Nitrofurantoin-induced liver injury: long-term follow-up in two prospective DILI registries.

Nitrofurantoin is a synthetic antibiotic that is recommended as first-choice treatment for uncomplicated urinary tract infections. The prescription of this drug has increased dramatically, especially in Latin American countries. We described the demographics, clinical characteristics, biochemical features, and outcome of nitrofurantoin-induced liver injury. We analyzed 23 cases from the Latin American DILI Network (LATINDILI) and the Spanish DILI Registry. Causality was assessed with the RUCAM and RECAM scale. Of the 23 DILI cases included in our series, 96% patients were women, and the mean age of the whole cohort was 61 years. The median time of drug exposure was 175 days (interquartile range [IQR] 96-760), with 11 patients who were prescribed nitrofurantoin for more than six months. Hepatocellular damage was the most frequent pattern of liver injury (83%), and nearly half of the patients had an asymptomatic presentation (52%). Neither death nor liver transplantation was documented in this series. Overall, 65% of the patients (n = 15) presented with positive autoantibody titres. The median time to resolution was 81 days (IQR 57-141), and 15 patients (83%) recovered within six months. Five patients (22%) developed nitrofurantoin-induced autoimmune-like hepatitis (NI-AILH), of whom two were characterized by a persistent increase in transaminases that required immunosuppressive treatment to achieve normalization of liver enzymes. Clinicians who prescribe nitrofurantoin should be aware that patients who had taken nitrofurantoin for a long term may be at risk of developing nitrofurantoin-induced autoimmune-like hepatitis.

Serious liver injury induced by Nimesulide: an international collaborative study.

Nimesulide is a non-steroidal anti-inflammatory drug still marketed in many countries. We aim to analyze the clinical phenotype, outcome, and histological features of nimesulide-induced liver injury (nimesulide-DILI). We analyzed 57 cases recruited from the Spanish and Latin American DILI registries. Causality was assessed by the RUCAM scale. Mean age of the whole case series was 59 years (86% women) with a median time to onset of 40 days. A total of 46 patients (81%) were jaundiced. Nimesulide-DILI pattern was hepatocellular in 38 (67%), mixed in 12 (21%), and cholestatic in 7 (12%) cases. Transaminases were elevated with a mean of nearly 20-fold the upper limit of normality (ULN), while alkaline phosphatase showed a twofold mean elevation above ULN. Total bilirubin showed a mean elevation of 13-fold the ULN. Liver histology was obtained in 14 cases (25%), most of them with a hepatocellular pattern. Median time to recovery was 60 days. Overall, 12 patients (21%) developed acute liver failure (ALF), five (8.8%) died, three underwent liver transplantation (5.3%), and the remaining four resolved. Latency was ≤ 15 days in 12 patients (21%) and one patient developed ALF within 7 days from treatment initiation. Increased total bilirubin and aspartate transaminase levels were independently associated with the development of ALF. In summary, nimesulide-DILI affects mainly women and presents typically with a hepatocellular pattern. It is associated with ALF and death in a high proportion of patients. Shorter (≤ 15 days) duration of therapy does not prevent serious nimesulide hepatotoxicity, making its risk/benefit ratio clearly unfavorable.

Assessment of Serious Acute and Chronic Idiosyncratic Drug-Induced Liver Injury in Clinical Practice.

Drug-induced liver injury (DILI) is the leading cause of acute liver failure (ALF) in developed countries. The extremely variable phenotype of DILI, both in presentation and in severity, is one of the distinctive characteristics of the disease and one of the major challenges that hepatologists face when assessing hepatotoxicity cases. A new Hy's law that more accurately predicts the risk of ALF related to DILI has been proposed and validated. Other prognostic scoring algorithms for the early identification of DILI patients who may go on to develop ALF have been developed as it is of most clinical relevance to stratify patients for closer monitoring. Recent data indicate that acute DILI often presents a more prolonged resolution or evolves into chronicity at a higher frequency than other forms of acute liver injury. Risk factors for chronicity, specific phenotypes, and histological features are discussed in this study. Biomarkers to predict DILI outcome are in need.

Use of luminescent gunshot residues markers in forensic context-Part II.

