Sperm concentration of boar semen doses and sperm quality: Novel perspectives based on the extender type and sperm resilience.

This study evaluated the effect of sperm concentration of boar semen doses on their capacity to maintain its motility over the thermo-resistance test (TRT; sperm resilience) and verified if the extender type (short or long-term) could influence this effect. Thirty ejaculates from five crossbred mature PIC® boars were used, and a factorial design was followed to produce semen doses with 1.5 billion cells in 45 or 90 mL, using Beltsville Thawing Solution (BTS) or Androstar® Plus (APlus). Then, low-concentration doses (16.7 × 106 cells/mL in 90 mL) and higher-concentration doses (33.3 × 106 cells/mL in 45 mL) with BTS or APlus were produced and stored at 17 °C for 168 h. At 72 h, during the TRT, the low-concentration doses (16.7 × 106 cells/mL) lost three-fold less motility than doses with 33.3 × 106 cells/mL (P < 0.01), regardless of the extender type (11. 5% vs. 30.5% of initial motility, respectively). Similar results were found when the TRT was carried out at 168 h, with low-concentration doses losing two-fold less motility (11.4%) than highly concentrated doses (25.9%; P < 0.01). No sperm concentration effect was observed on membrane integrity or mitochondrial membrane potential (P ≥ 0.23). The osmolarity was not affected by the sperm concentration (P = 0.56), only by the extender and the storage time (P < 0.01). In conclusion, the sperm concentration effect on sperm quality was not influenced by extender type, and the data suggest that a low concentration of semen doses positively affects sperm resilience.

Síndrome de Burnout entre profissionais que trabalham com atendimento ao público / Burnout syndrome among professionals who work with public service / Síndrome de Burnout en profesionales que trabajan en el servicio público

Objetivo: Identificar a ocorrência da Síndrome de Burnout nos profissionais que trabalham com atendimento ao público. Método: estudo de corte transversal, descritivo com 81 profissionais de uma faculdade em município brasileiro, entre os meses de setembro e outubro de 2021. Aplicou-se o instrumento validado Maslach Burnout Inventory e um formulário com as caracteristicas sociodemográficas. Resultados: A maioria dos entrevistados tem entre 18 e 30 anos, se auto declaram pardos e possuem ensino superior. Observou-se que 45% dos participantes tem uma possibilidade de desenvolvimento da sindrome, e 38% estão na fase inicial. Conclusão: profissionais mais jovens são mais propensos a apresentar a síndrome de Burnout. Estimula-se o desenvolvimento de estudos interdisciplinares para o processo saúde-doença-mental possibilitando uma nova abordagem de preveção e cuidado em condutas investigativas e intervencionistas em academias de níveis superiores, de forma a buscar momentos saudáveis para o profissional.

Objective: To identify the occurrence of Burnout Syndrome in professionals who work with public service. Method: cross-sectional, descriptive study with 81 professionals from a college in a Brazilian municipality, between September and October 2021. The validated Maslach Burnout Inventory instrument and a form with sociodemographic characteristics were applied. Results: Most respondents are between 18 and 30 years old, self-declared brown and have higher education. It was observed that 45% of the participants have a possibility of developing the syndrome, and 38% are in the initial phase. Conclusion: younger professionals are more likely to present the Burnout syndrome. The development of interdisciplinary studies for the mental health- illness process is encouraged, enabling a new approach to prevention and care in investigative and interventional conducts in higher education academies, in order to seek healthy moments for the professional.

Objetivo: Identificar la ocurrencia del Síndrome de Burnout en profesionales que actúan en el servicio público. Método: estudio descriptivo transversal con 81 profesionales de una facultad de un municipio brasileño, entre septiembre y octubre de 2021. Se aplicó el instrumento Maslach Burnout Inventory validado y un formulario con características sociodemográficas. Resultados: La mayoría de los encuestados tienen entre 18 y 30 años, se declaran morenos y tienen estudios superiores. Se observó que el 45% de los participantes tiene posibilidad de desarrollar el síndrome, y el 38% se encuentra en fase inicial. Conclusión: los profesionales más jóvenes son más propensos a presentar el síndrome de Burnout. Se fomenta el desarrollo de estudios interdisciplinarios para el proceso salud-enfermedad mental, posibilitando un nuevo abordaje de la prevención y el cuidado en las conductas investigativas e intervencionistas en las academias de educación superior, con el fin de buscar momentos saludables para el profesional.

