RESUMEN Objetivo: Describir algunas características epidemiológicas y clínicas del edema agudo de pulmón por mal de altitud (EAP) observadas en un hospital de Áncash (3052 m s. n. m.). Materiales y métodos: Estudio observacional descriptivo de 57 pacientes, quienes se presentaron en el Servicio de Emergencia del Hospital Víctor Ramos Guardia Huaraz entre enero de 1997 y enero del 2020. Todos cumplieron con los criterios diagnósticos de Lake Louise y una radiografía del tórax. La información se analizó mediante los usos de mediana y rango. Resultados: El 91,20 % de casos fueron del sexo masculino; 38,61% hicieron EAP de ascenso; 61,40 %, EAP de reascenso. El 21,10 % tuvo antecedente de EAP; 19,33 % desarrolló infección respiratoria previa; 10,53 %, un proceso patológico concomitante; 40,42 % hizo EAP durante el primer trimestre del año, y 45 % estuvo 10 días o menos a baja altitud. La presentación clínica incluyó disnea de reposo, crepitantes pulmonares, taquipnea, taquicardia y radiografía del tórax anormal en 100 % de los casos; tos productiva (96,52 %), dolor torácico (92,95 %), cefalea (56,11 %), cianosis (68,41 %), esputo rosado (42,13 %), fiebre (21,13 %) y leucocitosis (60,82 %). La mediana para la edad fue 20 años, frecuencia respiratoria 36/min, frecuencia cardiaca 124/min, PAS 100 mmHg, PAD 60 mmHg, temperatura 37,2 ºC, Hb 17,3 g/dl, Hto 53 %, recuento de leucocitos 12,500/mm3, resolución radiográfica del edema a las 48 horas. No hubo fallecidos. Conclusiones: Los factores que influyen en el EAP y sus determinantes son altura alcanzada, velocidad de ascenso, factores genéticos y antecedentes de EAP.

ABSTRACT Objective: To describe some epidemiological and clinical characteristics of acute high-altitude pulmonary edema (HAPE) observed in a hospital of the highlands of Ancash, located at 3,052 m a.s.l. Materials and methods: A descriptive observational study conducted with 57 patients who attended the emergency service of Hospital Víctor Ramos Guardia - Huaraz between January 1997 and January 2020. All patients fulfilled Lake Louise Criteria and had a chest X-ray. Median and range were used to analyze the information. Results: Male sex accounted for 91.20 %, ascent HAPE 38.61 % and re-ascent HAPE 61.40 %. Out of all patients, 21.10 % had a history of HAPE, 19.33 % developed a previous respiratory infection, 10.53 % had a concomitant disease, 40.42 % had HAPE during the first quarter of the year and 45 % had been 10 days or less at low altitude. Patients’ clinical presentation included dyspnea at rest, pulmonary crackles, tachypnea, tachycardia and abnormal X-ray in 100 %; productive cough in 96.52 %; chest pain in 92.95 %; headache in 56.11 %; cyanosis in 68.41 %; pink sputum in 42.13 %; fever in 21.13 % and leukocytosis in 60.82 %. The median age was 20 years, respiratory rate 36/min, heart rate 124/min, SBP 100 mmHg, DBP 60 mmHg, temperature 37.2 °C, HGB 17.3 g/dl, HCT 53 %, WBC 12,500/mm3, radiographic resolution of the edema in 48 hours. There were no deaths. Conclusions: The factors that influence HAPE and its determinants are altitude, rate of ascent, genetic factors and history of HAPE.

