resumo Crianças com déficit de crescimento por desnutrição perinatal apresentam especificidades na distribuição do percentual de gordura corporal (%GC) que não puderam ser detectadas por equações anteriores baseadas no %GC. Este estudo desenvolveu e validou equações preditivas do %GC derivadas de variáveis antropométricas em crianças de 7 a 10 anos residentes no Nordeste do Brasil, utilizando como referência a absorciometria radiológica de dupla energia (DXA). Foram utilizados dados de composição corporal de 58 crianças. O DXA foi usado como modelo de referência. Um modelo estatístico de regressão múltipla stepwise (forward) foi usado para desenvolver as equações. A análise de Bland-Altman (IC: 95%), teste t de Student pareado e o coeficiente de correlação intraclasse (CCI) foram utilizados para validar e comparar as equações. Duas novas equações foram desenvolvidas para ambos os sexos: meninos: %GC: 13,642 + (1,527*IMC) + (-0,345*Altura) + (0,875*Tríceps) + (0,290* Circunferência da cintura) e meninas: %GC: - 13,445 + (2,061*coxa). A análise de Bland-Altman mostrou boa concordância, com limites variando de -1,33 a 1,24% para meninos e -3,35 a 4,08% para meninas. O teste t de Student pareado não mostrou diferença entre %GC-DXA e as duas novas equações (p>0,05), e o CCI foi de 0,948 e 0,915, respectivamente.

abstract Children with a deficit of growth because of perinatal malnutrition present specificities in the percentage of body fat (%BF) that could not be detected by previous fat mass-based equations. This study developed and validated predictive equations of the %BF derived from anthropometric variables in children aged 7 to 10 living in Northeast Brazil, using dual-energy x-ray absorptiometry (DXA) as a reference. Body composition data from 58 children were utilized. DXA was used as a reference. A stepwise (forward) multiple regression statistical model was used to develop the new equations. The Bland-Altman analysis (CI: 95%), paired Student's t-test, and the intraclass correlation coefficient (ICC) was used to validate and compare the developed equations. Two new equations were developed for either gender: boys: %BF: 13.642 + (1.527*BMI) + (-0.345*Height) + (0.875*Triceps) + (0.290* Waist Circumference) and girls: %BF: -13.445 + (2.061*Tight). The Bland-Altman analysis showed good agreement, with limits ranging from -1.33 to 1.24% for boys and -3.35 to 4.08% for girls. The paired Student’s t-test showed no difference between %BF-DXA and the two new equations (p> 0.05), and the ICC was 0.948 and 0.915, respectively. DXA-based anthropometric equations provide an accurate and noninvasive method to measure changes in the %BF in children.

Introduction: Membranoproliferative glomerulonephritis is a pattern of glomerular injury on renal biopsy with characteristic light microscopic changes, namely mesangial hypercellularity, endocapillary proliferation and double contour formation along the glomerular capillary walls. This pattern does not represent a disease per se but can occur as a result of different pathologic processes. Case Presentation: We present a case of a 37-year-old caucasian female patient with thrombotic microangiopathy (TMA), severe hypertension and immune-complex-mediated glomerulonephritis, secondary to hepatitis C virus (HCV) infection. Steroid therapy and fresh-frozen plasma infusions were started, with progressive improvement of lab results. Treatment of HCV infection was started with direct-acting antiviral therapy. The results of the genetic study of the complement alternative pathway regulatory proteins were positive for a homozygote variant of the gene CFHR5 (p.Val110Ala) and a homozygote deletion on CFHR3/CFHR1 proteins. Discussion: Hypertension is commonly associated with TMA and could explain the features of this case. Nevertheless, the differential diagnosis is often difficult because TMA caused by hypertension is indistinguishable from all other entities. The finding of a homozygote variant of the gene CFHR5, and a homozygote deletion on CFHR3/CFHR1 proteins, raised the possibility that this case might have been an Atypical Hemolytic Uremic Syndrome (aHUS) triggered by the endothelial damage caused by the HCV-related cryoglobulinemic glomerulonephritis

RESUMO Tumor fibroso solitário (TFS) é uma neoplasia mesenquimatosa rara composta por células fusiformes monótonas, intercaladas por fibras de colágeno. Localização renal é incomum, com escassos casos descritos. Relatamos dois casos do gênero masculino, com 40 e 48 anos, um com detecção incidental de massa periférica; outro com lesão hilar descoberta na sequência de investigação por hematúria. Ambos revelaram proliferação fusocelular sem mitoses nem necrose. Imuno-histoquímica: positividade para CD34, CD99 e linfoma de células B2 (Bcl-2). Não há evidência de recidiva nove e cinco meses após cirurgia, respetivamente. TFS é maioritariamente benigno, mas pode revelar comportamento agressivo. Características morfológicas e imuno-histoquímicas são essenciais para o diagnóstico.