Percepções simbólicas e enfrentamentos de mães sobre aleitamento materno / Symbolic perceptions and facing mothers about breastfeeding / Percepciones simbólicas y frente a las madres sobre la lactancia materna

Objetivo: avaliar as percepções simbólicas sobre aleitamento materno de mães residentes em município paraibano. Método: Trata-se de um estudo descritivo, de corte transversal, com abordagem qualitativa, realizado com 67 mães. A pesquisa foi desenvolvida via questionário virtual enviado por smartphones, por meio do Google Forms®, através da técnica de Respondent Driven Sampling (RDS), durante os meses de dezembro de 2020 a abril de 2021. Os dados foram tabulados e analisados por meio do programa Microsoft Excel®, versão 97-2003, para Windows 8. Os dados foram analisados por meio da técnica de análise temática de conteúdo, seguindo as etapas de pré-análise, exploração do material e tratamento dos resultados A pesquisa foi aprovada pelo CEP por meio do parecer 4.469.159, protocolo 302/2020 e CAAE 40194920.0.0000.5179. Resultados: a maioria das mulheres eram auto declarante pardas, evangélicas, com faixa etária entre 30 e 40 anos, graduadas, vivem com dois salários mínimos ou mais, possuem parceiro fixo, vivem com parceiro e filhos, tiveram seis ou mais consultas de pré-natal e tiveram parto em ambiente hospitalar via cesariana. Os discursos geraram as categorias: expressão de amor, vínculo, renúncia e sacrifício enquanto simbologias maternas frente ao aleitamento; as dimensões do nutrir: colo de mãe, crescimento e desenvolvimento enquanto percepções simbólicas; aleitamento materno e enfrentamentos frente à sexualidade: indiferença, redução da libido e zona proibida; conselhos para enfrentamentos direcionados às mães de primeira viagem: busca pelo conhecimento, rede de apoio e auto aceitação. Conclusão: esse estudo permitiu compreender as simbologias que estavam relacionadas a laço afetivo, expressão de amor, renúncia, vínculo, rede de apoio primária, secundária e sexualidade.

Objective: to evaluate the symbolic perceptions about breastfeeding of mothers residing in a municipality in Paraíba. Method: This is a descriptive, cross- sectional study with a qualitative approach, carried out with 67 mothers. The survey was carried out via a virtual questionnaire sent via smartphones, through Google Forms®, through the Respondent Driven Sampling (RDS) technique, during the months of December 2020 to April 2021. The data were tabulated and analyzed using the Microsoft Excel® program, version 97-2003, for Windows 8. The data were analyzed using the thematic content analysis technique, following the steps of pre-analysis, material exploration and treatment of results The research was approved by CEP by through opinion 4,469,159, protocol 302/2020 and CAAE 40194920.0.0000.5179. Results: most women were self-declared brown, evangelical, aged between 30 and 40 years old, graduated, living with two minimum wages or more, having a steady partner, living with a partner and children, having had six or more prenatal consultations. birth and delivered in a hospital environment via cesarean section. The speeches generated the categories: expression of love, bond, renunciation and sacrifice as maternal symbologies in front of breastfeeding; the dimensions of nurturing: mother's lap, growth and development as symbolic perceptions; breastfeeding and coping with sexuality: indifference, reduced libido and forbidden zone; advice for coping aimed at first-time mothers: search for knowledge, support network and self-acceptance. Conclusion: this study allowed us to understand the symbologies that were related to the affective bond, expression of love, renunciation, bond, primary and secondary support network and sexuality.

