Surface magnon-polaritons at a dielectric/graphene/gyromagnetic interface in a perpendicular applied magnetic field.

We present a theoretical study of the surface magnon-polaritons at an interface formed by vacuum and a gyromagnetic medium (that can be either ferromagnetic or antiferromagnetic), when there is a graphene layer deposited between the media at the interface and a magnetic field is applied perpendicular to the interface. The retarded-mode dispersion relations are calculated by considering a superposition of transverse magnetic and transversal electric electromagnetic waves in both media. Our results reveal the appearance of the surface magnon-polariton modes (with frequencies typically of a few GHz) that do not exist in the absence of graphene at the interface. Also, a typical magnon-polariton dispersion relation with damping is revealed, including a resonant frequency that depends on the applied magnetic field. The effects of varying the doping levels, which modify the Fermi energies in the graphene, and varying the perpendicular applied magnetic field are presented, revealing a strong influence exerted by the presence of graphene on the surface magnon-polariton modes. Other effects include the control of the slope of the dispersion curves (with respect to the in-plane wave vector) for the modes as the Fermi energies of the graphene sheet are changed and the distinctive localization properties for the emerging surface modes.

Treatment of bladder dysfunction with solifenacin: is there a risk of dementia or cognitive impairment?

The use of bladder antimuscarinics is very common in the elderly. However, recent population-based studies that assessed the use of anticholinergics or bladder antimuscarinics showed an increased risk of dementia when these drugs were used for a prolonged period. Several of these population-based studies included patients who used solifenacin, which is a bladder antimuscarinic released in 2005 with the prospect of being a more selective antimuscarinic for M3 receptors (M3R), which could make it a safer drug when trying to avoid unwanted effects of older bladder antimuscarinics such as oxybutynin, especially with regard to changes in cognition. Since the various bladder antimuscarinics have distinct pharmacological characteristics, such as in the ability to penetrate the blood-brain barrier, in selectivity for muscarinic receptors, and in brain efflux mechanisms, their effects on the central nervous system (CNS) may vary. Solifenacin was the drug selected in this review, which aims to describe the results of several articles published in recent years reporting the effects of solifenacin on cognition or the risk of dementia development. Although preclinical studies show that solifenacin can also act on brain M1 receptors (M1R), short-term clinical studies have shown it to be safe for cognition. However, there are no long-term randomized studies that prove the safety of this drug for the CNS. Thus, until the safety of solifenacin has been established by long-term studies, it seems advisable to avoid prolonged use of this drug in elderly patients.

Treatment of bladder dysfunction with solifenacin: is there a risk of dementia or cognitive impairment?

The use of bladder antimuscarinics is very common in the elderly. However, recent population-based studies that assessed the use of anticholinergics or bladder antimuscarinics showed an increased risk of dementia when these drugs were used for a prolonged period. Several of these population-based studies included patients who used solifenacin, which is a bladder antimuscarinic released in 2005 with the prospect of being a more selective antimuscarinic for M3 receptors (M3R), which could make it a safer drug when trying to avoid unwanted effects of older bladder antimuscarinics such as oxybutynin, especially with regard to changes in cognition. Since the various bladder antimuscarinics have distinct pharmacological characteristics, such as in the ability to penetrate the blood-brain barrier, in selectivity for muscarinic receptors, and in brain efflux mechanisms, their effects on the central nervous system (CNS) may vary. Solifenacin was the drug selected in this review, which aims to describe the results of several articles published in recent years reporting the effects of solifenacin on cognition or the risk of dementia development. Although preclinical studies show that solifenacin can also act on brain M1 receptors (M1R), short-term clinical studies have shown it to be safe for cognition. However, there are no long-term randomized studies that prove the safety of this drug for the CNS. Thus, until the safety of solifenacin has been established by long-term studies, it seems advisable to avoid prolonged use of this drug in elderly patients.