Gunshot residues (GSR) are important physical evidence in firearm-related crimes. Recently developed non-toxic ammunition, however, requires a new methodology for its characterization. To overcome this drawback, the introduction of noncommercial luminescent markers in ammunition was proposed. These markers, synthesized and added to the gunpowder, presented as a versatile tool for GSR analysis, since they require UV radiation alone to visualize the luminescent GSR (LGSR). This has opened up new perspectives for understanding GSR behavior at a crime scene. This work aims to expand previous studies performed with the luminescent markers in forensic contexts, exploring four different important aspects related to GSR behavior. Using LGSR amount/dispersion and a series of blind tests with marked ammunition, we tried to (1) identify the shooter position; (2) estimate the shooting distance; (3) evaluate the influence of the pistol type on the LGSR distribution on the shooter's hands and guns; and (4) study the transference of LGSR by a chain of handshaking. For this purpose, a portable UV lamp (λ=254nm) and/or techniques such as video spectral comparator (VSC) and scanning electron microscopy with energy dispersive X-ray analysis (SEM/EDS) were used to visualize and analyze the residues. As a result, the observation of the LGSR enabled accurate determination of the shooter position and the firing distance without any chemicals. Besides, the LGSR were visualized on different kinds of pistols, regardless of firing mechanism. And finally, this study evidenced transference of residues from shaking hands with the shooter, which should be carefully considered when interpreting the results of a GSR analysis.

Hepatotoxicity induced by coxibs: how concerned should we be?

INTRODUCTION: The selective inhibitors of COX-2, coxibs, are nonsteroidal anti-inflammatory drugs (NSAIDs) that have much better gastrointestinal safety profile as compared with non-selective NSAIDs. In this review, we analyze both the epidemiological features of coxib-induced hepatotoxicity and the clinical impact of coxib-associated liver damage, based on literature data. Areas covered: We carried out a search of the databases MEDLINE (PubMed), LILACS and SCIELO, from December 1999 to January 2016, to retrieve studies exploring the real impact of coxibs in liver toxicity as compared to non-selective COX-2 inhibitor NSAIDs. Expert opinion: Although reliable data on the incidence of celecoxib- and etoricoxib-induced hepatotoxicity are lacking, because of cohort studies have been generally underpowered to detect hepatic events, coxibs have been scarcely related to hepatotoxicity. Hence, coxib-induced liver injury seems to be an uncommon event, yet exhibits a wide spectrum of damage. Increasing COX-2 drug selectivity, as for rofecoxib, valdecoxib, parecoxib, and lumiracoxib, has been associated with higher cardiovascular risk, as well as dermatological and serious hepatic reactions. The actual risk of liver toxicity from the currently approved coxibs compared with non-selective NSAIDs will be discussed. Finally, classical and novel molecular mechanisms of coxib-induced hepatotoxicity are also described.

Tumour necrosis factor-alpha (-308G/A) promoter polymorphism is associated with ulcerative colitis in Brazilian patients.

Inflammatory bowel disease consists of multifactorial diseases whose common manifestation is inflammation of the gastrointestinal tract and their pathogenesis remains unknown. This study aimed to analyse the gene polymorphisms in Brazilian patients with inflammatory bowel disease. A total of 101 patients diagnosed with inflammatory bowel disease were analysed for the tumour necrosis factor-alpha (-308 G/A; rs1800629) and interleukin-10 (-1082 G/A; rs1800896) gene polymorphisms. Genotyping was performed through polymerase chain reaction-sequence-specific primer, then fractionated on 2% agarose gel and visualized after staining by ethidium bromide. The anatomic-clinical form of Crohn's disease (CD) predominant was the inflammatory (32.75%), followed by fistulizing (29.31%) and 27.58% stricturing. As control group, a total of 136 healthy subjects, from the same geographical region, were enrolled. The statistical analyses were performed using R program. The frequency of the A allele at tumour necrosis factor-alpha was high in ulcerative colitis (UC) patients (51%) than in controls (22%; P > 0.01). No statistical difference was found with the genotypic and allelic frequencies of CD patients compared to controls (P = 0.54). The polymorphism -1082G/A of interleukin-10 was not statistical different between the diseases compared to controls. Tumour necrosis factor-alpha (TNF-α) (-308G/A) is associated with UC onset, suggesting that the presence of -308A allele could confer a relative risk of 3.62 more to develop UC in general population. Further studies, increasing the number of individuals, should be performed to ratify the role of TNF-α in the inflammatory bowel disease pathogenesis.

