, Brazil.

American cutaneous leishmaniasis is an infectious disease caused by the protozoa of the genus Leishmania. Clinical manifestations vary according to the virulence of the parasite speciesand the host's immune response. We report a case of a 2-year-old girl vertically exposed to HIV who presented painful and itchy papules throughout her lower limbs with further dissemination of vegetative ulcers all over the body and scalp. The histopathological examination evidenced the amastigote form of Leishmania and the polymerase chain reaction was positive for Leishmania sp. in the tissue sample. The patient was treated with amphotericin B and demonstrated improvement of lesions. Despite successful treatment for American cutaneous leishmaniasis, she developed osteomyelitis related to a bacterial secondary infection over the site of a previous ulcer on the left ankle and required a 6-week course of intravenous antimicrobial treatment. Children with vertical exposure to HIV, even without seroconversion, are at greater risk of infections if compared to non-exposed children. This is perhaps the reason for such an exuberant and rare case of complicated eishmaniasis.

In Vivo and In Silico Studies of the Hepatoprotective Activity of Tert-Butylhydroquinone.

Tert-butylhydroquinone (TBHQ) is a synthetic food antioxidant with biological activities, but little is known about its pharmacological benefits in liver disease. Therefore, this work aimed to evaluate TBHQ during acute liver damage induced by CCl4 (24 h) or BDL (48 h) in Wistar rats. It was found that pretreatment with TBHQ prevents 50% of mortality induced by a lethal dose of CCl4 (4 g/kg, i.p.), and 80% of BDL+TBHQ rats survived, while only 50% of the BDL group survived. Serum markers of liver damage and macroscopic and microscopic (H&E staining) observations suggest that TBHQ protects from both hepatocellular necrosis caused by the sublethal dose of CCl4 (1.6 g/kg, i.p.), as well as necrosis/ductal proliferation caused by BDL. Additionally, online databases identified 49 potential protein targets for TBHQ. Finally, a biological target candidate (Keap1) was evaluated in a proof-of-concept in silico molecular docking assay, resulting in an interaction energy of -5.5491 kcal/mol, which was higher than RA839 and lower than monoethyl fumarate (compounds known to bind to Keap1). These findings suggest that TBHQ increases the survival of animals subjected to CCl4 intoxication or BDL, presumably by reducing hepatocellular damage, probably due to the interaction of TBHQ with Keap1.

Liposomes Bearing Non-Bilayer Phospholipid Arrangements Induce Specific IgG Anti-Lipid Antibodies by Activating NK1.1+, CD4+ T Cells in Mice.

Liposomes are artificial models of cellular membranes that are used as delivery systems for genes, drugs and protein antigens. We have previously used them to study the antigenic properties of their phospholipids. Here, we used them to induce the production of IgG anti-non-bilayer phospholipid arrangements (NPAs) antibodies in mice; these antibodies cause cell lysis and trigger a lupus-like disease in mice. We studied the mechanisms that lead to the production of these antibodies, and provide evidence that NK1.1+, CD4+ T cells respond to NPA-bearing liposomes and deliver the help required for specific B cell activation and antibody class-switching to IgG. We found increased numbers of IL-4-producing NK1.1+, CD4+ T cells in the secondary lymphoid organs of mice administered with NPAs, and these cells also expressed CD40L, which is required for B cell activation. Additionally, we isolated and purified NK1.1+, CD4+ T cells from spleens and determined that they over-expressed 40 genes, which are key players in inflammatory processes and B cell stimulation and have TRAF6 and UNC39B1 as key nodes in their network. These results show that liposomes are membrane models that can be used to analyze the immunogenicity of lipids.

Pulmonary Synovial Sarcoma: An Unpleasant Surprise.

The authors describe the case of a patient with primary monophasic pulmonary synovial sarcoma presenting as a right pleural effusion, and discuss the underlying diagnostic challenges. LEARNING POINTS: There has been tremendous progress in the diagnosis and management of malignant effusion, with thoracoscopic biopsy of the pleura providing the highest diagnostic yield.Even though advanced techniques such as image-guided biopsy and pleuroscopy have relatively high sensitivity and specificity, in rare cases, the diagnosis can still be missed.In clinical practice, all such techniques should be considered in order to achieve an early diagnosis and a better outcome.

