Abstract Objective To assess emergency service professionals’ sleep quality and its association with the level of fatigue and quality of life. Methods A descriptive, cross-sectional and correlational study, carried out in the units of the Mobile Emergency Care Service (SAMU) and in the Emergency Care Unit (ECU), in 2021, with 108 participants. To assess sleep quality, the Pittsburgh Sleep Quality Index, Brazilian version (PSQI-BR), was used; to assess fatigue, the Chalder Fatigue Scale was used, together with the Need for Recovery Scale (NFR); and to assess quality of life, the World Health Organization Quality of Life Brief Version (WHOQOL-bref) was used, and the instruments used were adapted to Portuguese in previous studies. Association tests were applied for statistical analysis, using Pearson’s chi-square test, Mann-Whitney U test or Kruskal Wallis and Spearman’s correlation. P-values <0.05 were considered significant. Results It was identified that 72.2% of participants had poor sleep quality and 75.9% were fatigued. A significant association was observed between sleep quality and fatigue, the need for recovery and quality of life. Conclusion It was identified that health professionals working in emergency services have poor sleep quality and life, and high levels of fatigue and need for recovery, which can directly impact their personal and professional activities.

Resumen Objetivo Evaluar la calidad del sueño de profesionales de los servicios de emergencia y su relación con el nivel de fatiga y calidad de vida. Métodos Estudio descriptivo, transversal y correlacional, realizado en las unidades del Servicio de Atención Móbil de Urgencia (SAMU) y en la Unidad de Pronta Atención (UPA), en el año 2021, con 108 participantes. Para evaluar la calidad del sueño, se utilizó el Índice de Calidad del Sueño de Pittsburgh, versión brasileña (PSQI-BR). Para evaluar la fatiga, se utilizó la Escala de Fatiga de Chalder, junto con la Escala de Necesidad de Descanso (ENEDE). Para evaluar la calidad de vida, se utilizó el World Health Organization Quality of Life Brief Version (WHOQOL-bref). Los instrumentos utilizados fueron adaptados al idioma portugués en estudios anteriores. Se aplicaron pruebas de asociación para el análisis estadístico, para lo cual se utilizó la Prueba χ2 de Pearson, la Prueba U de Mann-Whitney o la prueba de Kruskal-Wallis y la correlación de Spearman. Se consideraron valores de p<0,05 como significativos. Resultados Se identificó que el 72,2 % de los participantes presentó una mala calidad de sueño y el 75,9 % tenía fatiga. Se observó una asociación significativa entre la calidad del sueño y la fatiga, la necesidad de descanso y la calidad de vida. Conclusión Se identificó que los profesionales de la salud que trabajan en servicios de urgencia y emergencia presentaron mala calidad de sueño y de vida y niveles elevados de fatiga y necesidad de descanso, lo que puede impactar directamente en sus actividades personales y profesionales.

Resumo Objetivo Avaliar a qualidade do sono de profissionais dos serviços de emergência e sua associação com o nível de fadiga e qualidade de vida. Métodos Estudo descritivo, transversal e correlacional, realizado nas unidades do Serviço de Atendimento Móvel de Urgência (SAMU) e na Unidade de Pronto Atendimento (UPA), no ano de 2021, com 108 participantes. Para avaliação da qualidade do sono, foi utilizado o Índice de Qualidade do Sono de Pittsburgh versão Brasileira (PSQI-BR); para avaliação da Fadiga, foi utilizada a Escala de Fadiga de Chalder, em conjunto com a Escala de Necessidade de Descanso (ENEDE); e para avaliação da qualidade de vida, foi utilizado o World Health Organization Quality of Life Brief Version (WHOQOL-bref), sendo que os instrumentos utilizados foram adaptados para a língua portuguesa em estudos anteriores. Foram aplicados testes de associação para a análise estatística, tendo sido utilizados o Teste Qui-Quadrado de Pearson, o Teste U Mann-Whitney ou Kruskal Wallis e a correlação de Spearman. Valores de p <0,05 foram considerados como significativos. Resultados Foi identificado que 72,2% dos participantes apresentaram má qualidade do sono e 75,9% estavam fadigados. Foi observada associação significativa entre a qualidade do sono e a fadiga, a necessidade de descanso e a qualidade de vida. Conclusão Foi identificado que os profissionais de saúde que trabalham em serviço de urgência e emergência apresentam má qualidade do sono e de vida e níveis elevados de fadiga e necessidade de descanso, o que pode impactar diretamente suas atividades pessoais e profissionais.