The Latin American DILI Registry Experience: A Successful Ongoing Collaborative Strategic Initiative.

Drug induced liver injury (DILI) is a rare but well recognized serious adverse reaction. Pre-marketing studies may not detect liver injury, and DILI becomes very often apparent after the drug is launched to the market. Specific biomarkers for DILI prediction or diagnosis are not available. Toxic liver reactions present with a wide spectrum of phenotypes and severity, and our knowledge on the mechanisms underlying idiosyncratic reactions and individual susceptibility is still limited. To overcome these limitations, country-based registries and multicenter research networks have been created in Europe and North America. Reliable epidemiological data on DILI in Latin America (LA), a region with a large variety of ethnic groups, were however lacking. Fortunately, a LA network of DILI was set up in 2011, with the support of the Spanish DILI Registry from the University of Malaga. The primary aim of the Latin DILI Network (LATINDILIN) Registry was to prospectively identify bona fide DILI cases and to collect biological samples to study genetic biomarkers. Physicians involved in the project must complete a structured report form describing the DILI case presentation and follow-up which is submitted to a Coordinator Center in each country, where it is further assessed for completeness. During the last four years, several LA countries (Argentina, Uruguay, Chile, Mexico, Paraguay, Brazil, Ecuador, Peru, Venezuela and Colombia) have joined the network and committed with this project. At that point, to identify both our strengths and weaknesses was a very important issue. In this review, we will describe how the LATINDILI Registry was created. The aims and methods to achieve these objectives will be discussed in depth. Additionally, both the difficulties we have faced and the strategies to solve them will be also pinpointed. Finally, we will report on our preliminary results, and discuss ideas to expand and to keep running this network.

Cyproterone acetate induces a wide spectrum of acute liver damage including corticosteroid-responsive hepatitis: report of 22 cases.

BACKGROUND & AIMS: Cyproterone acetate (CPA), an anti-androgenic drug for prostate cancer, has been associated with drug-induced liver injury (DILI). We aim to expand the knowledge on the spectrum of phenotypes and outcomes of CPA-induced DILI. METHODS: Twenty-two males (70 ± 8 years; range 54-83) developing liver damage as a result of CPA therapy (dose: 150 ± 50 mg/day; range 50-200) were included. Severity index and causality by RUCAM were assessed. RESULTS: From 1993 to 2013, 22 patients were retrieved. Latency was 163 ± 97 days. Most patients were symptomatic, showing hepatocellular injury (91%) and jaundice. Liver tests at onset were: ALT 18 ± 13 × ULN, ALP 0.7 ± 0.7 × ULN and total serum bilirubin 14 ± 10 mg/dl. International normalized ratio values higher than 1.5 were observed in 14 (66%) patients. Severity was mild in 1 case (4%), moderate in 7 (32%), severe in 11 (50%) and fatal in 3 (14%). Five patients developed ascitis, and four encephalopathy. One patient had a liver injury that resembled autoimmune hepatitis. Eleven (50%) were hospitalized. Nineteen patients recovered after CPA withdrawal, although three required steroid therapy (two of them had high ANA titres). Liver biopsy was performed in seven patients (two hepatocellular collapse, one submassive necrosis, two cholestatic hepatitis, one cirrhosis with iron overload and one autoimmune hepatitis). RUCAM category was 'highly probable' in 19 (86%), 'probable' in 1 (4%), and 'possible' in 2 (9%). CONCLUSIONS: CPA-induced liver injury is severe and can be fatal, and may occasionally resemble autoimmune DILI. The benefit/risk ratio of this drug should be thoroughly assessed in each patient.