Effects of conditioning on the welfare of jaguars (Panthera onca) in captivity / Efeitos do condicionamento sobre o bem-estar de onças-pintadas (Panthera onca) em cativeiro

The jaguar is the largest feline in the Americas and in the face of the threat of extinction and the reduction of natural areas, keeping the species in captivity may be important for its conservation. This condition can lead to a reduction in well-being, especially due to spatial limitation and lack of environmental stimulus. In recent decades, techniques have been sought to minimize the negative impacts of captivity, with an increase in the use of environmental enrichment and operational conditioning in order to facilitate routine procedures for the animal management. In this scenario, this study aimed to evaluate the effects of conditioning on the welfare of jaguars in captivity, analyzing behavioral and physiological effects through salivary cortisol. Seven jaguars were studied in a Scientific Breeder. There was an increase in behaviors associated with welfare and cortisol during conditioning, possibly related to learning. The increase in behaviors associated with welfare suggests that the technique can contribute to improve the quality of life of these animals in captivity.(AU)

A onça-pintada é o maior felino das Américas e, diante da ameaça de extinção e da redução de áreas naturais, manter a espécie em cativeiro pode ser importante para sua conservação. Essa condição pode levar à redução no bem-estar, especialmente devido à limitação espacial e à carência de estímulos ambientais. Nas últimas décadas, têm sido buscadas técnicas para minimizar os impactos negativos do cativeiro, com crescimento da utilização de enriquecimento ambiental e do condicionamento operante, com o intuito de facilitar procedimentos de rotina do manejo dos animais. Nesse cenário, o presente estudo teve por finalidade avaliar os efeitos do condicionamento sobre o bem-estar de onças-pintadas em cativeiro, analisando-se efeitos comportamentais e fisiológicos por meio do cortisol salivar. Foram estudadas sete onças-pintadas em um criadouro científico. Houve aumento dos comportamentos associados ao bem-estar e do cortisol durante o condicionamento, possivelmente relacionados à aprendizagem. O aumento nos comportamentos de bem-estar sugere que a técnica pode contribuir para melhorar a qualidade de vida desses animais em cativeiro.(AU)

Sociodemographic factors associated with COVID-19 in-hospital mortality in Brazil.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has highlighted inequalities in access to healthcare systems, increasing racial disparities and worsening health outcomes in these populations. This study analysed the association between sociodemographic characteristics and COVID-19 in-hospital mortality in Brazil. STUDY DESIGN: A retrospective analysis was conducted on quantitative reverse transcription polymerase chain reaction-confirmed hospitalised adult patients with COVID-19 with a defined outcome (i.e. hospital discharge or death) in Brazil. Data were retrieved from the national surveillance system database (SIVEP-Gripe) between February 16 and August 8, 2020. METHODS: Clinical characteristics, sociodemographic variables, use of hospital resources and outcomes of hospitalised adult patients with COVID-19, stratified by self-reported race, were investigated. The primary outcome was in-hospital mortality. The association between self-reported race and in-hospital mortality, after adjusting for clinical characteristics and comorbidities, was evaluated using a logistic regression model. RESULTS: During the study period, Brazil had 3,018,397 confirmed COVID-19 cases and 100,648 deaths. The study population included 228,196 COVID-19-positive adult in-hospital patients with a defined outcome; the median age was 61 years, 57% were men, 35% (79,914) self-reported as Black/Brown and 35.4% (80,853) self-reported as White. The total in-hospital mortality was 37% (85,171/228,196). Black/Brown patients showed higher in-hospital mortality than White patients (42% vs 37%, respectively), were admitted less frequently to the intensive care unit (ICU) (32% vs 36%, respectively) and used more invasive mechanical ventilation (21% vs 19%, respectively), especially outside the ICU (17% vs 11%, respectively). Black/Brown race was independently associated with high in-hospital mortality after adjusting for sex, age, level of education, region of residence and comorbidities (odds ratio = 1.15; 95% confidence interval = 1.09-1.22). CONCLUSIONS: Among hospitalised Brazilian adults with COVID-19, Black/Brown patients showed higher in-hospital mortality, less frequently used hospital resources and had potentially more severe conditions than White patients. Racial disparities in health outcomes and access to health care highlight the need to actively implement strategies to reduce inequities caused by the wider health determinants, ultimately leading to a sustainable change in the health system.