RESUMEN Se describen dos casos de neumomediastino espontáneo (NME) en adolescentes varones, saludables y nativos de la altura cuando retornaron a sus hogares provenientes del nivel del mar. Ambos acudieron por el Servicio de Emergencia del hospital Víctor Ramos Guardia de Huaraz, Ancash (3052 m s. n. m.) en el mes de febrero del 2020. El primer caso es el de un joven de 16 años que retornó a su hogar (a 2964 m s. n. m.) luego de permanecer doce días a nivel del mar, en Lima. Seis horas después del regreso fue a trabajar a la chacra, se sintió cansado y empezó a toser, y luego empezó el dolor torácico, la disnea y el enfisema subcutáneo. El segundo caso corresponde a un varón de 17 años, que volvió a su hogar (3140 m s. n. m.) después de pasar dos semanas a nivel del mar (Barranca); doce horas después del retorno, va a trabajar a la chacra y presenta tos, disnea, dolor torácico, dolor de garganta y enfisema subcutáneo. Ambos jóvenes desarrollaron una hipoxemia. El neumomediastino espontáneo se diagnosticó con las radiografías de tórax. En el segundo paciente, el cuadro se asoció a un leve edema pulmonar de altura. Ninguno de los pacientes tenía antecedentes de traumatismos, uso de drogas ilícitas, comorbilidad o de enfermedades previas asociadas a la altura. El manejo de la enfermedad fue conservador, sintomático, de soporte y observación clínica. Cuando un paciente joven y saludable acude a la emergencia con dolor torácico, disnea y enfisema subcutáneo, el neumomediastino espontáneo se debe considerar como un posible diagnóstico y, de inmediato, solicitar radiografías torácicas, frontal y lateral, que abarquen la región cervical. El diagnóstico diferencial permite un manejo adecuado y preciso para los pacientes con neumomediastino espontáneo.

ABSTRACT We describe two cases of spontaneous pneumomediastinum (SPM) that occurred in healthy, high-altitude native adolescent males when returning to their home from sea level. Both attended the Emergency Department of the Hospital Víctor Ramos Guardia in Huaraz, Ancash (3,052 m a.s.l.), in February 2020. Case 1 was a 16-year-old man who returned home (2,964 m a.s.l.) after twelve days at sea level (Lima). Six hours after returning, he went to work in the field. He then presented fatigue, cough, chest pain, dyspnea, and subcutaneous emphysema. Case 2 was a 17-year-old man who returned home (3,140 m a.s.l.) two weeks after staying at sea level (Barranca). Twelve hours after returning, he went to work in the field. He then presented cough, dyspnea, chest pain, sore throat, and subcutaneous emphysema. Both patients developed hypoxemia, and SPM was diagnosed with the help of chest X-rays. Case 2 was associated with mild high-altitude pulmonary edema. Both patients had no previous history of trauma, illicit drug use, comorbidity, and high-altitude-related diseases. Disease management was conservative, symptomatic, supportive, and based on clinical observation. When a healthy young patient comes to an emergency department because of chest pain, dyspnea, and subcutaneous emphysema, we should consider the possibility of SPM and immediately request frontal and lateral chest X-rays that include the cervical region. A differential diagnosis enables physicians to provide adequate and accurate treatment to patients with SPM.

ABSTRACT We described a MRSA bloodstream infection outbreak that was rapidly identified and controlled in a Neonatal Intensive Care Unit after implementation of a bundle of measures, including PCR-screening and HCW decolonization. We found 35% of healthcare workers(HCW) colonized with S. aureus by PCR, one of them that presented skin lesion positive for MSSA (same clone and spa type than two patients). Our findings raise the hypothesis that the outbreak could be related to HCW colonization.

Autosomal dominant tubulointerstitial kidney disease (ADTKD) is characterized by autosomal dominant inheritance, progressive chronic kidney disease, and a bland urinary sediment. ADTKD is most commonly caused by mutations in the UMOD gene encoding uromodulin (ADTKD-UMOD). We herein report the first confirmed case of a multi-generational Brazilian family with ADTKD-UMOD, caused by a novel heterozygous mutation (c.163G>A, GGC→AGC, p.Gly55Ser) in the UMOD gene. Of 41 family members, 22 underwent genetic analysis, with 11 individuals found to have this mutation. Three affected individuals underwent hemodialysis, one peritoneal dialysis, and one patient received a kidney transplant from a family member later found to be genetically affected. Several younger individuals affected with the mutation were also identified. Clinical characteristics included a bland urinary sediment in all tested individuals and a kidney biopsy in one individual showing tubulointerstitial fibrosis. Unlike most other reported families with ADTKD-UMOD, neither gout nor hyperuricemia was found in affected individuals. In summary, we report a novel UMOD mutation in a Brazilian family with 11 affected members, and we discuss the importance of performing genetic testing in families with inherited kidney disease of unknown cause.