Hyponatremia: A Tip of the Iceberg in the Late Diagnosis of Tuberous Sclerosis Associated With Lymphangioleiomyomatosis.

Tuberous sclerosis (TS) is a rare, autosomal dominant, multisystem genetic disease that causes multiple benign tumors in the brain and other vital organs. Rarely, it can be associated with lymphangioleiomyomatosis (LMA) that is characterized by the proliferation of immature smooth muscle cells in the walls of the airways, venules, and lymphatic vessels in the lung. Here, we present the case of a 44-year-old intellectually disabled woman with a history of marked polydipsia who presented to the emergency department with persistent vomiting. She was hemodynamically stable and did not have any fever. The analytical study showed severe and symptomatic hyponatremia. On physical examination, multiple skin lesions compatible with angiofibromas were noted and the diagnosis of TS was made (confirmed with the genetic study). The multiorgan study documented the presence of multiple cystic images in the lung parenchyma associated with LMA. The aim of this case report is to highlight the importance of targeting cutaneous lesions for a rapid diagnosis of this pathology and to identify the etiology of a severe (symptomatic) ionic disorder and referral to a multidisciplinary team.

Mycolicibacterium brumae Is a Safe and Non-Toxic Immunomodulatory Agent for Cancer Treatment.

Intravesical Mycobacterium bovis Bacillus Calmette-Guérin (BCG) immunotherapy remains the gold-standard treatment for non-muscle-invasive bladder cancer patients, even though half of the patients develop adverse events to this therapy. On exploring BCG-alternative therapies, Mycolicibacterium brumae, a nontuberculous mycobacterium, has shown outstanding anti-tumor and immunomodulatory capabilities. As no infections due to M. brumae in humans, animals, or plants have been described, the safety and/or toxicity of this mycobacterium have not been previously addressed. In the present study, an analysis was made of M. brumae- and BCG-intravenously-infected severe combined immunodeficient (SCID) mice, M. brumae-intravesically-treated BALB/c mice, and intrahemacoelic-infected-Galleria mellonella larvae. Organs from infected mice and the hemolymph from larvae were processed to count bacterial burden. Blood samples from mice were also taken, and a wide range of hematological and biochemical parameters were analyzed. Finally, histopathological alterations in mouse tissues were evaluated. Our results demonstrate the safety and non-toxic profile of M. brumae. Differences were observed in the biochemical, hematological and histopathological analysis between M. brumae and BCG-infected mice, as well as survival curves rates and colony forming units (CFU) counts in both animal models. M. brumae constitutes a safe therapeutic biological agent, overcoming the safety and toxicity disadvantages presented by BCG in both mice and G. mellonella animal models.

Lupresan, a new drug that prevents or reverts the formation of nonbilayer phospholipid arrangements that trigger a murine lupus resembling human lupus.

Non-bilayer phospholipid arrangements (NPA) are lipid associations different from the bilayer, formed by the interactions of conic anionic lipids and divalent cations that produce an inverted micelle which is inserted between the lipid layers, so the polar heads of the outer lipids spread and expose new antigens. Since these structures are transient, they are not immunogenic, but if they are stabilized by drugs, such as chlorpromazine, they become immunogenic and induce anti-NPA antibodies that trigger a lupus-like disease in mice. Chloroquine is a drug used for the treatment of lupus; chloroquine has a quinoline ring and two positive charges that interact with conic anionic lipids and prevent or revert the formation of NPA. However, the polyamine spermidine is more effective, since it has three positive charges and interacts with more lipids, but polyamines cannot be used as drugs, because they are highly toxic. Here we report the design and synthesis of Lupresan, an analogous of chloroquine with its quinoline ring but with three positive charges. Lupresan is more effective in preventing or reverting the formation of NPA than chloroquine or spermidine, and as a consequence, it decreased auto-antibody titers and healed the malar rash in mice with lupus to a greater extent than chloroquine. A drug as Lupresan could be used for the treatment of human lupus.