Levantamento etnobotânico de plantas medicinais em área de Caatinga na comunidade do Sítio Nazaré, município de Milagres, Ceará, Brasil / Ethnobotanical survey of medicinal plants in the Caatinga area in the community of Sitio Nazaré, Milagres, Ceará, Brazil

O presente trabalho teve como objetivo realizar um levantamento das plantas medicinais nativas no bioma Caatinga na comunidade do Sítio Nazaré, no município de Milagres, Ceará. Foram utilizadas entrevistas semiestruturadas com 100 informantes entre 25 a 85 anos registrando informações de 62 espécies medicinais sobre o uso, parte utilizada, indicação terapêutica, e formas de preparo dos remédios caseiros, além de coleta do material botânico e produção de exsicatas. As famílias com maior representatividade na pesquisa foram Fabaceae (16 spp.), Euphorbiaceae (7 spp.), Cucurbitaceae e Malvaceae (3 spp.), e as demais com duas ou uma espécie cada. Nas preparações dos remédios caseiros verificou-se que todas as partes da planta são utilizadas, predominando as raízes (33,77%) e as cascas (29,87%). Observaram-se várias formas de preparo, sendo o chá a mais indicada (49,21%), seguida do lambedor (40,69%). Os dados encontrados revelaram que o conhecimento popular sobre as plantas medicinais é de extrema importância para o controle das afecções e contribui para a realização de estudos etnofarmacológicos.

The present study aimed to survey the native medicinal plants in the biome Caatinga in the community of Sítio Nazaré from Milagres, in Ceará, Brazil. Semi-structured interviews with 100 persons, from 25 to 85 years old, were recorded. Sixty-two species were pointed for medical information on use, used plant part, therapeutic indication and methods of preparation of home remedies. We also prepared the collection of botanical material and production of exsiccates. The most representative families reported in this study were: Fabaceae (15 spp.), Euphorbiaceae (7 spp.), Cucurbitaceae and Malvaceae (3 spp.). On the preparation of remedies, we found that all parts of the plants were used, predominantly the roots (33.77%) and the barks (29.87%). The most common way of preparation observed was tea (49.21%), followed by syrup (40.69%). These collected data revealed that popular knowledge on medicinal Caatinga plants were important for disease control in the local population and it has contributed to other ethnopharmacology studies.

Profile of idiosyncratic drug induced liver injury in Latin America: an analysis of published reports.

INTRODUCTION: Drug-induced liver injury (DILI) remains a major problem for drug development and represents a challenging diagnosis for clinicians. The absence of specific biomarkers for diagnosing DILI precludes the availability of reliable data on the epidemiology of the disease. In this study we aimed to describe the features of idiosyncratic hepatotoxicity reports in Latin American countries. MATERIAL AND METHODS: A literature search was performed using the online version of MEDLINE, EMBASE, Scopus, Google Scholar and specific data bases from Latin America (LA) (Scielo, Lilacs) to identify any case report or case series of published DILI from 1996 to 2012. From 1996 to 2012, a total of 176 patients with DILI were published in LA, involving 53 suspicious drugs. The median age in the adult population of these patients was 55 years (17-82) with prevalence of women (67%). Among main therapeutic classes, the rank order was led by non-steroidal anti-inflammatory (61 cases) and systemic antibacterial drugs (37 cases). Nimesulide was the individual drug responsible for the highest number of cases (53), followed by cyproterone acetate (18), nitrofurantoin (17), antituberculous drugs (13) and flutamide (12). Thirty two percent of published cases evolved to acute liver failure (ALF), and half of the subjects required liver transplantation or eventually died. CONCLUSIONS: This study represents the first structured attempt to assess the spectrum of DILI profile in LA. The establishment of a Latin American registry to collect prospective DILI cases using a standardized protocol will advance our knowledge about idiosyncratic DILI in this region.

Outbreak of acute gastroenteritis in young children with death due to rotavirus genotype G9 in Rio Branco, Brazilian Amazon region, 2005.

BACKGROUND: An epidemic of acute gastroenteritis occurred in Rio Branco City, Acre State, in Brazil's Amazon region in 2005. An investigation was conducted to confirm the etiology and identify possible risk factors for death. METHODS: Rio Branco municipality surveillance data for the period May to October 2005 were reviewed. In a case-control study, children who died following acute gastroenteritis were compared to age-matched controls with acute gastroenteritis who survived. Rotavirus A (RV-A) was investigated in 799 stool samples and genotyped by reverse transcription polymerase chain reaction (RT-PCR). RESULTS: The cumulative incidence of diarrhea in children aged <5 years was 21%. A fatal outcome was significantly associated with uncovered household water storage containers. RV-A was identified in 88% of samples and G9 was the prevalent genotype (71%). CONCLUSIONS: Oral rehydration solution and boiling or chlorinating drinking water likely limited mortality. This epidemic was caused by RV-A genotype G9. After the outbreak, a rotavirus vaccine was introduced into the official childhood immunization schedule in Brazil.