BACKGROUND: Cystic fibrosis (CF) is a hereditary condition in which lung disease affects all patients. In addition to pulmonary involvement, the multisystemic components of CF cause significant physical limitations. However, the impact of lung function on balance control in CF has not been studied. OBJECTIVE: To assess body balance in adults with CF and to test its possible associations with lung function, nutritional status, and functional capacity. METHOD: This was a cross-sectional study in which 14 adults with CF underwent pulmonary function testing (spirometry, body plethysmography, and carbon monoxide diffusing capacity (DLco), respiratory muscle strength, 6-min walking distance (6MWD), Berg balance scale (BBS), nutritional analysis (body mass index and bioelectrical impedance), and stabilometry. Body balance was quantified using stabilometry; all participants performed the following two trials: opened base, eyes open (OBEO); closed base, eyes closed (CBEC). RESULTS: In stabilometry, the median for the lateral range and anterior-posterior range in the CBEC trial was 0.10 (0.08-0.11) and 0.13 (0.11-0.22), respectively (p<0.05). The maximal inspiratory pressure (MIP) correlated inversely with the lateral standard deviation (ρ=–0.61; p<0.05) as the DLco correlated positively with the anterior-posterior range (ρ=0.54; p<0.05). There were significant relationships between body composition indexes and almost all stabilometric variables measured. There were no relationships of the BBS and 6MWD with the stabilometric variables. CONCLUSIONS: In adults with CF, imbalance occurs mainly in the anterior-posterior direction and is especially associated with body composition.

Noni, nome Havaiano da fruta de Morinda citrifolia L., é uma planta medicinal e tradicional da Polinésia amplamente usada para o tratamento de muitas doenças entre as quais artrite, diabetes, asma, hipertensão e câncer. Neste trabalho, um suco comercial de noni (TNJ) foi avaliado para suas atividades protetoras contras as lesões induzidas por mitomicina C (MMC) e doxorrubicina (DXR) usando o teste de mutação e recombinação somática em Drosophila melanogaster. Larvas de terceiro estágio, trans-heterozigotas para dois genes marcadores (mwh e flr3 ), foram cotratadas com TNJ mais MMC ou DXR. Observamos uma redução dos efeitos genotóxicos de MMC e DXR pelo suco. TNJ induziu uma forte redução em todos os tipos de manchas mutantes induzidas por MMC e DXR principalmente devido a uma atividade antirecombinante. Os efeitos protetotes de TNJ foram dependentes da concentração, indicando uma correlação dose-resposta, os quais podem ser atribuídos a uma potente ação antioxidante e/ou habilidade de sequestrar radicais livres pelo TNJ.

Noni, a Hawaiian name for the fruit of Morinda citrifolia L., is a traditional medicinal plant from Polynesia widely used for the treatment of many diseases including arthritis, diabetes, asthma, hypertension and cancer. Here, a commercial noni juice (TNJ) was evaluated for its protective activities against the lesions induced by mitomycin C (MMC) and doxorrubicin (DXR) using the Somatic Mutation and Recombination Test (SMART) in Drosophila melanogaster. Three-day-old larvae, trans-heterozygous for two genetic markers (mwh and flr3 ), were co-treated with TNJ plus MMC or DXR. We have observed a reduction in genotoxic effects of MMC and DXR caused by the juice. TNJ provoked a marked decrease in all kinds of MMC- and DXR-induced mutant spots, mainly due to its antirecombinagenic activity. The TNJ protective effects were concentration-dependent, indicating a dose-response correlation, that can be attributed to a powerful antioxidant and/or free radical scavenger ability of TNJ.