ABSTRACT Introduction: Improving survival of Acute Lymphoblastic Leukemia (ALL) in adult patients has been a challenge. Despite intensive chemotherapy treatment, overall survival is poor. However, several studies demonstrate that young adult patients have better survival when treated with pediatric-based intensive regimens. Considering these results, We decided to treat newly diagnosed ALL patients according to age and risk factors. The goal of this study was to describe the results of this intensive chemotherapy treatment approach for ALL adult patients diagnosed at our institution. Methods: Fifty-eight ALL patients, diagnosed from 2004 to 2013, were included in the analysis. Patients were assigned to either the St. Jude Total Therapy XIIIB high-risk arm (St Jude) or the CALGB 8811 (CALGB). The Kaplan-Meier survival curve was used for the survival analyses and the Cox proportional hazard regression, for multivariable analysis. Results: The overall survival was 22.9% at 10 years. The St. Jude improved survival, compared to the CALGB (p = 0.007), with 32.6% vs. 7.4% survival rate at 10 years. However, no survival benefit was found for patients younger than 20 years old (p = 0.32). The multivariable analysis demonstrated that undetectable minimal residual disease (MRD) and hematopoietic stem cell transplantation (HSCT) had beneficial impact on survival (p = 0.0007 and p = 0.004, respectively). Conclusion: ALL is a disease of poor prognosis for adults. The joint effort to standardize treatment and seek solutions is the way to start improving this scenario.

Abstract Introduction: The minimal residual disease (MRD) status plays a crucial role in the treatment of acute lymphoblastic leukemia (ALL) and is currently used in most therapeutic protocols to guide the appropriate therapeutic decision. Therefore, it is imperative that laboratories offer accurate and reliable results through well standardized technical processes by establishing rigorous operating procedures. Method: Our goal is to propose a monoclonal antibody (MoAb) panel for MRD detection in ALL and provide recommendations intended for flow cytometry laboratories that work on 4-color flow cytometry platforms. Results and conclusion: The document includes pre-analytical and analytical procedures, quality control assurance, technical procedures, as well as the information that needs to be included in the reports for clinicians.

RESUMO Objetivo: Descrever as características clínicas e os preditores de ventilação mecânica em pacientes adultos internados com COVID-19. Métodos: Conduziu-se um estudo de coorte retrospectiva com inclusão de pacientes hospitalizados entre 17 de março e 3 de maio de 2020, que tiveram o diagnóstico de infecção pelo SARS-CoV-2. As características clínicas e demográficas foram extraídas de registros em prontuário eletrônico. Resultados: Incluíram-se no estudo 88 pacientes consecutivos. A mediana da idade dos pacientes foi de 63 anos (IQR: 49 - 71); 59 (67%) pacientes eram do sexo masculino, 65 (86%) tinham educação universitária e 67 (76%) tinham, no mínimo, uma comorbidade. Dentre eles, 29 (33%) pacientes foram admitidos à unidade de terapia intensiva, 18 (20%) necessitaram de ventilação mecânica e nove (10,2%) morreram durante a hospitalização. O tempo mediano de permanência na unidade de terapia intensiva e o tempo mediano de ventilação mecânica foram, respectivamente, de 23 e 29,5 dias. Idade acima ou igual a 65 anos foi fator de risco independente para ventilação mecânica (RC: 8,4; IC95% de 1,3 - 55,6; valor de p = 0,02). Conclusão: Nossos achados descrevem a primeira onda de pacientes brasileiros hospitalizados por COVID-19. Em nossa população, idade foi o maior preditor de insuficiência respiratória e necessidade de ventilação mecânica.

Abstract Objective: This study aims to describe the clinical characteristics and predictors of mechanical ventilation of adult inpatients with COVID-19 in a single center. Methods: A retrospective cohort study was performed and included adult inpatients hospitalized from March 17th to May 3rd, 2020, who were diagnosed with SARS-CoV-2 infection. Clinical and demographic characteristics were extracted from electronic medical records. Results: Overall, 88 consecutive patients were included in this study. The median age of the patients was 63 years (IQR 49 - 71); 59 (67%) were male, 65 (86%) had a college degree and 67 (76%) had at least one comorbidity. Twenty-nine (33%) patients were admitted to the intensive care unit, 18 (20%) patients needed mechanical ventilation, and 9 (10.2%) died during hospitalization. The median length of stay in the intensive care unit and the median duration of mechanical ventilation was 23 and 29.5 days, respectively. An age ≥ 65 years was an independent risk factor for mechanical ventilation (OR 8.4 95%CI 1.3 - 55.6 p = 0.02). Conclusion: Our findings describe the first wave of Brazilian patients hospitalized for COVID-19. Age was the strongest predictor of respiratory insufficiency and the need for mechanical ventilation in our population.