Objetivo: evaluar las percepciones simbólicas sobre la lactancia materna de madres residentes en un municipio de Paraíba. Método: Se trata de un estudio descriptivo, transversal, con abordaje cualitativo, realizado con 67 madres. La encuesta se realizó a través de un cuestionario virtual enviado vía smartphones, por medio de Google Forms®, a través de la técnica Respondent Driven Sampling (RDS), durante los meses de diciembre de 2020 a abril de 2021. Los datos fueron tabulados y analizados utilizando el programa Microsoft Excel®, versión 97-2003, para Windows 8. Los datos fueron analizados utilizando la técnica de análisis de contenido temático, siguiendo los pasos de pre-análisis, exploración de material y tratamiento de resultados La investigación fue aprobada por el CEP mediante dictamen 4.469.159, protocolo 302/2020 y CAAE 40194920.0.0000.5179. Resultados: la mayoría de las mujeres se autodeclaró morena, evangélica, con edad entre 30 y 40 años, graduada, viviendo con dos salarios mínimos o más, teniendo pareja estable, viviendo con pareja e hijos, habiendo tenido seis o más consultas prenatales. nacimiento y dado a luz en ambiente hospitalario por cesárea. Los discursos generaron las categorías: expresión de amor, vínculo, renuncia y sacrificio como simbologías maternas frente a la lactancia; las dimensiones de la crianza: regazo materno, crecimiento y desarrollo como percepciones simbólicas; lactancia y afrontamiento de la sexualidad: indiferencia, libido reducida y zona prohibida; consejos de afrontamiento dirigidos a madres primerizas: búsqueda de conocimiento, red de apoyo y autoaceptación. Conclusión: este estudio permitió comprender las simbologías relacionadas con el vínculo afectivo, la expresión del amor, la renuncia, el vínculo, la red de apoyo primaria y secundaria y la sexualidad.

The role of mucosal-associated invariant T cells in visceral leishmaniasis.

Mucosal-associated invariant T (MAIT) cells are restricted by MR1 and are known to protect against bacterial and viral infections. Our understanding of the role of MAIT cells in parasitic infections, such as visceral leishmaniasis (VL) caused by protozoan parasites of Leishmania donovani, is limited. This study showed that in response to L. infantum, human peripheral blood MAIT cells from children with leishmaniasis produced TNF and IFN-γ in an MR1-dependent manner. The overall frequency of MAIT cells was inversely correlated with alanine aminotransferase levels, a specific marker of liver damage strongly associated with severe hepatic involvement in VL. In addition, there was a positive correlation between total protein levels and the frequency of IL-17A+ CD8+ MAIT cells, whereby reduced total protein levels are a marker of liver and kidney damage. Furthermore, the frequencies of IFN-γ+ and IL-10+ MAIT cells were inversely correlated with hemoglobin levels, a marker of severe anemia. In asymptomatic individuals and VL patients after treatment, MAIT cells also produced IL-17A, a cytokine signature associated with resistance to visceral leishmaniasis, suggesting that MAIT cells play important role in protecting against VL. In summary, these results broaden our understanding of MAIT-cell immunity to include protection against parasitic infections, with implications for MAIT-cell-based therapeutics and vaccines. At last, this study paves the way for the investigation of putative MAIT cell antigens that could exist in the context of Leishmania infection.

General hospital specialists' attitudes toward psychiatry: a cross-sectional survey in seven countries.