Anti-inflammatory and antinociceptive effects of the isatin derivative (Z)-2-(5-chloro-2-oxoindolin-3-ylidene)-N-phenyl-hydrazinecarbothioamide in mice.

Several isatin derivatives have shown important biological activities, which have attracted interest from researchers. For this reason, the present study aimed to evaluate the anti-inflammatory and antinociceptive effects of the isatin derivative (Z)-2-(5-chloro-2-oxoindolin-3-ylidene)-N-phenyl-hydrazinecarbothioamide (COPHCT) in mice. Three doses of this compound were tested: 1.0, 2.5, and 5.0 mg/kg. The anti-inflammatory activity was assessed using the carrageenan-induced paw edema model and the zymosan-induced air pouch model. The evaluation of the antinociceptive effect was performed through the formalin test and the acetic acid-induced abdominal writhing test. The paw edema assay demonstrated that all doses of the compound showed a significant reduction of the edema in the second hour evaluated, but a better response was observed in the fourth hour. The zymosan-induced air pouch model indicated that the compound, in all doses, significantly reduced leukocyte migration and total protein concentration levels. In the formalin test, the doses 1.0, 2.5, and 5.0 mg/kg of COPHCT showed activity only in the second phase, with reduction in paw pain time of 73.61, 79.46, and 73.85%, respectively. The number of abdominal writhings decreased with the increasing dose, but only 5.0 mg/kg COPHCT exhibited a significant response, with a reduction of 24.88%. These results demonstrated the ability of this compound to interfere in the anti-inflammatory activity of edema, vascular permeability, and cell migration. In addition, its possible antinociceptive effect may be related to the dose used.

Mobile health technologies for the management of systemic lupus erythematosus: a systematic review.

OBJECTIVE: We aimed to perform a standardized review of available mobile health (mHealth) applications (apps) for systemic lupus erythematosus (SLE) and to conduct a systematic review of the literature on mHealth technologies in SLE. METHODS: Google Play and AppStore in the United States of America were queried and the quality of eligible mHealth apps was assessed using the Mobile App Rating Scale (MARS). Web of Science, EMBASE, Medline, and Cochrane databases were systematically searched from inception through June 2019. RESULTS: Of 324 mHealth apps found, 20 were eligible for inclusion; 10 focused on education, 7 offered tools to track patient-reported symptoms, 5 included interactive online communities, and 1 enabled emoji sharing. The reviewed apps scored poorly on the MARS quality scale with a mean score 2.3 (0.6) out of 5. Of 1147 studies identified in the literature review, 21 were eligible for inclusion; 11 studies (52.4%) focused on the development and use of mHealth for providing patient information, while only 2 (9.5%) were randomized trials of mHealth interventions. CONCLUSIONS: Although there is growing interest in the development of mHealth technologies to support SLE patients, currently available tools are of poor quality and limited functionality, and the literature examining this area is sparse.

Anti-inflammatory and antinociceptive effects of the isatin derivative (Z)-2-(5-chloro-2-oxoindolin-3-ylidene)-N-phenyl-hydrazinecarbothioamide in mice

Several isatin derivatives have shown important biological activities, which have attracted interest from researchers. For this reason, the present study aimed to evaluate the anti-inflammatory and antinociceptive effects of the isatin derivative (Z)-2-(5-chloro-2-oxoindolin-3-ylidene)-N-phenyl-hydrazinecarbothioamide (COPHCT) in mice. Three doses of this compound were tested: 1.0, 2.5, and 5.0 mg/kg. The anti-inflammatory activity was assessed using the carrageenan-induced paw edema model and the zymosan-induced air pouch model. The evaluation of the antinociceptive effect was performed through the formalin test and the acetic acid-induced abdominal writhing test. The paw edema assay demonstrated that all doses of the compound showed a significant reduction of the edema in the second hour evaluated, but a better response was observed in the fourth hour. The zymosan-induced air pouch model indicated that the compound, in all doses, significantly reduced leukocyte migration and total protein concentration levels. In the formalin test, the doses 1.0, 2.5, and 5.0 mg/kg of COPHCT showed activity only in the second phase, with reduction in paw pain time of 73.61, 79.46, and 73.85%, respectively. The number of abdominal writhings decreased with the increasing dose, but only 5.0 mg/kg COPHCT exhibited a significant response, with a reduction of 24.88%. These results demonstrated the ability of this compound to interfere in the anti-inflammatory activity of edema, vascular permeability, and cell migration. In addition, its possible antinociceptive effect may be related to the dose used.