Validación de la escala barrat de impulsividad (bis-11) en población bogotana / Validation of the barrat impulsivity scale (bis-11) in bogotana population

Resumen El presente trabajo se realizó con el fin de validar la Escala de Impulsividad de Barratt (bis-11) en población bogotana, y de esta forma aportar evidencia empírica que permita unificar los criterios de interpretación y análisis. Participaron 313 personas: 98 privadas de la libertad transitoriamente en Unidad de Reacción Inmediata (uri); 86 diagnosticadas con trastornos relacionados con impulsividad y 126 estudiantes universitarios. Se realizó la adaptación cultural de la prueba por medio de revisión por lingüista, juicio de expertos y pilotaje. Posteriormente, se definió el instrumento sometido a validación. Los resultados arrojaron una fiabilidad de la escala total de a 0,7 y para las sub escalas motora a 0,6, atencional a 0,5 y no planeada a 0,4; el análisis factorial exploratorio identificó 2 factores que explican el 29,77% de la varianza total. La evidencia permite concluir una calidad psicométrica moderada, por lo cual se recomienda no usar esta versión para diagnóstico y realizar la traducción de la última actualización de la escala original.

Abstract The present work was carried out in order to validate the Barratt Impulsivity Scale (bis-11) in the population of Bogota, and thus provide empirical evidence to unify the interpretation and analysis criteria. Participated 313 people: 98 deprived of freedom temporarily in the Unit of Immediate Reaction (URI); 86 diagnosed with disorders related to impulsivity and 126 university students. The cultural adaptation of the test was made through linguistic revision, expert judgment and piloting. Subsequently, the instrument was validated. The results showed a reliability of the total scale of a 0.7 and for motor subscales a 0.6, attentional a 0.5 and unplanned a 0.4; the exploratory factor analysis identified 2 factors that explain 29.77% of the total variance. The evidence allows to conclude a psychometric quality moderate, for which it is recommended not to use this version for diagnosis and perform the translation of the last update of the original scale.

Dysregulation of miR-155-5p and miR-200-3p and the Anti-Non-Bilayer Phospholipid Arrangement Antibodies Favor the Development of Lupus in Three Novel Murine Lupus Models.

Systemic lupus erythematosus (SLE) is characterized by deregulated activation of T and B cells, autoantibody production, and consequent formation of immune complexes. Liposomes with nonbilayer phospholipid arrangements (NPA), induced by chlorpromazine, procainamide, or manganese, provoke a disease resembling human lupus when administered to mice. These mice produce anti-NPA IgM and IgG antibodies and exhibit an increased number of TLR-expressing spleen cells and a modified gene expression associated with TICAM1-dependent TLR-4 signaling (including IFNA1 and IFNA2) and complement activation. Additionally, they showed a diminished gene expression related to apoptosis and NK cell activation. We hypothesized that such gene expression may be affected by miRNAs and so miRNA expression was studied. Twelve deregulated miRNAs were found. Six of them were common to the three lupus-like models. Their validation by qRT-PCR and TaqMan probes, including miR-342-3p, revealed that miR-155-5p and miR-200a-3p expression was statistically significant. Currently described functions for these miRNAs in autoimmune diseases such as SLE reveal their participation in inflammation, interferon production, germinal center responses, and antibody maturation. Taking into account these findings, we propose miR-155-5p and miR-200a-3p, together with the anti-NPA antibodies, as key players in the murine lupus-like models and possible biomarkers of the human SLE.

Fixation of Light Weight Polypropylene Mesh with n-Butyl-2-cyanocrylate in Pelvic Floor Surgery: Experimental Design Approach in Sheep for Effectiveness Evaluation.