RESUMO O desenvolvimento de um protocolo específico na natação para detectar a Frequência cardíaca máxima (FCmáx) pode qualificar a prescrição e controle de treinamento na natação. Dessa forma, o estudo objetivou validar um teste específico para obtenção da FCmáx em natação, para o nado crawl. Onze nadadores masculinos, de nível universitário, nadaram as distâncias de 100 e 200 metros crawl, em velocidade máxima, com monitoramento da FC, através de um monitor cardíaco. A validade foi avaliada pela relação entre FCmáx e lactato e a confiabilidade por teste e reteste de cada distância. A FCmáx dos 100 e 200 metros no teste foi de 187,6 ± 7,23 e 187,6 ± 7,54 bpm (p > 0,05) e no reteste de 188,3 ± 8,3 e 189,5 ± 8 bpm (p > 0,05). Encontraram-se altos valores de correlação para FCmáx obtida e concentração de lactato nos dois testes (100 e 200 metros). Correlações positivas significativas entre teste e reteste mostraram a confiabilidade dos testes (100 metros - 0,910, p < 0,001 e 200 metros - 0,950, p < 0,001). Conclui-se que os testes propostos são capazes de gerar, com precisão, a FCmáx de nadadores de nível universitário, são uma importante variável usada para cálculo das zonas de intensidade do treinamento e ferramenta para monitoramento da evolução do atleta durante a temporada.

ABSTRACT The development of a specific protocol to detect swimming Maximum Heart Rate (HRmax) can qualify the prescription and control training in swimming. Thus, the aim of this study was to validate a specific test to obtain HRmax in swimming, to freestyle. Eleven male swimmers, college-level, swam the distances of 100 and 200 meters at maximum speed, with heart rate monitoring, through a cardiac monitor. The validity was evaluated by the relation between HRmax and lactate, and the reliability by test and retest of each distance. The HRmax of the 100 and 200 meters in the test was 187.6±7.23 and 187.6±7.54 bpm (p>0.05) and in the retest of 188.3±8.3 and 189.5±8 bpm (p>0.05). High correlation values were found for HRmax obtained and lactate concentration in both tests (100 and 200 meters). Significant positive correlations between test and retest showed the reliability of the tests (100 meters - 0.910, p<0.001 e 200 meters - 0.950, p<0.001). It is concluded that the proposed tests are capable of generating, with accuracy, the HRmax of college-level swimmers, being an important variable used to calculate training intensity zones and a tool to monitor the evolution of the athlete during the season.

RESUMEN El desarrollo de un protocolo específico en natación para detectar la frecuencia cardíaca máxima (FCmáx) puede condicionar la prescripción y el control del entrenamiento en natación. De esta forma, el objetivo del estudio fue validar una prueba específica para la obtención de la FCmáx en natación, en el estilo crol. Once nadadores masculinos, de nivel universitario, nadaron las distancias de 100 y 200 metros a toda velocidad, con control de la frecuencia cardíaca mediante un monitor cardíaco. La validez se evaluó por la relación entre la FCmáx y el lactato, y la fiabilidad por la relación entre el test y el retest de cada distancia. La FCmáx de 100 y 200 metros en el test fue 187,6 ± 7,23 y 187,6 ± 7,54 lpm (p > 0,05) y en el retest, 188,3 ± 8,3 y 189,5 ± 8 lpm (p > 0,05). Se encontraron elevados valores de correlación obtenidos para la FCmáx y la concentración de lactato en las dos pruebas (100 y 200 metros). Correlaciones positivas importantes entre el test y el retest mostraron la fiabilidad de las pruebas (100 metros: 0,910; p < 0,001 y 200 metros: 0,950; p < 0,001). Se concluye que las pruebas propuestas son capaces de generar, con precisión, la FCmáx de nadadores de nivel universitario y son una importante variable usada para calcular las zonas de intensidad del entrenamiento y una herramienta para el control de la evolución del nadador durante la temporada.

Resumo Procurando entender o problema do declínio da atividade física (AF) entre os adolescentes, cresce a importância de se identificar quais as barreiras percebidas (BP) que podem reduzir a chance de envolvimento na prática de AF. Objetivou-se identificar as BP à prática de AF pelos escolares do Ensino Médio (EM) de uma escola pública federal. Participaram 348 escolares, de 14 a 19 anos, 46,8% do sexo feminino e 53,2% do sexo masculino. Para investigar as BP foi utilizado um instrumento composto por 12 afirmativas, validado para a população do estudo. Foi realizada análise dos resultados por estatística descritiva, teste de Kruskal Wallis para verificar a possível diferença das BP entre os anos de EM e Qui-quadrado para a diferença de proporções das barreiras. Ter muitas tarefas para fazer, a falta de tempo e as adversidades climáticas, foram as BP que receberam maiores frequências de respostas positivas. Não foi encontrada diferença na percepção das barreiras entre os anos de EM (masculino: p=0,44; feminino: p=0,23). As barreiras “não tenho como ir ou voltar” (p=0,04), “o clima dificulta” e “tenho preguiça” (p=0,02), “falta tempo” (p=0,01) e “em casa ninguém faz” (p=0,04) apresentaram diferença estatisticamente significativa entre os sexos. Ambos os sexos relataram barreiras semelhantes, porém, as meninas referiram um maior número de BP e com maiores frequências de respostas. A identificação de quais as BP que dificultam ou impedem a adoção de um estilo de vida fisicamente ativo, pode ser o início de soluções que minimizem os efeitos negativos destas.