Predicting acquisition of carbapenem-resistant Gram-negative pathogens in intensive care units.

BACKGROUND: Infections by multidrug-resistant Gram-negative (MDRGN) bacteria are among the greatest contemporary health concerns, especially in intensive care units (ICUs), and may be associated with increased hospitalization time, morbidity, costs, and mortality. AIM: The study aimed to predict carbapenem-resistant MDRGN acquisition in ICUs, to determine its risk factors, and to assess the impact of this acquisition on mortality rate. METHODS: A matched case-control study was performed in patients admitted to the ICU at a large Brazilian hospital over a five-year period. Cases were defined as patients who acquired carbapenem-resistant MDRGN bacteria during hospitalization. Controls were defined as patients who had no detection of carbapenem-resistant MDRGN bacteria. Cases were matched to controls according to the admission period. Risk factors were identified by multiple logistic regression using a stepwise selection method. FINDINGS: In total, 343 cases and 1029 controls were analysed. The 30-day mortality rate for subjects with ICU-associated carbapenem-resistant MDRGN was 37.6%. Five variables were identified as statistically significant and more relevant for the acquisition of multidrug-resistant strains: increased Simplified Acute Physiology Score 3, patients with severe chronic obstructive pulmonary disease and exposure to haemodialysis catheter, central venous catheter, or mechanical ventilation. Models developed displayed good results with an accuracy of ∼90%. Patients who acquired MDRGN were 2.72 times more likely to die than non-MDRGN acquisition patients. CONCLUSION: Finding risk factors and developing predictive models may benefit patients through early detection and by controlling the spread of MDR. The presence of mechanical ventilation and central venous catheter were the main risk factors demonstrated, and their use requires special attention.

Cone beam computed tomography devices in the evaluation of buccal bone in anterior teeth.

OBJECTIVE: To determine the accuracy of various cone beam computed tomography (CBCT) devices in assessing the buccal bone in anterior teeth. MATERIAL AND METHODS: A skull encased in tissue equivalent material was imaged with six CBCT devices: 3D Accuitomo 170 (J. Morita, Japan), CS 9000 3D (Carestream Dental, France), CS 9300 (Carestream Dental, France), Eagle 3D (Dabi Atlante, Brazil), i-CAT Classic (Imaging Sciences International, USA) and Orthophos XG 3D (Sirona Dental System, USA). The exposure and acquisition protocols were determined using the manufacturer's guidelines, the voxel size adjusted as close as possible to 0.2 mm. Cross-sectional images were evaluated randomly, and the buccal bone was assessed. RESULTS: The statistics were calculated based on a logistic regression model with the significance level set at 5%. All CBCT devices showed high accuracy; however, observers noted that the accuracy and sensitivity of CS 9300 device were slightly superior. CONCLUSION: The diagnostic performance of all CBCT devices was high for the evaluation of buccal bone in anterior teeth. When the clinical usefulness of an imaging modality is equivalent, the choice of appropriate imaging should be directed towards the modality that delivers the least radiation dose to the patient for a specific diagnostic task.

Purinergic receptors and neglected tropical diseases: why ignore purinergic signaling in the search for new molecular targets?

Purinergic receptors are widespread in the human organism and are involved in several physiological functions like neurotransmission, nociception, platelet aggregation, etc. In the immune system, they may regulate the expression and release of pro-inflammatory factors as well as the activation and death of several cell types. It is already described the participation of some purinergic receptors in the inflammation and pathological processes, such as a few neglected tropical diseases (NTDs) which affect more than 1 billion people in the world. Although the high social influence those diseases represent endemic countries, most of them do not have an efficient, safe or affordable drug treatment. In that way, this review aims to discuss the current literature involving purinergic receptor and immune response to NTDs pathogens, which may contribute in the search for new therapeutic possibilities.