Anxiety and stress-related disorders are severe psychiatric conditions that affect performance in daily tasks and represent a high cost to public health. The initial observation of Charles Darwin that animals and human beings share similar characteristics in the expression of emotion raise the possibility of studying the mechanisms of psychiatric disorders in other mammals (mainly rodents). The development of animal models of anxiety and stress has helped to identify the pharmacological mechanisms and potential clinical effects of several drugs. Animal models of anxiety are based on conflict situations that can generate opposite motivational states induced by approach-avoidance situations. The present review revisited the main rodent models of anxiety and stress responses used worldwide. Here we defined as “ethological” the tests that assess unlearned/unpunished responses (such as the elevated plus maze, light-dark box, and open field), whereas models that involve learned/punished responses are referred to as “conditioned operant conflict tests” (such as the Vogel conflict test). We also discussed models that involve mainly classical conditioning tests (fear conditioning). Finally, we addressed the main protocols used to induce stress responses in rodents, including psychosocial (social defeat and neonatal isolation stress), physical (restraint stress), and chronic unpredictable stress.

O potencial de três macrófitas aquáticas - Azolla caroliniana, Salvinia mínima e Lemna gibba - foi avaliado neste estudo, com vistas à seleção de plantas para remediação de ambientes contaminados com arsênio (As). Os experimentos foram conduzidos em casa de vegetação durante seis dias, em vasos contendo solução Hoagland (¼ força iônica) e As nas concentrações de 0,5; 2,5 e 5,0mgL-1. As três espécies mostraram acúmulo crescente de As tanto quanto a concentração do metalóide na solução foi aumentada. No entanto, foi detectada redução no ganho de massa fresca e seca quando as plantas foram expostas a altas concentrações de As. As três espécies de macrófitas mostraram diferenças na eficiência de remoção de As na solução. A. caroliniana, S. minima e L. gibba acumularam, em média, 0,130, 1,200 e 1,397mgmDM-1 de As, respectivamente, quando expostas a 5,0mgL-1. As macrófitas absorveram maior quantidade de As na solução com baixo índice de fosfato. Quanto maior a concentração de As nos tecidos da L. gibba, menor foi o conteúdo de clorofila e carotenoide, mostrado pela alta incidência de clorose. Lemna gibba também apresentou diminuição no tamanho da folha e As não afetou a síntese total de clorofila e carotenoide em A. caroliniana. Esta espécie apresentou folhas arroxeadas com alta concentração de antocianina cuja presença sugere associação à deficiência de fosfato. A necrose marginal ocorreu nas folhas flutuantes de S. minima, e as plantas-filha não mostraram nenhum sintoma visual. A porcentagem de As removida da solução pelas plantas foi reduzida quando estas foram expostas a altas concentrações do poluente. Das três espécies estudadas, somente L. gibba pode ser considerada como hiperacumuladora de As, porém sua utilização para remediar ambientes aquáticos contaminados com As mostrou-se limitada e exige investigação mais aprofundada.

The potential of three aquatic macrophytes, Azoll caroliniana, Salvinia minima and Lemna gibba, was evaluated in this work aimed at selection of plants to be used in remediation of environments contaminated by arsenic (As). The experiments were carried out in a greenhouse during six days in pots containing Hoagland solution (¼ ionic strength) at As concentrations of 0.5; 2.5 and 5.0 mg L-1. The three species showed greater As accumulation as the concentration of the metalloid in solution increased. However, a reduction was detected in fresh and dry mass gain when the plants were exposed to high As concentrations. The macrophytes showed differences in efficiency of removal of As in solution. A. caroliniana, S. minima and L. gibba accumulated, on average, 0.130; 0.200; and 1.397 mg mDM-1, respectively, when exposed to 5.0 mg L-1 of As. The macrophytes absorbed a greater quantity of As in solution with low phosphate content. The greater As concentration in L. gibba tissues lowered the chlorophyll and carotenoid contents as shown by the high chlorosis incidence. Lemna gibba also exhibited a decrease in leaf size, with the total chlorophyll and carotenoid synthesis not being affected by As in A. caroliniana. This species exhibited purplish leaves with high concentration of anthocyanin, whose presence suggested association to phosphate deficiency. Marginal necrosis occurred on S. minima floating leaves, with the released daughter-plants not showing any visual symptoms during the treatment. The percentage of As removed from the solution decreased when the plants were exposed to high concentrations of the pollutant. Among the three species studied, only L. gibba could be considered an As hyper-accumulator. The use of this plant species for remediation of aquatic environments was shown to be limited and requires further investigation.