Utilidad de la histerosalpingografía como método diagnóstico en la infertilidad / Usefulness of hysterosalpingography in diagnosis in infertility

Objetivo: presentar una base a nuestra experiencia el estado actual de la histerosalpingografía (HSG) discutiendo las diferentes metodologías utilizadas y los hallazgos relacionados con anormalidades tanto a nivel uterino como de las trompas de Falopio. Material y Métodos: Estudiamos 256 pacientes consecutivas desde Julio de 2004 a Mayo de 2007 con edad media de 32.3 años en los días 7 a 10 del ciclo menstrual. Se colocó espéculo y luego de la higiene y antisepsia de la cavidad vaginal se utilizó pinza listerina para la fijación uterina y se administró material de contraste iodado a la cavidad uterina a través de cánula de Rubistein con oliva plástica bajo control radioscópico. Se obtuvieron incidencias radiográficas digitales en decúbito dorsal con relleno parcial, total y ambas oblicuas. Luego de las mismas se realizó la prueba de Cotte. Resultados: En 7 casos no se pudo realizar el estudio por incapacidad de canular el orificio cervical externo. En los demás estudios los resultados fueron clasificados en normales, defectos de relleno intrauterinos, adenomiosis, anomalías mûllerianas, hidrosálpinx, espasmos tubario, obstrucción tubaria, prueba de Cotte positiva o negativa uni o bilateral y sospecha de adherencias pelvianas o masas anexiales acorde a la distribución del material de contraste en la cavidad abdominal. Conclusión: La HSG sigue siendo e la actualidad el estudio de elección para la valoración de las trompas de Falopio y también de gran utilidad para la evaluación interna de la cavidad uterina. Hemos evidenciado un incremento paulatino de las pacientes que se someten a este tipo de estudio proporcional al desarrollo de nuevas metodologías terapéuticas médicas y quirúrgicas para el tratamiento de la infertilidad.

Purpose: To show our experience related to the actual state of the hysterosalpingography including techniques and findings that compromise the uterus and the Fallopian tubes. Material and Methods:We have studied 256 patients from July 2004 till May 2007 with a media of 32.3 years of age, between the days 7 and 10 of the menstrual cycle. We have used an speculum, cleaned the vaginal cavity and afteruterus fixation, the contrast material have been introduced through a Rubistein canula with a plastic olive. We have obtained radiographs in different positions such as partial and full filled endometrial cavity, both oblique incidences and post Cotte test. Results: In 7 cases we couldn´t perform the study because of tiny external cervical orifice. In the rest of the patients thefindings have been classified in normal, uterine filling defects, adenomyosis, müllerian anomalies, hydrosalpinx, tubalspasm, tubal obstruction, positive or uni o bilateral negative Cotte test, and peritoneal or anexial masses suspicion.Conclusion: The HSG is the elective study for the study of the Fallopian tube and have great utility to evaluate theendometrial cavity. We have observed an increase in the number of patients that go through this study related to thedevelopment of new therapeutical strategies (medical or surgical) for the treatment of infertility.

Estudo comparativo dos efeitos biológicos utilizando-se os aparelhos ortodônticos Jones Jig e Pêndulo / A comparative study of the biological effects using the Jones Jig and Pendulum orthodontic appliances