OBJECTIVE: Psychiatric comorbidities are common in physical illness and significantly affect health outcomes. Attitudes of general hospital doctors toward psychiatry are important as they influence referral patterns and quality of care. Little is known about these attitudes and their cultural correlates. The aim of this study was to identify attitudes toward psychiatry among general hospital specialists in relation to culture of the practice setting and other clinician factors (gender, age, seniority and specialty). METHODS: A cross-sectional, descriptive study was carried out in seven countries (New Zealand, China, Sri Lanka, Russia, Israel, Brazil, the Netherlands). Data were collected from senior medical staff of various disciplines using an updated version of Mayou and Smith's (1986) self-administered questionnaire. RESULTS: A total of 889 hospital doctors participated. While favourable attitudes toward both psychiatric consultation and management were endorsed by a majority, significant differences were also observed between countries. Subgroup differences were mostly confined to gender, acuity of practice setting and specialty. For example, female doctors in Russia (χ2=7.7, p=0.0056), China (χ2=9.2, p=0.0025) and the Netherlands (χ2=5.7, p=0.0174) endorsed more positive attitudes compared with their male counterparts, but this gender effect was not replicated in the total sample. Chronic care specialists were overall more inclined to manage patients' emotional problems compared with those working in acute care (χ2=70.8, p (adjusted)<0.0001), a significant finding seen also in individual countries (China, New Zealand, the Netherlands, Russia). Physicians were more favourably disposed toward psychiatry compared with other specialists, especially surgeons, in all countries except Israel. CONCLUSIONS: This study adds to evidence for the association of medical attitudes with individual clinician factors and demonstrates that the influence of these factors varies by country. Understanding these issues may help to overcome barriers and improve quality of care provided to general hospital patients.

Lipoenxertia na reconstrução mamária após tratamento do câncer de mama: revisão de literatura / Lipografting in breast reconstruction after breast cancer treatment: literature review

Introdução: O tratamento de câncer de mama através de mastectomia causa grande impacto na qualidade de vida dos pacientes, ocasionando um número crescente de buscas por procedimentos reconstrutivos. O enxerto de gordura, também conhecido como lipoenxertia, foi descrito pela primeira vez em 1893, por Neuber, tendo aumentado o seu uso e aceitação no decorrer dos anos. De acordo com a Sociedade Brasileira de Cirurgia Plástica, as cirurgias reparadoras correspondem a 39,7% dos procedimentos plásticos realizados no Brasil, com as reconstruções mamárias sendo 6,1% desse número, configurando parte do tratamento do câncer de mama. O presente estudo objetivou revisar o uso de lipoenxertia na reconstrução mamária após tratamento do câncer de mama. Métodos: Foi realizada uma revisão da literatura utilizando os bancos de da-dos PubMed, MEDLINE, LILACS e SciELO, através dos descritores: "breast reconstruction"; "fat grafting"; and "breast cancer". Resultados: No total, foram encontrados 838 artigos nas bases de dados pesquisadas, dos quais 20 foram selecionados para a extração dos dados após a aplicação dos critérios de inclusão e exclusão. Conclusão: Constatou-se que a gordura autóloga é um procedimento bem estabelecido para reconstrução mamária, apesar de apresentar algumas possíveis complicações. Ademais, mais estudos a longo prazo devem ser realizados visando conso-lidar o entendimento e segurança do procedimento.

Introduction: The treatment of breast cancer through mastectomy greatly impacts patients' quality of life, causing an increasing number of searches for reconstructive procedures. The fat graft, also known as lipografting, was described by Neuber in 1893, and has increased its use and acceptance over the years. According to the Sociedade Brasileira de Cirurgia Plástica (Brazilian Society of Plastic Surgery), reconstructive surgeries correspond to 39.7% of plastic procedures performed in Brazil, with breast reconstructions being 6.1% of this number, constituting part of breast cancer treatment. The present study aimed to review the use of lipografting in breast reconstruction after breast cancer treatment. Methods: A review of the literature was carried out using the databases of PubMed, MEDLINE, LILACS and SciELO, using the descriptors: "breast reconstruction"; "fat grafting"; and "breast cancer". Results: In total, 838 articles were found in the databases searched, of which 20 were selected for data extraction after applying the inclusion and exclusion criteria. Conclusion: It was found that autologous fat is a well-established procedure for mammary reconstruction, despite presenting some possible complications. Furthermore, more long-term studies should be conducted to address the understanding and safety of the procedure.

Chemokines in Leishmaniasis: Map of cell movements highlights the landscape of infection and pathogenesis.