Effects of passiflora incarnata and midazolam for control of anxiety in patients undergoing dental extraction.

BACKGROUND: Anxiety symptoms are frequently observed in dental patients, whether they are undergoing simple or more invasive procedures such as surgery. This research aimed to compare the effects of Passiflora incarnata and midazolam for the control of anxiety in patients undergoing mandibular third molar extraction. MATERIAL AND METHODS: Forty volunteers underwent bilateral extraction of their mandibular third molars in a randomized, controlled, double-blind, crossover clinical trial. Passiflora incarnata (260 mg) or midazolam (15 mg) were orally administered 30 minutes before surgery. The anxiety level of participants was evaluated by questionnaires and measurement of physical parameters, including heart rate (HR), blood pressure (BP), and oxygen saturation (SpO2). RESULTS: Considering each procedure independently, there were no significant differences between the protocols in BP, HR, and SpO2. Over 70% of the volunteers responded that they felt quiet or a little anxious under both protocols. With midazolam, 20% of the participants reported amnesia (not remembering anything at all), while Passiflora showed little or no ability to interfere with memory formation. CONCLUSIONS: Passiflora incarnata showed an anxiolytic effect similar to midazolam, and was safe and effective for conscious sedation in adult patients who underwent extraction of their mandibular third molars.

Occurrence of the accessory foramina of the mandibular ramus in Brazilian adults and its relation to important mandibular landmarks / Presencia de forámenes accesorios de la rama mandibular en adultos brasileños y su relación con importantes puntos de referencia de la anatomía mandibular

The presence of the Accessory Foramina of the Mandibular Ramus (AFMR) may be related to anaesthetic failures in the inferior alveolar nerve block and complications in the ramus surgeries. The purpose of the present investigation was to determine the occurrence of the AFMR in adults and, when present, measure its distance to the Mandibular Foramen (MF), to the Mandibular Lingula (ML) and to the posterior margin of the mandibular ramus (PM), comparing data obtained in both sides of the mandible. Thirty dry human mandibles were selected to the present study. The AFMR was considered as every foramina identified between the MF and the PM. When present, its distance to the MF, to the ML and to the PM was measured. The AFMR was identified in 15 of the 30 examined mandibles (50 %), presenting exclusively on the right side in four cases (13.33 %), exclusively on the left side in other four cases (13.33 %) and simultaneously on both mandibular antimeres in seven of the 30 inspected mandibles (23.33 %). The AFMR is a structure considered as anatomic vari4ation but it was present in one of each two mandibles investigated, with the same occurrence in both mandibular sides. For the cases of occurrence of the AFMR, the professional will be able to locate it in a central position between the MF and the PM, distant about seven millimeters to the MF and 10.50 mm to the ML in both sides of the mandible.

La presencia de forámenes accesorios de la rama mandibular (FARM) puede estar relacionada con fallas que ocurren en el bloqueo anestésico del nervio alveolar inferior y con complicaciones durante cirugías de la rama mandibular. El propósito del presente estudio fue determinar la presencia de FARM en adultos brasileños y cuando éstos estuvieren presentes, medir la distancia al foramen mandibular (FM), a la língula de la mandíbula (LM) y al margen posterior de la rama mandibular (MP), comparando estos datos en ambos lados de la mandíbula. Para ello fueron seleccionadas 30 mandíbulas humanas secas. El FARM fue considerado como cada foramen identificado entre el FM y MP. El FARM fue identificado en 15 de las 30 mandíbulas examinadas (50 %), presentándose en el lado derecho en 4 casos (13,33 %), en el lado izquierdo en 4 (13,33 %) y en ambos lados en 7 (23,33 %). Los FARM son considerados como una variación anatómica pero en este estudio estuvo presente en una de cada dos mandíbulas, con la misma frecuencia en ambas mandíbulas. En el caso de presencia del FARM, el profesional será capaz de identificarlo en una posición central entre el FM y el MP, distante 7 mm aproximadamente del FM y a 10,5 mm de la LM en ambos lados de la mandíbula.