OBJECTIVE: The aim of this study was to find a proper experimental design and to evaluate n-butyl-2-cyanoacrylate (Histoacryl) as a fixation method for a light-weight and large pore PP mesh (Synthetic PP Mesh-1) using the sheep as an animal model. METHODS: Posterior vaginal implantation by means of episiotomy was used to implant 8 ewes which were evaluated macroscopically and histologically at 3 months (n = 4) and 6 months (n = 4) post-surgery. In previous pilot studies anterior vaginal implantation was evaluated, as well as different synthetic mesh materials, sizes and fixation methods (n = 1 to 3) during three weeks. In all cases a clinical evaluation of the animal was performed. RESULTS: A reduction in the mesh size (Synthetic PP Mesh-1) together with precise application of the surgical glue Histoacryl to fix the mesh yielded significantly better histocompatibility results (P < 0.01) compared to larger size or other fixation methods. CONCLUSION: The combination of Synthetic PP Mesh-1 with Histoacryl offered a high degree of graft integration without vaginal ulceration and a minimal foreign body reaction, being the sheep a proper animal model to test these types of medical devices.

Desarrollo de una intervención centrada en espiritualidad en pacientes con cáncer / Building a Model of Spirituality-Centered Psychotherapy for Patients with Cancer

Teniendo en cuenta la crisis existencial y espiritual que experimentan los pacientes con cáncer en estadios avanzados se buscó desarrollar una intervención que fomentara el bienestar espiritual y que fuera aplicable a nuestro contexto. Para esto, a partir de una búsqueda de literatura sobre intervenciones centradas en espiritualidad, se establecieron ejes metodológicos y temáticos y se estructuró una psicoterapia orientada a la búsqueda y construcción del sentido de la vida, organizada en ocho sesiones semanales de 90 minutos, para grupos de cuatro a siete pacientes. Se concluye que esta intervención es adecuada para pacientes colombianos con cáncer y con otras enfermedades terminales y se sugiere realizar estudios sobre su eficacia y efectividad antes de su aplicación en la práctica clínica.

Taking into account the spiritual and existential crisi that patients diagnosed with cancer have to face along their advance phases, it was necessary to plan an intervention that promoted the existential wellbeing and could be applied to our context. To do this, based on literature about spititual interventions, we could establish methodological and thematic points in order to structure a psychotherapy focused on building the sense of life. It was organized on eight sessions a week, each one 90 minutes long, for groups of four to seven patients, and it is suggested to develop research about its efficiency and effectiveness before its application on the clinical practice.

Avaliação da magnitude da desvantagem da osteoartrite na vida das pessoas: estudo MOVES / Assessing the magnitude of osteoarthritis disadvantage on people's lives: the MOVES study

Introdução A osteoartrite (OA) é uma das dez doenças mais incapacitantes nos países desenvolvidos e uma das principais causas de dor e incapacitação no mundo. O diagnóstico precoce aumenta a probabilidade de prevenção da progressão da doença. Objetivos Estimar a prevalência de osteoartrite auto-referida e a qualidade de vida em adultos portugueses com 45 ou mais anos de idade. Métodos Estudo observacional, transversal, implementado em domicílios por entrevista interpessoal. Resultados Foram incluídos no estudo 1039 indivíduos com idade média de 62 anos, sendo 54,2% do gênero feminino. A prevalência de osteoartrite auto-referida foi de 9,9%. Os joelhos e as mãos foram o local mais freqüente da doença. A prevalência de OA foi maior em mulheres e em participantes sem atividade profissional. A presença de OA foi maior em participantes com comorbidades. A maioria dos indivíduos já tinham passado por algum tratamento em alguma ocasião de suas vidas para esta doença: 94,5% tiveram tratamento farmacológico, 49,5% fisioterapia, e 19,8% atividade física. A dor estava associada com a estatura, com alguns locais da doença, especificamente pescoço, coluna lombar e ombros, pontuação do SF12 para qualidade de vida, e medidas de impacto no cotidiano dos participantes, gravidade da doença e incapacitação. O impacto da OA no dia-a-dia foi maior em indivíduos que tinham gozado licença por doença ou que pararam de trabalhar por causa da OA, apresentavam-se com pior saúde física e mental, e exibiam maior gravidade da doença. Conclusão Este estudo confirmou que a osteoartrite é uma doença muito relevante, com impacto potencial elevado na qualidade de vida, no funcionamento e na capacidade para o trabalho e, por causa de sua prevalência, exerce um impacto social muito elevado e crescente. .