Abstract In an attempt to understand the problem of declining physical activity (PA) among adolescents, there has been an increasing interest in identifying perceived barriers (PB) that can reduce the involvement of adolescents in PA. The aim of this study was to identify PB to PA practice among public high school students. The samples was composed of 348 students aged 14-19 years, 46.8% females and 53.2% males. To investigate BP, an instrument consisting of 12 statements and validated for the study population was used. The analysis of results was carried out by descriptive statistics, Kruskal Wallis test to check the possible differences in PB throughout high school years and chi-square for the difference in proportions of barriers. Having many tasks to do, lack of time and adverse weather conditions were the most cited PB. There was no difference in the perception of barriers among high school years (males: p = 0.44; females: p = 0.23). PB “not having how to go or return” (p = 0.04), “adverse weather conditions” and “laziness” (p = 0.02), “lack of time” (p = 0.01) and “at home nobody performs PA” (p = 0.04) showed statistically significant differences between sexes. Both sexes reported similar barriers; however, girls reported higher number of PB and with greater frequency. Identifying which PB prevent the adoption of a physically active lifestyle may be the beginning of solutions to minimize the negative effects.

Resumo A maturidade visomotora e as funções executivas estão intimamente relacionadas no processo de desenvolvimento infantil. O objetivo deste estudo foi investigar a relação entre habilidades visomotoras e funções executivas em 83 crianças hígidas, de 7 a 10 anos. Os instrumentos utilizados foram Teste Gestáltico Visomotor de Bender - Sistema de Pontuação Gradual (B-GSS), Teste Wisconsin de Classificação de Cartas (WCST), Matrizes Progressivas de Raven (RPM) e Rey- Osterrieth Figura Complexa Test (ROCF). A correlação entre os escores de B-GSS e WCST foi negativa e significativa (r = 0,23, p < 0,033) e variáveis do ROCF, como Cópia Total e Memória Total apresentaram correlação moderada e significativa com o escore total do B-GSS (r = -0,55, p < 0,001; r = -0,44, p < 0,001, respectivamente). Os resultados evidenciam empiricamente a relação entre funções executivas e maturidade visomotora e são discutidos à luz da neuropsicologia do desenvolvimento.

Abstract Visual-motor maturity and executive functions are closely related in the child development process. This study aimed to investigate the relation between visual-motor abilities and executive functions in 83 healthy children between 7 and 10 years old. The tools used were the Bender Gestalt Visual-Motor Test - Gradual Scoring System (B-GSS), Wisconsin Card Sorting Test (WCST), Raven's Progressive Matrices (RPM), and Rey-Osterrieth Complex Figure (ROCF). The correlation between the B-GSS and WCST scores was significantly negative (r = -.23, p < .033), while ROCF variables, such as Total Memory and Total Copy, had a moderate, significant correlation with total B-GSS score (r = -.55, p < .001; r = -.44, p < .001, respectively). The results empirically show the relation between executive functions and visual-motor maturity and are discussed in face of developmental neuropsychology.

Resumen La madurez visual-motora y las funciones ejecutivas están estrechamente relacionados en el proceso de desarrollo del niño. El objetivo de este estudio fue investigar la relación entre habilidades visomotoras y funciones ejecutivas en 83 niños sanos, de 7-10 años. Los instrumentos utilizados fueron Prueba Gestáltica Visomotora de Bender - Sistema de Puntuación Gradual (B-GSS), Prueba Wisconsin de Clasificación de Cartas (WCST), Matrices Progresivas de Raven (RPM) y Prueba Rey- Osterrieth Figura Compleja (ROCF). La correlación entre las puntuaciones B-GSS y WCST fue negativa y significativa (r = 0,23, p < 0,033) y ROCF variables, como Copiar y Memoria Total mostraron correlación moderada y significativa con la puntuación total de la B-GSS (r = -0,55, p < 0,001; r = -0,44, p < 0,001, respectivamente). Los resultados demuestran empíricamente la relación entre las funciones ejecutivas y la madurez visomotora y se discuten a la luz de la neuropsicología del desarrollo.