Pathogen interactions with the host immune response components are critical for establishing protective immunity and pathological responses against Leishmania parasites. A predominant proinflammatory profile associated with enhanced phagocytosis trigger a cell-mediated immune response that is relevant to infection control. On the other hand, an anti-inflammatory phenotype, correlated with a predominant modulated/regulatory response, favors intracellular proliferation of Leishmania parasites and disease progression. In this context, chemokines play an important role in determining cellular composition at inflammatory sites. Leishmania infection induces the expression of various chemokines and chemokine receptors in the mammalian host, which can subvert the host immune responses. Indeed, the balance and dynamic changes in cytokines and chemokines may control or predict the disease outcome. In this review, we address our current knowledge regarding the chemokines and chemokines receptors' role in the immunopathogenesis of Tegumentary and Visceral Leishmaniasis.

O bem-estar de cuidadores de crianças típicas e crianças com necessidades especiais Autores / The well-being of caregivers of typical children and children with special needs of care / El bienestar de los/as cuidadores/as de niños/as con y sin necesidades especiales

El presente trabajo es sobre un estudio exploratorio descriptivo de abordaje cualitativo, realizado en un ambulatorio de pediatría de una universidad federal de la región del Triángulo Minero, Brasil. Tuvo como objetivo, investigar el bienestar de cuidadores de niños típicos y niños con necesidades especiales de salud, desde el nacimiento hasta los 12 años de edad. Participaron de la pesquisa 20 cuidadores en el período de noviembre de 2018 hasta mayo de 2019. Los instrumentos de recolección de datos fueron un cuestionario cerrado y una entrevista semiestructurada. El tratamiento de los datos se obtuvo a través del análisis de contenido temático de Bardin. El estudio correspondió la resolución 466/12 del Consejo Nacional de Salud, fue aprobada por el Comité de Ética en Pesquisa, y por los participantes a través del Termo de Consentimiento Libre y Esclarecido. Por medio de la lectura, análisis y la organización de las informaciones obtenidas, fueron elaboradas tres categorías temáticas: 1) El impacto de la maternidad en el cotidiano de los cuidadores; 2) Relación bienestar y apoyo social; 3) El bienestar influenciado por la condición de salud del niño. Se concluye que, las alteraciones en el cotidiano materno, en las posibilidades de elección en la vida diaria y del apoyo social recibido o no, irán interferir en el bienestar tanto de los cuidadores de niños típicos cuanto de niños con necesidades especiales, siendo que estas sufren mayor impacto en su bienestar, con interferencia en las esferas psicológica, física, social y económica.

To carry out this study, an exploratory-descriptive and qualitative approach was used, in a pediatric outpatient facility from a federal university of Triângulo Mineiro's region, Brazil. The main goal of the following study is to investigate the well-being of caregivers of typical children, and with special needs of care, from birth to the age of 12 years old. Twenty caregivers participated of this research between November 2018 to May 2019. The data collection instruments were a questionnaire and a semi-structured interview, and the collected information was processed through a Bardin themed analysis. The study followed the 466/12 Resolution of the National Health Council and was approved by the Research Ethics Committee of the same University and by the participants through a Consent Form. After reading, analyzing and organizing data, three themed categories were created: 1) The motherhood impact on the caregiver's routine; 2) Relation between well-being and social support; 3)The child's health condition's influence on the well-being of the caregiver. It was concluded that the changes in the maternal routine, the choices in everyday life and existing or nonexisting social support, will interfere in the well-being of the caregivers and the children, both typical and with special needs; it is important to note that the ones with children with special needs will suffer greater impact in all aspects of life, such as psychological, physical, social and economic.

Follicular dynamic and reproductive performance of gilts submitted to estrous cycle synchronization using two different progestogen sources.