Exigência nutricional de proteína bruta para codornas japonesas (Coturnix coturnix japonica) na fase de postura / Nutritional requirement of crude protein for japanese quail (Coturnix coturnix japonica) in the production phase

O objetivo do trabalho foi determinar o melhor nível de proteína bruta na alimentação de codornas japonesas em fase de produção. Foram utilizadas 300 codornas com 16 semanas de idade, alojadas em gaiolas, em um delineamento inteiramente casualizado, com cinco tratamentos, seis repetições e dez aves por unidade experimental. Os níveis avaliados foram 14, 17, 20, 23 e 26 por cento de proteína bruta, e as dietas foram formuladas para serem isoenergéticas. Foi verificado efeito quadrático para consumo de ração, peso de ovo, massa de ovo, ingestão de energia, eficiência energética por dúzia de ovo, coeficiente de digestibilidade de nitrogênio, retenção de nitrogênio, peso de gema, casca e albúmen. Efeito linear foi verificado para produção de ovos, ingestão de proteína, conversão alimentar por massa de ovos, eficiência energética por massa de ovo em kg, peso final e gravidade específica. Não houve efeito significativo para conversão alimentar por dúzia e concentração sérica de ácido úrico. Recomenda-se nível de 20 por cento de proteína bruta para codornas japonesas em fase de postura...

The aim of this study was to determine the best level of crude protein in the diet of Japanese quails in the production phase. A total of 300 quails at 16 weeks of age in cages, in a completely randomized design with five treatments and six replicates of ten birds per experimental unit was used. The levels evaluated were 14, 17, 20, 23 and 26 percent crude protein and diets were formulated to be isoenergetic. A quadratic effect was observed for feed intake, egg weight, egg mass, energy intake, energy efficiency per dozen eggs, nitrogen digestibility, shell percentage, nitrogen retention, weight of yolk, albumen and shell. A linear effect was observed for egg production, protein intake, feed conversion by egg mass, energy efficiency per egg mass in kg, final weight and yolk percentage and specific gravity. There was no significant effect on feed conversion per dozen, percentage of albumen, shell thickness and serum uric acid. The recommendation is of a 20 percent crude protein level for Japanese quail during the laying phase...

Prevalence and predictors of nonadherence to hemodialysis.

BACKGROUND: The prevalence of nonadherence to dialysis (NAD) presents a wide variation, depending on the parameters used and demographic regions studied. This study aimed to assess the prevalence and predictors of NAD of patients with chronic kidney disease undergoing hemodialysis (HD). MATERIALS AND METHODS: This was a cross-sectional study with 255 adult patients receiving HD for >3 months. Skipping a session per month, shortening a session for at least 10 min, phosphorus >7.5 mg/dl, potassium >6.0 mmol/l and interdialytic weight gain (IDWG) >5.7% of body weight were indicative of NAD. The association of sociodemographic and clinical variables with NAD was assessed using logistic regression. RESULTS: Mean age was 50 ± 13.1 years, 62.7% were male, 85.5% were of African descent and 62% were married. The prevalence rates of NAD were: 49% of shortening sessions, 18% of hyperkalemia, 12% of hyperphosphatemia, 9% of IDWG >5.7% of dry weight and 8% of skipping HD. Independent predictors of NAD were: age ≤50 years, not being married, living alone, living in Salvador, attending dialysis without a companion, ethnic African descent, Kt/V <1.3 and residual diuresis <100 ml/day. CONCLUSION: NAD is frequent and distinct sociodemographic and clinical variables predict different parameters.