Introduction Osteoarthritis (OA) is one of the ten most disabling diseases in developed countries and one of the leading causes of pain and disability over the world. Early diagnosis increases the likelihood of preventing disease progression. Objectives To estimate the prevalence of self-reported osteoarthritis and quality of life in Portuguese adults with 45 or more years old. Methods Observational, cross-sectional study, implemented in households by face-to-face interview. Results 1039 subjects with mean age of 62 years and 54.2% female were included. The prevalence of self-reported osteoarthritis was 9.9%. Knees and hands were the most frequent site of disease. The prevalence of OA was higher in women and in participants without professional activity. Presence of OA was higher in participants with comorbidities. Most subjects have done some treatment at some point in time for this disease: 94.5% had drug therapy, 49.5% physiotherapy, and 19.8% physical activity. Pain was associated with height, with some disease locations specifically neck, lower spine and shoulders, SF12 scores of quality of life, and measurements of impact in daily living, severity of disease and disability. The impact of OA in daily living was greater in subjects that had been on sick leave or stopped working due to OA, had worse physical and mental health, and with more severe of disease. Conclusion This study confirmed that osteoarthritis is a very relevant disease with a high potential impact on quality of life, function and work ability and because of its prevalence with a very high growing social impact. .

[Assessing the magnitude of osteoarthritis disadvantage on people's lives: the MOVES study]. / Avaliação da magnitude da desvantagem da osteoartrite na vida das pessoas: estudo MOVES.

INTRODUCTION: Osteoarthritis (OA) is one of the ten most disabling diseases in developed countries and one of the leading causes of pain and disability over the world. Early diagnosis increases the likelihood of preventing disease progression. OBJECTIVES: To estimate the prevalence of self-reported osteoarthritis and quality of life in Portuguese adults with 45 or more years old. METHODS: Observational, cross-sectional study, implemented in households by face-to-face interview. RESULTS: 1,039 subjects with mean age of 62 years and 54.2% female were included. The prevalence of self-reported osteoarthritis was 9.9%. Knees and hands were the most frequent site of disease. The prevalence of OA was higher in women and in participants without professional activity. Presence of OA was higher in participants with comorbidities. Most subjects have done some treatment at some point in time for this disease: 94.5% had drug therapy, 49.5% physiotherapy, and 19.8% physical activity. Pain was associated with height, with some disease locations specifically neck, lower spine and shoulders, SF12 scores of quality of life, and measurements of impact in daily living, severity of disease and disability. The impact of OA in daily living was greater in subjects that had been on sick leave or stopped working due to OA, had worse physical and mental health, and with more severe of disease. CONCLUSION: This study confirmed that osteoarthritis is a very relevant disease with a high potential impact on quality of life, function and work ability and because of its prevalence with a very high growing social impact.

How do titanium and Ti6Al4V corrode in fluoridated medium as found in the oral cavity? An in vitro study.

The purpose of this work was to evaluate the corrosion of commercially pure (CP) titanium and Ti6Al4V in vitro at different F(-) concentrations regularly found in the oral cavity by using different electrochemical tests and surface analysis techniques. electrochemical impedance spectroscopy (EIS), open circuit potential (OCP) and potentiodynamic polarization tests were associated to advanced characterization techniques such as SEM, EDS, AFM, ICP-MS and XPS. OCP tests revealed a higher reactivity of both CP titanium and Ti6Al4V at 12,300 ppm F(-) concentration than that recorded at 227 ppm F(-). Also, a significant decrease of the corrosion resistance of both materials was noticed by EIS in fluoride solutions. Material loss caused by corrosion was noticed on titanium surfaces by SEM and AFM in the presence of high F(-) concentration. CP titanium degraded by pitting corrosion while Ti6Al4V suffered from general corrosion showing micro-cracks on surface. Furthermore, a high release of metallic ions from the test samples after immersion at high F(-) concentrations was detected by ICP-MS, that can be potentially toxic to oral tissues.