A idealização dos aparelhos distalizadores objetivando a correção da má oclusão de Classe II dentária, com deficiência de espaço no arco superior, foi de grande importância na Ortodontia, visto que má oclusão de Classe II é uma das mais frequentes atingindo até 60% da população ortodôntica. A proposta deste estudo foi comparar o grau das reabsorções radiculares nos primeiros molares e segundos pré-molares superiores, antes, após a distalização dos molares e após o fechamento do espaço obtido através dos aparelhos Jone Jig e Pêndulo, como também identificar as alterações ocorridas na morfologia das cristas ósseas e comparar os dois aparelhos no que diz respeito à significância das reabsorções radiculares ocasionadas pelos mesmos. A amostra constou de 31 pacientes para o aparelho Jones Jig e 30 para o pêndulo. As análises foram feitas através de radiografias periapicais. Os resultados mostraram que: 1) para o grupo de pacientes tratados com o aparelho Jone Jig, uma porcentagem de 61,35% já apresentava reabsorção radicular para o grau 1, enquanto nos pacientes tratados com o aparelho pêndulo, 50% apresentavam do mesmo modo, reabsorção do grau 1; 2) as reabsorções observadas após a distalização dos molares e após o fechamento do espaço obtido foram predominantes nos graus 1 e 2; 3) na comparação entre os graus tratados com os aparelhos Jones Jig e Pêndulo, não houve significância com relação às reabsorções radiculares

Perfil epidemiológico e coproparasitológico de crianças menores de 5 anos internadas no Hospital Governador João Alves Filho em Aracaju - SE com quadro de diarréia aguda / Epidemic profile and coproparasitologic of smaller children 5 years old interned at the hospital governor João Alves Filho with picture of sharp diarrhea

A maioria das diarréias é provocada por vírus, bactérias ou parasitas, durando menos de duas semanas. O diagnóstico baseia-se nos achados clínicos e exames laboratoriais precoces, direcionando o tratamento conforme determinação do Ministério da Saúde.O presente estudo visa traçar o perfil epidemiológico e coproparasitológico de crianças menores de 5 anos, internadas no Hospital Governador João Alves Filho, entre os meses de Julho à Setembro de 2004, com diarréia aguda e destacar a incidência de cada agente etiológico. Foram analisadas 30 amostras fecais de crianças com diarréia, utilizando 3 métodos: Método de Hoffman, coprocultura e reação de látex para Rotavírus. Juntamente, foram aplicados questionários aos responsáveis pela criança, caracterizando os aspectosepidemiológicos. Das amostras analisadas, observou-se a presença de Escherichia coli em 10 casos (33,33%), 9 casos (30%) foram positivos para Rotavírus, 4 casos (13,33%) de Giárdia lamblia, ancilostomídeos em 2 casos (6,66%) e 5 casos (16,66%) não apresentaramresultados conclusivos. Quanto às condições de saneamento básico, 56,6% não possuem rede de esgoto; 59,9% não possuem recolhimento diário do lixo; 93,3% são de famílias com renda per capita menor que 2 salários mínimos; 43,3% das mães não completaram o ensino fundamental. Verificou-se que as mínimas condições sócio-econômicas e culturais favorecem a disseminação dosagentes etiológicos da diarréia.

Disfunción del esfinter de oddi / Oddi`s sphincter dysfunction

La disfuncion del esfinter de Oddi (DEO) es un trastorno adquirido en la que ocurre obstrucción benigna, no litiásica del flujo de bilis o del flujo pancreático a nivel de la unión pancreático biliar, suele sospecharse con muy poca frecuencia como causa de obstrucción de la vía biliar, a pesar de que constituye una de las causas principales después de la patología litiásica y tumoral. Determinar la frecuencia y características de la DEO entre las causas de obstrucción de la vía biliar. Se evaluaron de forma retrospectiva los registros de 18 pacientes, a quienes se les hizo el diagnóstico de DEO, mediante pancreatocolangiografía retrograda endoscópica (PCRE) en el Hospital Miguel Pérez Carreño, Caracas, Venezuela durante los años 2001 al 2002. Los pacientes tuvieron edades comprendidas entre los 16 y 87 años (promedio 47,6 años), con un predominio del sexo femenino (5:1). El diagnóstico de DEO se realizó en 18 de los 197 pacientes que fueron sometidos a PCRE (9,1 por ciento), siendo la tercera causa de obstrucción de la vía biliar, después de la coledocolitiasis y la patología tumoral. Los diagnósticos más frecuentes, previos a la PCRE fueron, síndrome icterobstructivo (44,4 por ciento), dilatación de vías biliares (33,3 por ciento) y pancreatitis (16,7 por ciento). El colédoco presentó diámetro entre 5 y 25 mm (promedio 14 mm), con dilatación del colédoco (>10 mm), en 16 de los 18 pacientes. Las patologías de vías biliares más frecuentemente asociadas a DEO resultaron la litiasis coledociana (5 casos) y la litiasis vesicular (5 casos, 4 confirmados por PCRE). La DEO representa una causa frecuente y poco sospechada de obstrucción de la vía biliar, no se lograron demostrar características diferenciales clínicas o de laboratorio con respecto a otras causas de obstrucción