Fundamento: A associação entre proteína C-reativa ultrassensível e eventos cardiovasculares maiores recorrentes em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST submetidos à intervenção coronariana percutânea primária é controversa. Objetivo: Verificar se a proteína C-reativa ultrassensível está associada a risco aumentado de eventos cardiovasculares maiores, como morte, insuficiência cardíaca, reinfarto e nova revascularização, em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST tratados com intervenção coronariana percutânea primária. Métodos: Coorte prospectiva, incluindo 300 indivíduos maiores de 18 anos admitidos em um centro terciário com diagnóstico de infarto agudo do miocárdio com supradesnivelamento do segmento ST submetidos à intervenção coronariana percutânea primária. Utilizou-se instrumento contendo variáveis clínicas e escores de risco TIMI e GRACE, além da proteína C-reativa ultrassensível analisada por nefelometria. Os pacientes foram acompanhados na internação e até 30 dias após o infarto para a ocorrência de eventos cardiovasculares maiores recorrentes. Na análise estatística, foram utilizados os testes t de Student, Mann-Whitney, qui-quadrado e regressão logística. O valor de p ≤ 0,05 foi considerado significativo. Resultados: A média de idade foi de 59,76 anos, sendo 69,3% do gênero masculino. Não houve associação estatisticamente significativa entre proteína C-reativa ultrassensível e eventos cardiovasculares maiores recorrentes (p = 0,11). No entanto, a proteína C-reativa ultrassensível foi associada a óbito em 30 dias, de forma independente, quando ajustada para o escore TIMI (razão de chances de 1,27; intervalo de confiança de 95% de 1,07-1,51; valor de p = 0,005) e GRACE (razão de chances de 1,26; intervalo de confiança de 95% de 1,06-1,49; valor de p = 0,007). Conclusão: Embora a proteína C-reativa ultrassensível não tenha sido preditora de eventos cardiovasculares maiores combinados até o 30° dia de evolução de infarto agudo do miocárdio com elevação do segmento ST, em pacientes submetidos à angioplastia primária e implante de stent, ela foi um preditor independente de mortalidade em 30 dias.

Background: The association between high-sensitivity C-reactive protein and recurrent major adverse cardiovascular events (MACE) in patients with ST-elevation myocardial infarction who undergo primary percutaneous coronary intervention remains controversial. Objective: To investigate the potential association between high-sensitivity C-reactive protein and an increased risk of MACE such as death, heart failure, reinfarction, and new revascularization in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Methods: This prospective cohort study included 300 individuals aged >18 years who were diagnosed with ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention at a tertiary health center. An instrument evaluating clinical variables and the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores was used. High-sensitivity C-reactive protein was determined by nephelometry. The patients were followed-up during hospitalization and up to 30 days after infarction for the occurrence of MACE. Student's t, Mann-Whitney, chi-square, and logistic regression tests were used for statistical analyses. P values of ≤0.05 were considered statistically significant. Results: The mean age was 59.76 years, and 69.3% of patients were male. No statistically significant association was observed between high-sensitivity C-reactive protein and recurrent MACE (p = 0.11). However, high-sensitivity C-reactive protein was independently associated with 30-day mortality when adjusted for TIMI [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.07-1.51; p = 0.005] and GRACE (OR, 1.26; 95% CI, 1.06-1.49; p = 0.007) risk scores. Conclusion: Although high-sensitivity C-reactive protein was not predictive of combined major cardiovascular events within 30 days after ST-elevation myocardial infarction in patients who underwent primary angioplasty and stent implantation, it was an independent predictor of 30-day mortality.

BACKGROUND: Onychomycosis or nail fungal infection is the most common nail disease. Despite the wide range of studies on this condition, it remains difficult to establish the correct diagnosis and effective treatment. OBJECTIVES: To evaluate the efficacy of classical laboratory methods for the diagnosis of onychomycosis, and the in vitro susceptibility of the its main etiological agent to antifungals used in routine. METHODS: Nail samples of 100 patients with clinically suspected feet onychomycosis were collected to confirm the diagnosis by direct mycological examination and fungal culture. In vitro antifungal susceptibility testing was performed against strains of the main dermatophyte isolated by microdilution, according to the standardized protocol (M38-A2 - CLSI) RESULTS: Clinical diagnosis of onychomycosis was confirmed by laboratory analysis in 59% of patients. Of these, 54.2% were positive only in direct mycological examination, 44.1% in direct mycological examination and culture, and one case (1.7%) was positive only in culture, resulting in weak agreement between these tests (Kappa = 0.385; p <0.001) High minimum inhibitory concentration values of fluconazole and itraconazole were observed in 66.7% and 25.0% of isolates of T. rubrum tested. Additionally, high MIC values of terbinafine and ciclopirox was detected in only one isolate, and this was one of the strains in which in vitro activity of itraconazole and fluconazole has not been proven. CONCLUSIONS: Poor agreement was observed between direct mycological examination and culture for the diagnosis of onychomycosis, with direct mycological examination being significantly more sensitive. Except for fluconazole, the other three antifungals tested showed good in vitro activity against clinical isolates of T. rubrum.

AIDS-related lymphomas (ARL) present high biological heterogeneity. For better characterization of this type of lymphoma, the objectives of the present study were to evaluate the expression of immunohistochemical markers of cell differentiation (CD10, Bcl-6, MUM-1) and determine cell origin profile according to Hans' classification of diffuse large B-cell lymphoma in AIDS patients. This study included 72 consecutive patients with ARL diagnosed at the University Hospital, Universidade Federal do Rio de Janeiro (UFRJ) and at the Brazilian Instituto Nacional de Câncer (INCA) from 2000 to 2006. The morphologic distribution of the lymphomas was the following: 61% were diffuse large B-cell lymphomas (DLBCLs), 15% were Burkitt's lymphomas, 13% were plasmablastic lymphomas, 10% were high-grade lymphomas and 1% was follicular lymphoma. The positivity for each immunohistochemical marker in DLBCLs, Burkitt's lymphoma and plasmablastic lymphoma was respectively: CD20, 84%, 100%, and 0; CD10, 55%, 100%, and 0; Bcl-6, 45%, 80%, and 0; MUM-1, 41%, 20%, and 88%. A higher positivity of CD20 (84% x 56%, p = 0.01) was found in DLBCL compared to non-DLBCL; in Burkitt's lymphomas a higher positivity of CD10 (100% x 49%, p = 0.04) and Bcl-6 (80% x 39%, p = 0.035) were found compared to non-Burkitt's lymphomas. Germinal center (GC) profile was detected in 60% of DLBCLs. Our study suggests particular findings in ARL, as the most frequent phenotype was GC, different from HIV-negative patients.