This study evaluated reproductive indicators of gilts treated with altrenogest or an intravaginal device (IVD) containing medroxyprogesterone acetate (MPA) for estrous cycle synchronization, starting the protocol on different days of the estrous cycle or replacing the IVD in the middle of treatment. In Experiment 1, 126 gilts were assigned, according to the day of treatment onset (Day 5 or 10 of the estrous cycle), to the following treatments: Control-5 (no hormone); Control-10 (no hormone); IVD-5 (IVD with MPA); IVD-10 (IVD with MPA); ALT-5 (altrenogest); or ALT-10 (altrenogest). The first day of the previous estrus was considered as Day 0 of the estrous cycle, and progestogen groups were treated for 14 d. In Experiment 2, 63 gilts were assigned to Control, ALT, or IVD groups. Progestogen treatment started on Day 10 of the estrous cycle, and the IVD was replaced after 7 d of treatment. In both experiments, no gilts expressed estrus during progestogen administration. In Experiment 1, the interval hormonal withdrawal-to-estrus (IHE) tended to be shorter when treatment started on Day 10 than on Day 5 (3.6 vs. 4.1 d, respectively; P = 0.09). The percentage of gilts expressing estrus after hormone withdrawal was lower for IVD-gilts (76.3%) compared to ALT (100%) and Control-gilts (92.9%; P ≤ 0.07). The percentage of persistent follicles (PFOL) was greater in IVD-10 (60.0%) and ALT-10 (33.3%) than CONT-10 (0.0%; P ≤ 0.06). The adjusted farrowing rate (AFR) was lower in IVD (65.5%) and ALT (80.5%) compared with CONT (97.4%; P ≤ 0.08). In Experiment 2, the IHE was longer for ALT than IVD (4.9 vs. 3.9 d, respectively; P < 0.01). No difference among groups was observed in the percentage of gilts expressing estrus (overall 86.4%), but the occurrence of PFOL was higher in IVD (61.5%) compared to ALT (5.3%), and Control groups (10.5%; P < 0.01). The AFR was lower in IVD (53.8%) than in ALT (88.2%) and Control (94.7%; P ≤ 0.05). The total number of piglets born was not affected by hormonal treatments in either experiment. Estrous expression was delayed in gilts treated with altrenogest or IVD-MPA. However, the reproductive performance of IVD-gilts was compromised, which was not circumvented by IVD replacement in the middle of treatment. Therefore, further studies are necessary to understand MPA pharmacodynamics and investigate alternative devices for a steady release of progestogens in gilts.

Influence of cavosurface angle on the stress concentration and gaps formation in class V resin composite restorations.

The study aimed to evaluate the influence of cavosurface angle on stress concentration and gap formation in class V restorations. Cylindrical cavities 3 mm in diameter were prepared in forty-five bovine incisors, changing only the angle of the bur in relation to the flat surface of the tooth. The cavities maintained the same volume (17.67 mm³). The samples were divided according to the cavosurface angle, into three groups (n = 15): 90°, 120°, 135°. After adhesive application (Futurabond U, VOCO), the cavity was filled with bulk placement of a resin composite (GrandioSO, VOCO). The teeth were analyzed with stereomicroscopy. Data of marginal gap formation were statistically analyzed with a one-way analysis of variance (ANOVA) followed by Tukey tests (significance level: α = 0.05). Finite element analysis (FEA) was used to study residual stress in these geometries and to correlate those stresses with experimentally measured gap formation. The elastic modulus and polymerization shrinkage were determined for FEA. Residual shrinkage stresses were expressed in maximum principal stress (MPS). There was a significant difference in the gap formation among the groups (p = 0.001). A significantly lower marginal gap formation was found for 120° and 135° angles, with no significant difference between them. The cavosurface angle at 90° caused substantially higher stresses, in the restoration interface, with greater marginal gap. For the 120° and 135° angles, the stress concentrations were smaller and were located in the dental structure. The cavosurface angle influenced the marginal gap formation and stress concentration.