Ocorrência de Hepatozoon spp. (Apicomplexa, Hepatozoidae) em serpentes captive Boa constrictor mantidas em cativeiro no semiárido do estado do Rio Grande do Norte / Occurrence of Hepatozoon spp. (Apicomplexa, Hepatozoidae) in captive Boa constrictor snakes in the semi-arid of Rio Grande do Norte State, Northeastern Brazil

The occurrence of Hepatozoon spp. in the blood cells of captive Boa constritor in captivity in the semi-arid of the Rio Grande do Norte State, Brazil, was analyzed. Blood samples from Geochelone carbonaria (n = 6), Geochelone denticulata (n = 4), Boa Constrictor (n = 7), and Tupinanbis teguixim (n = 10) were used. All snakes presented Hepatozoon spp. in their blood cells, and few erythrocytes were infected. G. carbonaria, G. denticulate, and T. teguixim were negative for Hepatozoon spp. gametocytes research. This is the first report of the occurrence of Hepatozoon spp. in captive B. constritor in the studied area.

Oral ciprofloxacin vs. intravenous ceftriaxone administered in an outpatient setting for fever and neutropenia in low-risk pediatric oncology patients: randomized prospective trial.

BACKGROUND: Infections are one of the major complications in children undergoing chemotherapy. Monotherapy with either ciprofloxacin or ceftriaxone is safe and efficient in low-risk patients (solid tumors and stage I/II lymphomas). The same drugs may be used in an outpatient setting, decreasing costs and the risk of nosocomial infections. PROCEDURE: Low-risk patients (N = 70) with episodes of fever and neutropenia (N = 116) were randomized to receive either oral ciprofloxacin or intravenous ceftriaxone as outpatients. Only one patient had a central venous catheter. RESULTS: Episodes of fever and neutropenia were classified as fever of unknown origin (41% vs. 32%) or clinically documented infection (56% vs. 63%) in the ciprofloxacin and ceftriaxone groups, respectively. Most of these infections were of upper respiratory tract, skin, or gastrointestinal origin. The mean duration of neutropenia was 5 vs. 6 days. Fever persisted for 1-9 days (mean 2 vs. 3 days). Therapy was successful with no modifications in 83% vs. 75% of the episodes. Patients were admitted in 7% vs. 4% of the episodes. No bone or joint side effects were seen in either group. All patients survived. CONCLUSIONS: Outpatient therapy with either oral ciprofloxacin or intravenous ceftriaxone for fever and neutropenia is effective and safe in pediatric patients with solid tumors and stage I/II non-Hodgkin lymphoma (low-risk patients).

Abordagem atual em carcinoma de pequenas células de pulmäo / Actual approach in small cell lung cancer

A neoplasia pulmonar tem sido por muitos anos a principal causa de morte por câncer nos homens e mulheres. A Sociedade Americana de Oncologia Clínica estimou que, em 1999, 171.500 novos casos de câncer de pulmäo seräo diagnósticados, e deste, 160.100 morreräo devido a essa neoplasia. Baseado no seu tratamento, dividiu-se o câncer de pulmäo em dois grupos: carcinoma de pequenas células, no qual, o tratamento é principalmente quimioterápico e representa 20 por cento dos casos, e carcinoma näo pequenas cálulas, no qual, nos estágios iniciais (I e II), é tratado exclusivamente com cirurgia, respresentando 80 por cento dos casos. Este artigo enfoco a abordagem atual no tratamento do carcinoma de pequenas células baseado nos quias publicados recentemente pela National Comprehensive Cancer Network e Sociedade Brasileira de Oncologia Clínica

Tumor germinativo extra-gonadal e síndrome de Klinefelter: relato de caso / Extragonadal germ cell tumor and Klinefelter's syndrome: case report

Muitos relatos vêm sugerindo a associaçäo entre a síndrome de Klinefelter e o tumor germinativo. Um risco elevado de tumor germinativo extragonadal (mediastinal) ocorre a partir da adolescência até 30 anos. O autor apresenta o caso de um jovem de 19 anos de idade com sintomas respiratórios, massa torácica e características clínicas de síndrome de Klinefelter. O cariótipo do sangue periférico foi de 47 XXY e o estudo da lesäo torácica foi de teratoma imaturo. O paciente foi tratado com quimioterapia combinada seguida de toracotomia, estando em remissäo completa há seis anos após o diagnóstico. Este estudo discute as características clínicas e laboratoriais dos pacientes com tumor germinativo extragonadal associado a síndrome de Klinefelter, e sua participaçäo na gênese dos tumores de células germinativas.