FUNDAMENTO: A circunferência abdominal (CA) é a medida que mais se correlaciona com os fatores de risco e morte por doença cardiovascular. Entretanto, o impacto da obesidade no prognóstico de pacientes com doenças cardiovasculares permanece controverso e requer maiores esclarecimentos. OBJETIVO: Avaliar a CA como preditor de evolução em 30 dias em pacientes que internaram com síndrome coronariana aguda (SCA), em hospital de referência no tratamento de doenças cardiovasculares. MÉTODOS: Coorte contemporânea com 267 pacientes que internaram por SCA e que foram seguidos por 30 dias após a alta levando em consideração os eventos cardiovasculares maiores - MACE - (óbito, reinfarto, reinternação para procedimentos de revascularização). Nas primeiras 24 horas da admissão, os pacientes responderam a um questionário e posteriormente tiveram a CA mensurada. A análise estatística foi realizada com SPSS 17.0, utilizando o teste do Qui-quadrado para variáveis categóricas e o teste t de Student para as variáveis numéricas, com o nível de significância de p < 0,05. As variáveis que apresentaram valores de p < 0,10, na análise bivariada, foram incluídas em um modelo de regressão logística para avaliar o papel da CA como preditor independente de MACE. RESULTADOS: Após análise multivariável, apenas o gênero feminino (RC = 8,86; 95% IC:4,55-17,10; p < 0,00), hipertensão arterial sistêmica (RC = 2,06; 95% IC:1,10-3,87; p = 0,02) e história familiar de cardiopatia isquêmica (RC = 2,10; 95% IC:1,17-3,74; p = 0,01) permaneceram associados com os MACE. CONCLUSÃO: Em nosso estudo, a CA alterada não se associou à maior incidência de MACE em 30 dias de seguimento.

BACKGROUND: Abdominal circumference (WC) is the measure that correlates most closely with the risk factors and death from cardiovascular disease. However, the impact of obesity on the prognosis of patients with cardiovascular disease remains controversial and requires further clarification. OBJECTIVE: To evaluate WA as a predictor of 30-day outcome in patients who were hospitalized with acute coronary syndrome (ACS), in a referral hospital for the treatment of cardiovascular diseases. METHODS: Contemporary cohort 267 patients who were hospitalized for ACS and who were followed for 30 days after discharge, taking into account the major cardiovascular events - MACE - (death, reinfarction, rehospitalization for coronary artery bypass grafting procedures). In the first 24 hours of admission, patients answered a questionnaire and were subsequently measured for WC. The statistical analysis was performed with SPSS 17.0, using the chi-square test for categorical variables and Student t test for numerical variables, with significance level of p < 0.05. The variables that had p < 0.10 in the bivariate analysis were included in a logistic regression model to evaluate the WC role as an independent predictor of MACE. RESULTS: After multivariate analysis, only the female gender (OR = 8.86; 95% CI: 4.55-17. 10, p < 0.00), hypertension (OR = 2.06; 95% CI: 1.10-3.87; p = 0.02) and family history of ischemic heart disease (OR = 2.10; 95% CI: 1.17-3.74; p = 0.01) remained associated with the MACE. CONCLUSION: In our study, the modified AC was not associated with increased incidence of MACE over the 30 days of follow-up.