Características epidemiológicas y clínicas de niños hospitalizados por enfermedad tuberculosa. centro hospitalario pereira rossell (2010-2013) / Epidemiological characteristics of children hospitalized for tuberculosis. pereira rossell hospital center (2010-2013)

Introducción: la tuberculosis (TBC) continúa siendo un problema de salud pública en el mundo. En Uruguay, en los últimos años se ha notificado un aumento en el número de casos de esta enfermedad en adultos y niños. L os diferentes métodos diagnósticos tienen bajo rendimiento en niños; arribar al diagnóstico especialmente en menores de 5 años constituye un gran desafío. Objetivo: describir las características epidemiológicas y clínicas de niños hospitalizados por enfermedad tuberculosa (ET) en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell ( HP-CHPR). Metodología: se realizó una descripción retrospectiva de los menores de 15 años que egresaron del HP-CHPR entre el 1° de enero de 2010 y el 31 de diciembre de 2013 con diagnóstico de ET. Se describen las características epidemiológicas, la forma de presentación clínica y la evolución. Resultados: en este período egresaron 64 niños con ET, tasa global de 15,4/10.000 egresos. La mayoría eran menores de 5 años, sanos. Se identificó algún contacto en 73,4% de los pacientes. La TBC pleuro-pulmonar fue la principal forma de presentación clínica. Se confirmó el diagnóstico en 17 pacientes (26,5%) en todos los casos de ET diseminada y tres de los cuatro niños con formas extrapulmonares. Las formas diseminada y extrapulmonar se asociaron a hospitalizaciones más prolongadas y mayor mortalidad. Conclusiones: en esta serie la ET afectó a niños pequeños previamente sanos, la mayoría con contacto identificado. La confirmación diagnóstica constituye un problema. La enfermedad extrapulmonar y diseminada presenta elevada morbimortalidad.

Introduction: tuberculosis is still a public health issue around the world. In Uruguay, the number of adults and children with tuberculosis has increased in the last years. The yield of different diagnostic methods is low in children, and thus its diagnosis in children under 5 years old is a great challenge. Objective: to describe the epidemiological and clinical characteristics in children hospitalized due to tuberculosis at the Pereira Rossell Hospital Center. Method: the study consisted of a retrospective description of children under 15 years old who were discharged from the Pereira Rossell Hospital Center from January 1, 2010 through December 31, 2013 with a diagnosis of tuberculosis. The epidemiological characteristics, the forms of clinical presentation and evolution are described in the study. Results: during this period, 64 children were discharged with tuberculosis, a global rate of 15.4/10.000 discharges. Most of them were healthy children under 5 years old. Some kind of contact was identified in 73.4% of patients. Pleuropulmonary tuberculosis was the main form of clinical presentation. Diagnosis was confirmed in 17 patients (26.5%), in all cases of disseminated tuberculosis and in three out of four children with extrapulmonary forms. The disseminated and extrapulmonary forms were associated longer hospitalizations and greater mortality rates. Conclusions: in this series tuberculosis affected small healthy children, most of them with an identified contact. Diagnostic confirmation is a problem. The disseminated and extrapulmonary disease has high morbimortality rates.

Introdução: a tuberculose (TBC) continua sendo um problema de saúde pública no mundo. No Uruguai, um aumento do número de casos em adultos e crianças foi registrado nos últimos anos. Os diferentes métodos diagnósticos disponíveis apresentam baixo rendimento em crianças; diagnosticar , especialmente em menores de 5 anos, é um grande desafio. Objetivo: descrever as características epidemiológicas e clínicas de crianças hospitalizadas por tuberculose (DT) no Hospital Pediátrico do Centro Hospitalario Pereira Rossell (HP-CHPR). Metodologia: uma descrição retrospectiva dos menores de 15 anos que tiveram alta do HP-CHPR no período 1° de janeiro de 2010 - 31 de dezembro de 2013 com diagnóstico de DT foi realizada. As características epidemiológicas, apresentação clínica e evolução foram descritas. Resultados: neste período 64 crianças com DT tiveram alta com uma taxa global de 15,4/10.000 altas. A maioria tinha menos de 5 anos e não apresentava outras patologias. Em 73,4% dos pacientes foi possível identificar pelo menos um contato. A TBC pleuro-pulmonar foi a principal forma de apresentação clínica. Em 17 pacientes (26,5%) o diagnóstico foi confirmado em todos os casos de DT disseminada e três das quatro crianças com formas extrapulmonares. As formas disseminada e extrapulmonar foram associadas a internações mais prolongadas e maior mortalidade. Conclusões: nesta série a DT afetou a crianças pequenas previamente saudáveis, a maioria com contacto identificado. A confirmação diagnóstica é um problema. A doença extrapulmonar e disseminada apresenta morbimortalidade elevada.