The etiology of a range of diseases is associated with an excessive generation of reactive oxygen species (ROS). Exacerbated ROS production leads to mitochondrial dysfunction, cellular damage and apoptosis. Nowadays, many strategies are being developed for the targeted delivery of antioxidants compounds to mitochondria, trying to minimize the damages. Production of ROS was investigated by the molecular probes CM-H2DCFDA and Amplex Red. The purpose of this work is to evaluate the antioxidant capacity of verbascoside, martinoside, betulinic acid from the Stachytarpheta cayennensis and quercetin by an in vitro assay with isolated mitochondria from mice's brain The results showed that all compounds tested exhibited a scavenger effect on the ROS generated by the isolated mitochondria, which displayed a dependent dose increase.

A 56-year-old woman underwent surgery for a ruptured carotid-ophthalmic artery aneurysm. Intraoperative visual inspection confirmed that the ophthalmic artery was left intact. She had no light perception on the operated side right after surgery. Angiography one week after surgery confirmed exclusion of the aneurysm, no filling of the proximal portion of the ophthalmic artery, and a very faint filling of its distal orbital part. She gradually recovered from this deficit and 9 months after surgery she is capable of counting fingers. At this time angiography displayed filling of all the portions of the ophthalmic artery, absence of recruitment of collateral blood supply, and exclusion of the aneurysm as before. Surgical manipulation seems to either have induced vasospasm or thrombosis of the ophthalmic artery. Regression of vasospasm or secondary recanalization of the thrombus without development of collateral blood supply may account for the gradual improvement of vision. A risk of monocular blindness is associated with the surgical treatment of para-clinoid aneurysms. Nevertheless, when it occurs, a perspective of recovery may exist if certain etiologies are involved.

Una mujer de 56 años fue intervenida de un aneurisma carotido-oftálmico roto. La inspección visual intraoperatoria confirmaba que la arteria oftálmica estaba intacta. Tras la cirugía la paciente no percibía luz por dicho ojo y la angiografía una semana después de la cirugía confirmó la exclusión del aneurisma, con falta de relleno de la porción proximal de la arteria oftálmica, y un relleno muy débil de la porción orbitaria distal. La paciente se fue recuperando progresivamente del déficit y 9 meses después de la cirugía es capaz de contar dedos. La angiografía actual demuestra un relleno de todas las porciones de la arteria oftálmica, con ausencia de circulación colateral, y exclusión del aneurisma. La manipulación quirúrgica parece haber inducido vasoespasmo o trombosis de la arteria oftálmica. La regresión del vasoespasmo o la recanalización secundaria del trombo sin desarrollo de circulación colateral pueden justificar la mejoría gradual de la visión. Hay un riesgo de amaurosis unilateral asociado al tratamiento quirúrgico de los aneurismas paraclinoideos, aunque existe posibilidad de mejoría en algunos casos.

OBJECTIVE: There is evidence showing that Gleason grading of prostatic adenocarcinoma is one of the most powerful predictors of biological behavior and one of the most influential factors used to determine treatment for prostate cancer. The aim of the current study was to compare the Gleason score for needle biopsy to the Gleason score for the correspondent surgical specimen, find any possible difference in the biochemical (PSA) progression following surgery in upgraded cases, correlate Gleason score in the specimens to several clinicopathologic variables, and compare outcomes between patients with low-grade vs. high-grade Gleason and Gleason scores 3+4 vs. 4+3. MATERIALS AND METHODS: The study population consisted of 200 consecutive patients submitted to radical prostatectomy. Biochemical progression was defined as PSA > 0.2 ng/mL. Time to PSA progression was studied using the Kaplan-Meier product-limit analysis. RESULTS: In 47.1% of the cases, there was an exact correlation and 40.6% of cases were underestimated in the biopsies. Half of the tumors graded Gleason 6 at biopsy were Gleason score 7 at surgery. These upgraded tumors had outcomes similar to tumors with Gleason score 7 in both biopsy and surgery. There was a positive correlation of high-grade Gleason score in the surgical specimens to higher preoperative PSA, more extensive tumors, positive margins and more advanced pathologic staging. Tumors with a Gleason score > 7 have lower PSA progression-free survival vs. Gleason scores < 7. In this series, there was no significant difference when comparing Gleason scores of 3+4 vs. 4+3. CONCLUSIONS: The findings support the importance of Gleason grading for nomograms, which are used by clinicians to counsel individual patients and help them make important decisions regarding their disease.