FUNDAMENTO: La circunferencia abdominal (CA) es la medición que se correlaciona con los factores de riesgo y la muerte por enfermedad cardiovascular. Sin embargo, el impacto de la obesidad en el pronóstico de los pacientes con enfermedades cardiovasculares sigue siendo controvertido y requiere una mayor clarificación. OBJETIVO: Evaluar la CA como un predictor de evolución en 30 días en pacientes que fueron hospitalizados con síndrome coronario agudo (SCA), en un hospital de referencia para el tratamiento de las enfermedades cardiovasculares. MÉTODOS: Cohorte contemporánea con 267 pacientes que fueron hospitalizados por SCA y que fueron seguidos durante 30 días después del alta, teniendo en cuenta los eventos cardiovasculares mayores - MACE - (muerte, reinfarto, rehospitalización por procedimientos de revascularización). En las primeras 24 horas del ingreso, los pacientes respondieron a un cuestionario y se midió posteriormente la CA. El análisis estadístico se realizó con SPSS 17.0, mediante la prueba de Chi-cuadrado para variables categóricas y prueba t de Student para las variables numéricas, con un nivel de significación de p < 0,05. Las variables que presentaron valores de p < 0,10, en el análisis bivariado, se incluyeron en un modelo de regresión logística para evaluar el papel de la CA como un predictor independiente de MACE. RESULTADOS: Tras el análisis multivariante, solamente el sexo femenino (RC = 8,86; 95% IC:4,55-17,10; p < 0,00), hipertensión arterial sistémica (RC = 2,06; 95% IC:1,10-3,87; p = 0,02) e historia familiar de cardiopatía isquémica (RC = 2,10; 95% IC:1,17-3,74; p = 0,01) permanecieron asociados con los MACE. CONCLUSIÓN: En nuestro estudio, la CA alterada no se asoció a una mayor incidencia de MACE a los 30 días de seguimiento. (Arq Bras Cardiol 2011;96(5):399-404)

Bacteria, fungi and parasites are in constant contact with the insect gut environment and can influence different aspects of the host gut physiology. Usually, some of these microorganisms develop and survive in the digestive tract. Therefore, the gut environment must be able to tolerate certain populations of these organisms for the establishment of interactions between non-pathogenic bacteria, parasites and the gut. This review provides a brief overview of the biological and molecular mechanisms that microorganisms use to interact with the gut epithelia in mosquitoes and speculates on their significances for the development of bacteria and Trypanosoma cruzi in the guts of triatomines.

OBJETIVO: Apesar de representar uma das principais causas de infecção nosocomial, o papel da pneumonia associada à ventilação mecânica (PAVM) no prognóstico ainda permanece indefinido. O objetivo deste estudo foi avaliar o impacto dessa doença na evolução clínica dos pacientes. MÉTODOS: Estabeleceu-se uma coorte prospectiva de 233 pacientes sob ventilação mecânica (grupo PAV, n = 64; grupo controle, n = 169). Os desfechos primários foram tempo de ventilação mecânica (TVM), tempo de permanência na UTI (TUTI), tempo de permanência hospitalar (TH) e mortalidade na UTI. Os desfechos secundários foram mortalidade hospitalar, perfil microbiológico, uso prévio de antibióticos e fatores de risco para PAVM. RESULTADOS: Os desfechos dos grupos controle e PAVM foram, respectivamente, os seguintes: mediana do TVM (dias), 9 (intervalo interquartílico [II]: 5-15) e 23 (II: 15-37; p < 0,0001); mediana do TUTI (dias), 12 (II: 8-21) e 27 (II: 17-42; p < 0,0001); mediana do TH (dias), 33 (II: 18-64) e 46 (II: 25-90; p = 0,02); e mortalidade na UTI, 38% (IC95%: 31-45) e 55% (IC95%: 42-67; p = 0,02). A PAVM foi um preditor de mortalidade na UTI (OR = 3,40; IC95%: 1,54-1,78). O TVM (OR = 2,27; IC95%: 1,05-4,87) e o uso prévio de antibióticos (OR = 1,07; IC95%: 1,04-1,10) foram fatores de risco para PAVM. A PAVM não afetou a mortalidade hospitalar. Acinetobacter spp. foi o isolado mais frequente (28%). Antibioticoterapia empírica inadequada foi administrada em 48% dos casos. CONCLUSÕES: No presente estudo, houve uma alta incidência de bactérias resistentes e de antibioticoterapia inicial inadequada. TVM longo e o uso prévio de antibióticos são fatores de risco para PAVM.

OBJECTIVE: Although ventilator-associated pneumonia (VAP) is a major cause of nosocomial infection, its role in the prognosis of patients remains undefined. The objective of this study was to evaluate the impact of VAP on the clinical evolution of patients. METHODS: This was a prospective cohort study involving 233 patients on mechanical ventilation (VAP group, n = 64; control group, n = 169). Primary outcomes were time on mechanical ventilation (TMV), time in ICU (TICU), overall length of hospital stay (LHS) and in-ICU mortality. Secondary outcomes were in-hospital mortality, microbiological profile, prior use of antibiotics and risk factors for VAP acquisition. RESULTS: Control and VAP group outcomes were, respectively, as follows: median TMV (days), 9 (interquartile range [IQR]: 5-15) and 23 (IQR: 15-37; p < 0.0001); median TICU (days), 12 (IQR: 8-21) and 27 (IQR: 17-42; p < 0.0001); median LHS (days), 33 (IQR: 18-64) and 46 (IQR: 25-90; p = 0.05); and in-ICU mortality, 38% (95% CI: 31-45) and 55% (95% CI: 42-67; p = 0.02). VAP was a predictor of in-ICU mortality (OR = 3.40; 95% CI: 1.54-7.48). TMV (OR = 2.27; 95% CI: 1.05-4.87) and prior use of antibiotics (OR = 1.07; 95% CI: 1.04-1.10) were risk factors for VAP. VAP did not affect in-hospital mortality. Acinetobacter spp. was the most common isolate (28%). Inappropriate empirical antibiotic therapy was administered in 48% of cases. CONCLUSIONS: In this study, there was a high incidence of infection with resistant bacteria and inappropriate initial antibiotic therapy. Long TMV and prior use of antibiotics are risk factors for VAP.