Tuberculosis infantil: un caso clínico de presentación típica / Childhood tuberculosis: a clinical case of atypical presentation

La tuberculosis (TBC) infantil, según la Organización Mundial de la Salud (OMS), es la que se presenta en menores de 15 años. Es responsable de aproximadamente 11% de todos los casos de TBC en el mundo. En Uruguay en los últimos años se ha observado un aumento de la incidencia de la enfermedad en niños. El diagnóstico de TBC infantil representa un desafío, ya que en el niño la infección suele cursar con manifestaciones clínicas inespecíficas y muchas veces en forma asintomática, lo que retrasa el diagnóstico. Se describe el caso de una escolar a la que se le diagnosticó TBC pulmonar y abdominal. La niña no tenía noción de contacto epidemiológico. Se presentó inicialmente con una clínica sugestiva de neumonía adquirida en la comunidad de probable etiología inespecífica. Su evolución no fue la esperada, por lo que se buscaron otros agentes etiológicos. La prueba tuberculínica fue positiva. La tomografía computada evidenció múltiples adenopatías torácicas y abdominales, hallazgos que sugirieron el diagnóstico de TBC, a forma pulmonar y abdómino-ganglionar. Ante la sospecha se comenzó el tratamiento antituberculoso, con buena evolución. Posteriormente se confirmó la infección por M tuberculosis. Se destaca la importancia de mantener un alto índice de sospecha de la enfermedad, en vista a un diagnóstico y tratamiento oportuno y eficaz.

According to the World Health Organization (WHO), childhood tuberculosis (TB) affects children under 15 years of age. It is accounts for approximately 11% of all cases of TB in the world. In Uruguay, the incidence of TB in children has increased in the recent years. The diagnosis of childhood TB is a challenge because clinical presentation is nonspecific in children, it is often asymptomatic, what delays diagnosis. The study presents the case of a girl with pulmonary and abdominal tuberculosis. She had no epidemiological contact and community acquired pneumonia was the initial clinical presentation. Clinical signs and symptoms failed to improve with treatment, so investigation of other etiologic agents was ruled out. Tuberculin test was positive. Computerized tomography revealed multiple thoracic and abdominal lymph nodes. Diagnosis of pulmonary and abdominal-nodal tuberculosis was suspected, tuberculosis treatment was started. M. tuberculosis infection was confirmed by sputum culture. High suspicion rates of the disease are necessary to provide a timely diagnosis and treatment.

Heme oxygenase-1 inhibits rat and human breast cancer cell proliferation: mutual cross inhibition with indoleamine 2,3-dioxygenase.

Heme oxygenase-1 (HO-1) is the rate limiting enzyme of heme catabolism whereas indoleamine 2,3 dioxygenase (IDO) catabolizes tryptophan through the kynurenine pathway. We analyzed the expression and biological effects of these enzymes in rat and human breast cancer cell lines. We show that rat (NMU and 13762) but not human cells (MCF-7 and T47D) express HO-1. When overexpressed, we found this enzyme to have anti-proliferative and proapoptotic effects by antioxidant mechanisms in these four cell lines. We show that IDO is expressed by rat and human breast cancer cells. IDO inhibition with 1-MT and siRNA leads to diminished proliferation in rat cells. In contrast, HO-1 negative human cell lines increase proliferation upon IDO inhibition. Since we also demonstrate that IDO inhibits the anti-proliferative HO-1, we propose that IDO has opposite effects on proliferation depending on the coexpression or not of HO-1. We also describe that HO-1 inhibits IDO at the post-translational level through heme starvation. In vivo, we show that rat normal breast expresses HO-1 and IDO. In contrast, N-nitrosomethylurea-induced breast adenocarcinomas only express IDO. In conclusion, we show that HO-1/IDO cross-regulation modulates apoptosis and proliferation in rat and human breast cancer cells.