Brote de varicela en un establecimiento carcelario de Bogotá, D. C., en 2012 / Chicken Pox Outbreak in a Prison Facility in Bogotá, D. C., 2012 / Surto de catapora em estabelecimento prisional de Bogotá, D. C., ano de 2012

Objetivos: Este es un reporte de caso que describe la investigación epidemiológica de campo de un brote de varicela prolongado y las medidas de control adaptadas a la dinámica de la población reclusa. Fechas y lugares de ejecución del estudio: Establecimiento carcelario en Bogotá, D. C., entre el 22 de julio y el 7 de diciembre de 2012. Métodos: El presente reporte de caso describe los diez pasos para la atención de brotes según la metodología de los Módulos de Principios de Epidemiología para el Control de Enfermedades (MOPECE), de la Organización Panamericana de la Salud (OPS), y las medidas de control para evitar la propagación y las posibles complicaciones de la varicela, aplicadas a los internos del establecimiento carcelario, ubicado en el Distrito Capital, que presenten síntomas como rash papulovesicular generalizado y poca fiebre, o ausencia de esta, sin otra causa. Resultados: De los internos sintomáticos del centro penitenciario que tienen edades entre los 18 y los 40 años, el 100 % son de sexo masculino. La tasa de ataque general fue del 0,18 %. El 100 % de los casos presentaron rash papulovesicular generalizado. El primer caso se presentó el 22 de julio de 2012, y el último, el 7 de diciembre de 2012. Se identificaron 21 casos en 5 de los 12 patios del centro penitenciario. Conclusiones: Aspectos como la reducción del hacinamiento, la optimización las condiciones de salubridad, el fortalecimiento del modelo de atención primaria en salud para la identificación y el control oportunos de casos de interés en salud pública, así como la inmunización de los internos, dada su condición de vulnerabilidad, propenden por la disminución en la frecuencia y por el fácil control de los brotes que se presentan en las prisiones. De esa forma, las mesas de trabajo interinstitucionales son espacios participativos que permiten un adecuado abordaje de este tipo de situaciones.

Objective: This is a case report that describes the epidemiological field investigation of a prolonged chicken pox outbreak, and the control measures adapted to the dynamics of incarcerated population. Date and place of study: Prison facility in the city of Bogotá, D.C, between July 22nd and December 7th 2012. Methods: This case report describes the ten steps for the attention of outbreaks according to Módulos de Principios de Epidemiología para el Control de Enfermedades (MOPECE) and the Pan American Health Organization (PAHO), and the control measures to avoid propagation and complications of chicken pox. This was applied to the inmates of a prison facility in the capital district that present symptoms like generalized papulovesicular rash, or little or no fever without other cause. Results: 100 % of the symptomatic inmates of the penitentiary facility in between 18 and 40 years were men. The overall attack rate was 0.18 %, and 100 % of cases presented generalized papulovesicular rash. The first case was registered on July 22nd and the last on December 7th 2012. 21 cases were identified in 5 of the 12 prison courtyards. Results: Overcrowding reduction, optimization of sanitary conditions, strengthening the model of primary health care for the opportune identification, and interest case control in public health, as well as immunization of inmates given their vulnerability condition, tends to reduce the frequency like the easy control of outbreaks that occur in prisons. Thus, the interagency groups are participatory spaces that permit adequate approaches for these types of situations.