Diabetes in spontaneously hypertensive rats is associated with cortical renal GLUT1 and GLUT2 overexpression. Our objective was to evaluate the effect of the angiotensin-converting enzyme blockade on cortical renal GLUT1 and GLUT2 expression, urinary albumin and urinary TGF-β1. Streptozotocin, 50 mg/kg, or citrate buffer (N = 16) was administered as a single injection into the tail vein in adult spontaneously hypertensive rats (~260 g). Thirty days later, these diabetic spontaneously hypertensive rats received ramipril by gavage: 0.01 mg·kg-1·day-1 (D0.01, N = 14), 1 mg·kg-1·day-1 (D1, N = 9) or water (D, N = 11) for 15 days. Albumin and TGF-β1 (24-h urine), direct arterial pressure, renal tissue angiotensin-converting enzyme activity (fluorometric assay), and GLUT1 and GLUT2 protein levels (Western blot, renal cortex) were determined. Glycemia and glycosuria were higher (P < 0.05) in the diabetic rats compared with controls, but similar between the diabetic groups. Diabetes in spontaneously hypertensive rats lowered renal tissue angiotensin-converting enzyme activity (40%), which was reduced further when higher ramipril doses were used. Diabetes associated with hypertension raised GLUT1 by 28% (P < 0.0001) and GLUT2 by 76% (P = 0.01), and both doses of ramipril equally reduced cortical GLUT1 (D vs D1 and vs D0.01, P ≤ 0.001). GLUT2 levels were reduced in D0.01 (P < 0.05 vs D). Diabetes increased urinary albumin and TGF-β1 urinary excretion, but the 15-day ramipril treatment (with either dose) did not reduce them. In conclusion, ramipril is effective in lowering renal tissue angiotensin-converting enzyme activity, as well as blocking cortical GLUT1 overexpression, which may be beneficial in arresting the development of diabetic nephropathy.

INTRODUÇÃO: Aproximadamente 80% das neoplasias malignas de pele não-melanomas são carcinomas basocelulares (CBC). Apesar das raras metástases, esses tumores são localmente agressivos. As metaloproteinases de matriz (MMPs), especialmente as MMP-2 e 9, são importantes no processo de invasão. Em contrapartida, os inibidores teciduais das MMPs (TIMPs) têm como principal função a inibição dessas enzimas. OBJETIVO: Investigar a associação de variáveis clinicopatológicas de pacientes portadores de CBC com a expressão de MMP-2, MMP-9, TIMP-1 e TIMP-2. MATERIAL E MÉTODOS: Foram selecionados 31 casos de CBC, sendo então obtidos, retrospectivamente, os dados referentes a idade, sexo e tamanho da lesão. Cortes histológicos das lesões foram submetidos a reação imuno-histoquímica pela técnica estreptavidina-biotina-peroxidase para detecção dos antígenos de interesse. Índices de imunomarcação foram construídos e comparados com os dados previamente obtidos. RESULTADOS: Observou-se correlação significativa entre idade e tamanho da lesão (R = 0,532; p = 0,008). Não foram observadas correlações significativas entre as outras variáveis e a expressão imuno-histoquímica dos antígenos de interesse. CONCLUSÃO: A expressão das metaloproteinases e de seus inibidores teciduais não parece ser influenciada pelos parâmetros investigados. Estudos adicionais são necessários para melhor compreensão de sua associação com o comportamento biológico do CBC.

INTRODUCTION: Approximately 80% of non-melanoma skin neoplasias are basal cell carcinomas (BCC). Although metastasis is rare, BBC carcinomas are locally aggressive tumors. Matrix metalloproteinases (MMPs), mainly MMP-2 and MMP-9, play an important role on the invasion process. On the other hand, tissue inhibitors of MMPs (TIMPs) have the main function of inhibiting these enzymes. OBJECTIVE: To investigate the association of clinical-pathological variables of BCC patients with the expression of MMP-2 and MMP-9, TIMP-1 and TIMP-2. Methods: Thirty-one BCC cases were selected. Gender, age of the patients and size of the lesions were obtained retrospectively. Histological cuts of the lesions were exposed to immunohistochemistry reaction by use of the streptavidine-biotin peroxidase technique in order to detect antigens. Immunomarking parameters were established and compared with previous data. RESULTS: A significant correlation between age and size of the lesion was observed (R = 0.532; p = 0.008). No significant correlations between other variables and immunohistochemical expression of antigens were observed. CONCLUSION: The expression of MMPs and TIMPs does not seem to be influenced by the parameters investigated in this work. Additional studies should be made to better understand its association with the biological behavior of basal cell carcinomas.