Embora a infecção por Mycoplasma haemofelis e "Candidatus Mycoplasma haemominutum" tenha sido reportada em felinos selvagens dos Estados Unidos, sua presença entre felinos selvagens de vida livre e de cativeiro no Brasil ainda é desconhecida. Um leão macho, saudável, com 12 anos de idade, residente no Zoológico de Curitiba, Brasil, foi anestesiado para transporte e avaliação dentária. Uma amostra de sangue foi coletada para a realização do hemograma completo e análise pela Reação em Cadeia da Polimerase (PCR). O DNA foi extraído e fragmentos do gene 16SrRNA do Mycoplasma haemofelis e "Candidatus Mycoplasma haemominutum" foram submetidos à metodologia da PCR. O hemograma apresentou valores normais. Uma banda de baixa intensidade de aproximadamente 192 pb do "Candidatus Mycoplasma haemominutum" foi detectada, e nenhuma banda foi observada pela PCR na detecção de Mycoplasma haemofelis. A banda de baixa intensidade, o hemograma normal e a ausência de parasitemia e sinais clínicos podem sugerir uma infecção crônica subclínica por "Candidatus Mycoplasma haemominutum". A ausência de sinais clínicos pode também indicar a baixa patogenicidade desse microrganismo; entretanto, a imunossupressão por manejo e/ou tratamento com corticóides podem levar a parasitemia e conseqüente anemia neste animal. Este achado sugere novos estudos em felinos selvagens de cativeiro em zoológicos brasileiros.

Although Mycoplasma haemofelis and "Candidatus Mycoplasma haemominutum" infections have been reported in wild cats from United States, their presence among native and captive wild cats in Brazil is still unknown. A 12 year old healthy male lion (Panthera leo) from the Zoological Garden of Curitiba, Brazil was anesthetized for transportation and dental evaluation. A blood sample was obtained for a complete blood cell count (CBC) and PCR analysis. DNA was extracted and fragments of Mycoplasma haemofelis and "Candidatus Mycoplasma haemominutum" 16S ribosomal RNA gene were amplified in PCR assays. CBC results were within reference intervals. A weak band of 192 pb for "Candidatus Mycoplasma haemominutum" was observed, and no band was amplified from Mycoplasma haemofelis reaction. A weak PCR band associated with normal CBC results and without visible parasitemia or clinical signs may suggest a chronic subclinical infection with "Candidatus Mycoplasma haemominutum". The lack of clinical signs may also represent the low pathogenicity of this organism; however, it is noteworthy that immune suppression caused by management and/or corticoids treatment may induce parasitemia and anemia in this animal. This detection suggests further studies in captive wild cats in Brazilian Zoological Gardens.

The Dermatobia hominis larvae (Linnaeus Jr., 1781) (Diptera: Cuterebridae) causes a subcutaneous nodular miyasis and brings about irreversible perforation on skin, which damages the leather and therefore lowers its price for commercialization. The main purpose of the present work is to establish the larva distribution in cattle corporal area and also to define the infestation according to sex, age and color of skin. This survey was elaborated covering 8124 cattle slaughted in a slaughterhouse in Nilópolis city, Rio de Janeiro state, Brazil, with the intention of to identify larvae localization and distribution. The leather surface was divided into four regions: I (left anterior quadrant), II (right anterior quadrant), III (left posterior quadrant), IV (right posterior quadrant); the skin color was also registered. 84,8% leather skin examined were totally free from parasite. The incidence of parasited on region I was significantly larger: 33.4% (3029), on region II 30.9% (2796), on region III 20% (1813), on region IV 15.7% (1423). As to sex frequency the females presented more parasites 16.7% (342) than the males 14.7% (894). The adults were more vulnerable (15.4%) than the younger ones (12.1%). The parasite appeared more in black skins (18.1%), black and red (15.2%), black and white (15.3%), red (15.2%), spotted (13.2%), gray (11.8%).