Pendulum: distalização do molar com simplicidade na confecção e utilização / Pendulum: molar distalization with simplicity on its making and utilization

Durante muito tempo, a correção da Classe II baseava-se no uso de ancoragem extrabucal. Atualmente, inúmeros dispositivos trazem a possibilidade de distalização dos molares superiores, dentre estes o aparelho pêndulo preconizado por Hilgers o qual requer um mínimo de cooperação do paciente, considerando-se que a falta de colaboração poderá levar ao fracasso o mais bem elaborado plano de tratamento. O objetivo deste trabalho, é descrever as características, confecção e indicações do Pêndulo, contando com a ilustração de casos clínicos

First report of Lutzomyia (Nyssomyia) umbratilis Ward & Frahia, 1977 outside of Amazonian Region, in Recife, State of Pernambuco, Brazil (Diptera: Psychodidae: Phlebotominae).

Lutzomyia umbratilis, a known vector of Leishmania guyanensis in the north of Amazon basin, has been exclusively found in the Amazonian region. Here we report for the first time the occurrence of this species in northeastern Brazil. The epidemiological importance of the occurrence of this species in the Atlantic Forest is commented.

[Accidental exposure to X-ray from a diffractometer]. / Uma exposição acidental aos raios X de um difratômetro.

The patients's clinical pictures, characterized by an erythema preceding the skin manifestations, their aspect and the occupational histories, made the diagnosis of a radiation accident possible before its dosimetric identification. Doses evaluations using thermoluminescence dosimeters and ionizing chambers correlated well with the clinical estimations. The immediate cause of the accident was poor maintenance of the device that caused its back window to be permanently open, but lack of adequate information on the biological effects of ionizing radiation and on the correct operational procedures were contributory facts. The description of this accident is relevant in virtue of the misconception that such equipment have "virtually no occupational risk". The patients's medical evolutions have had a favorable course, specially because the low energy of the X-ray and its low penetrating capacity. This accident highlights the need for the adequate training of workers on the handling of radiation devices.

Uma exposição acidental aos raios X de um difratômetro / Accidental exposure to the X-ray of a diffractometer

As mãos de três trabalhadores foram irradiadas acidentalmente numa indústria em Camaçari, Estado da Bahia, Brasil. O diagnóstico clínico de radiodermite aguda foi possível, antes mesmo da confirmação dosimétrica da ocorrência, em virtude das manifestações cutâneas exibidas, precedidas por um eritema, e também pelas histórias ocupacionais. As avaliações das doses recebidas pelos acidentados, usando-se restituições com dosímetros termoluminescentes, tiveram boa correlação com as doses estimadas em função das manifestações clínicas. A causa imediata do acidente foi a má manutenção do equipamento que levou a sua janela posterior a ficar permanentemente aberta, porém foram fatores contributórios importantes a falta de informação dos empregados sobre os possíveis efeitos biológicos das radiações ionizantes e o não seguimento dos procedimentos operacionais corretos. A descrição deste acidente é importante, face ao grande número de difratômetros existentes em laboratórios, universidades, centros de pesquisa e indústrias. Tais aparelhos são considerados "virtualmente isentos de risco ocupacional", o que não é verdadeiro, como comprova a ocorrência que descrevemos. A evolução médica dos pacientes tem sido satisfatória, especialmente em virtude da baixa energia do feixe de raios X do difratômetro e, em conseqüência, da sua pequena penetração tissular.

[Family planning in Brazil in the context of public health policies: important historical factors]. / O planejamento familiar no Brasil no contexto das políticas públicas de saúde: determinantes históricos.

This study searches historical records for the formulation and implementation of public health policies in Brazil, focusing on those referent to family planning. Initial conclusions show that the policies were geared toward international controlling interests. Family planning today, though officially recognized as an inalienable right of every citizen, still reflects the contradictory political, economic and ideological interests of the ruling power.