Objetivo: Este é um relato de caso que descreve a investigação epidemiológica de um surto de Catapora prolongada e as medidas de controle adaptadas à dinâmica da população carcerária. Datas e locais de execução do estudo: Estabelecimento Prisional na cidade de Bogotá, D. C., entre 22 de julho e 07 de dezembro de 2012. Métodos: Este relato de caso descreve os dez passos para o cuidado com os surtos de acordo com a metodologia dos Módulos de Princípios de Epidemiologia para o Controle de Doenças (MPECD), da Organização Pan-Americana de Saúde (OPS), e medidas de controle para prevenir a propagação e as possíveis complicações da catapora, aplicado aos reclusos do estabelecimento prisional localizado no Distrito Capital com sintomas como rash papulovesicular generalizada e pouca ou nenhuma febre sem outra causa. Resultados: Os presidiários sintomáticos que têm idade entre 18 e 40 anos, os 100 % são do sexo masculino. A taxa de ataque global foi de 0,18 %. Os 100 % dos casos presentou rash papulovesicular generalizado. O primeiro caso foi diagnosticado em 22 de julho e o último em 7 de dezembro de 2012. Foram identificados 21 casos em cinco dos 12 pátios da prisão. Conclusões: Aspectos como a redução da superlotação, otimização das condições de higiene e o fortalecimento do modelo de cuidados de saúde primários para a identificação oportuna e o controle de casos de interesse da saúde pública, como a imunização dos detentos dada a sua vulnerabilidade, tendem por uma diminuição na frequência, facilitando o controle de surtos que ocorrem nas prisões. Assim, os grupos de trabalho interinstitucionais são espaços de participação, que permitem uma abordagem adequada para este tipo de situação.

Reabilitação física na síndrome de fragilidade do idoso / Physical rehabilitation in the frailty syndrome among the elderly

São considerados idosos frágeis aqueles com vulnerabilidade intrínseca a desenvolver incapacidades e eventos adversos relacionados à saúde. A prevalência de fragilidade aumenta com a idade e a Associação Médica Americana estima que 40% das pessoas com mais de 80 anos são frágeis.Objetivo: Demonstrar os resultados obtidos com o protocolo de reabilitação para idosos frágeis, implementado no Hospital Israelita Albert Einstein-Unidade Vila Mariana. Metódo: Estudo do tipo série de casos, descritivo, retrospectivo, com 12 idosos que cumpriram o programa de reabilitaçãofísica, do ambulatório de geriatria, da Unidade Vila Mariana, do Hospital Israelita Albert Einstein. Resultados: A média de idade foi de 77 anos, 75% dos participantes eram do sexo feminino e apresentavam em média 7,5 diagnósticos. Houve melhora em todos os domínios avaliados: equilí-brio (p = 0,02), velocidade de marcha (p < 0,01), força de membros inferiores (p < 0,01) e força de preensão (p < 0,01) na população estudada. Os idosos com 80 anos ou mais apresentaram melhorade 83% enquanto aqueles com menos de 80 anos mostraram melhora de 41%. Verificou-se que 8 dos 10 idosos que encontravam se na faixa de alto risco para incapacidade, hospitalização e morte (SPPB igual ou menor que 9) conseguiram sair da faixa de risco. Todos demonstraram melhora empelo menos um domínio. Nenhuma piora ou complicação foi verificada. Conclusão: O protocolo de reabilitação para síndrome de fragilidade do idoso, utilizado no ambulatório da Unidade Vila Marina, do Hospital Israelita Albert Einstein, foi capaz de melhorar os domínios equilíbrio, velocidadede marcha, força de membros inferiores e força de preensão palmar na população estudada.

Frail elderly are those who have intrinsic vulnerability to develop disabilities and adverse events related to health. The prevalence of frailty increases with age. The American Medical Association estimates that 40% of those over 80 years old are fragile. Objective: To demonstrate the resultsobtained with the rehabilitation protocol for the frailty syndrome at Vila Mariana Geriatric Outpatient Unit of the Israelita Albert Einstein Hospital. Method: Series of cases study, descriptive and retrospective of 12 elderly who have accomplish the physical rehabilitation program at Vila Mariana geriatric outpatient unit in the Israelita Albert Einstein Hospital. Results: The average age was 77 years, 75% of the participants were female with an average of 7,5 diagnoses. There was improvement in all areas evaluated: balance (p = 0.02), gait speed (p < 0.01), lower limb strength(p < 0.01) and grip strength (p < 0.01). Those who aged 80 or more showed improvement of 83% while those with less than 80 years old, showed an improvement of 41%. It was found that 8 of 10 seniors who met on the track at high risk for disability, hospitalization and death (SPPB equal orless than 9) was able to leave the risk range. It was showed improvement in at least one domain. No deterioration or complication was observed. Conclusion: The rehabilitation protocol for the frailty syndrome that was used at Vila Mariana geriatric outpatient unit was able to improve thebalance, gait speed, lower limb strength and grip strength in the population studied.

Odontoameloblastoma: report of two cases.

Odontoameloblastoma (OA) is a very rare mixed odontogenic neoplasm, characterized by the simultaneous occurrence of an ameloblastoma and a compound or complex odontoma in the same tumor mass. To date, less than 50 cases of OA and/or ameloblastic odontoma have been reported in the English dental literature. This neoplasm was called ameloblastic odontoma. The term OA was included in the 1971 WHO classification. In this study, we present two cases of OA, which we hope will contribute to the awareness and knowledge of surgeons regarding the existence of this odontogenic tumor so that patients having it may be treated and followed-up properly.

Um retrato dos óbitos por acidente de trabalho em Mato Grosso do Sul / A portrait of deaths from work accidents in Mato Grosso do Sul

OBJETIVO: O estudo descreve a mortalidade por acidente de trabalho em Mato Grosso do Sul no ano de 2004. MÉTODO: Foi realizada análise de dados secundários das Declarações de Óbitos registradas em 2004. Do total de registros, foram identificados 88 como acidentes de trabalho e 57 óbitos sugestivos. Foram observadas as variáveis socio-demográficas, atividades econômicas e distribuição espacial. RESULTADOS: Constatou-se predomínio dos óbitos na população masculina, jovem, branca e com baixa escolaridade. Entre as principais ocupações atingidas está a dos motoristas, trabalhadores rurais e da construção civil. A maior ocorrência de registros foi em Dourados e Campo Grande. Os óbitos de trabalhadores no estado têm ocorrência similar ao do país em geral. CONCLUSÕES: Foram notificados apenas acidentes típicos, não houve registro de mortes ocorridas por doenças relacionadas ao trabalho que poderiam ter o campo correspondente preenchido. Recomenda-se a alteração dos termos do atestado de óbito substituindo o texto atual "acidente de trabalho" por "óbitos relacionados ao trabalho" de modo a introduzir no registro de óbito também as mortes resultantes de doenças do trabalho.

OBJECTIVE: This study describes mortalities due to work accidents in Mato Grosso do Sul State, using death certificates for 2004. METHOD: Of the total registered, 88 were identified as work accidents and 57 were suggestive of this fact. Socio-demographic aspects, economic activities and spatial distribution were observed as variables. RESULTS: It was found that the mortalities were predominantly in the population of young, white males of little schooling. Among the principal activities involved are motorists, rural, and civil construction workers. The accidents occurred mainly in the cities of Dourados and Campo Grande. CONCLUSIONS: It was concluded that in this State the mortality of workers is similar to that of the country: under-registration is important, and only typical accidents were notified. It is recommended that an alteration be made in the terms of the death certificate, substituting the present term "work accident" with death related to work so as to introduce in the register those deaths resulting from diseases related to work.

Microscopia ótica aplicada no estudo morfometria da prata de filmes radiográficos / Optical microscopy applied on silver morphometric study from radiographic films

Introdução - O presente estudo aplica a microscopia ótica para analisar os cristais de prata nos filmes radiográficos em Odontologia. Métodos - Filme oclusal foi exposto ao feixe de raios X, produzindo ionização na metade da radiografia, usando-se 67kVp e 8mAs. O filme foi processado utilizando-se a processadora automática Periomat. A avaliação microscópica dos cristais halogenados de prata foi obtida através de microscopia ótica com 100x, 200x e 400x de ampliação. Resultados - Observou-se diferenças entre áreas radiolúcidas e radiopacas na concentração, dispersão e número de cristais no campo de visão. Conclusões - A forma dos cristais permanece fusiforme em ambas as áreas, apesar das diferenças na sua distribuição no filme