ABSTRACT Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm, composed of monotonous spindle cells, intermingled with collagen fibers. Kidney location is sporadic, with few reports in literature. We present two cases of 40- and 48-year-old males, one with incidental detection of a peripheral mass; another with hilar lesion perceived following investigation of hematuria. Both revealed a spindle-cell proliferation, without mitosis and necrosis. Immunohistochemical studies: positivity for CD34, CD99 and B-cell lymphoma 2 (Bcl-2). No sign of disease were evident nine and five months after surgery, respectively. SFT is mostly benign, but can show malignant behavior. Morphologic and immunohistochemical characteristics are essential for diagnosis.

RESUMEN Tumor fibroso solitario (TFS) es una neoplasia mesenquimal infrecuente de células fusiformes monótonas, separadas por bandas de colágeno. Localización renal es poco habitual, con escasos casos descriptos. Reportamos dos casos de pacientes masculinos, de 40 e 48 anos, el uno con detección incidental de masaperiférica; el otro con lesión hiliar descubierta en la investigación de hematuria. Los dos revelaronproliferación fusocelular sin necrosis ni mitosis. Inmunohistoquímica: positividad para CD34, CD99 y linfoma de células B2 (Bcl-2). No hay evidencia de recidiva a los nueve y cinco meses de la cirugía, respectivamente. TFS es, por lo general, benigno, pero puede revelar comportamiento agresivo. Características morfológicas y inmunohistoquímicas son esencialespara el diagnóstico.

Resumo Introdução A Candida albicans é a levedura que mais acomete a cavidade oral, podendo causar infecção. Porém diversos fatores podem estar associados ao aparecimento da candidíase, que podem estar relacionados com a higiene e saúde dos indivíduos, mas também com a patogenicidade destes microrganismos. Objetivo Avaliar os fatores de virulência de leveduras do gênero Candida isoladas da mucosa oral dos idosos residentes na Comunidade Lago do Limão - Iranduba - Amazonas – Brasil. Material e método Foram realizados os testes de urease, proteinase, fosfolipase, e avaliação da produção de hemólise. Na análise estatística utilizou-se teste Exato de Fisher e Quiquadrado. Resultado Obteve-se a prevalência de espécies não-albicans, quanto aos fatores de virulência, todos os isolados foram ureases negativos, houve prevalência de produção muito forte de proteinase, enquanto que no teste da fosfolipase, a maioria dos isolados não apresentou produção desta enzima; todas as leveduras analisadas apresentaram produção de hemolisina, sendo mais prevalente a hemólise grau IV. Não houve diferença estatisticamente significativa entre a virulência dos isolados oriundos da cavidade oral e da prótese dos idosos analisados. Conclusão Diversos fatores de virulência podem apresentar-se com alta intensidade na presença de alterações da microbiota oral. Além disso, as espécies não-albicans apresentam fatores de virulência tanto quanto a C. albicans, com graus de patogenicidade elevados. Este estudo permite a análise de estratégias de prevenção da candidíase, com intuito de promover melhor saúde e qualidade de vida para os idosos.

Abstract Introduction Candida albicans is the yeast most commonly affecting the oral cavity, sometimes causing infection. However, several factors may be associated with the onset of candidiasis, which may be related not only to the hygiene and health of individuals, but also to the pathogenicity of these microorganisms. Objective To evaluate the virulence factors of Candida yeasts isolated from the oral mucosa of elderly people living in the “Comunidade Lago do Limão”, municipality of Iranduba, Amazonas state, Brazil. Material and method Testes were performed to assess the production of urease, proteinase, phospholipase and hemolysin. Statistical analysis used the Fisher's exact test and the Chi-squared test. Result Prevalence of non-albicans species was observed. As for virulence factors, all isolates were negative ureases, and there was prevalence of very strong proteinase production, whereas most isolates did not produce this enzyme in the phospholipase test. All yeasts analyzed presented hemolysin production, with grade IV hemolysis as the most prevalent. There was no statistically significant difference between the virulence of isolates from the oral cavity and the prostheses of the elderly analyzed. Conclusion Several virulence factors may present with high intensity in the presence of oral microbiota changes. In addition, non-albicans species present number of virulence factors similar to that of C. albicans, with high pathogenicity. This study allows a better analysis of candidiasis prevention strategies aiming to promote improvement in the health and quality of life for the elderly.

RESUMO Nefroma quístico pediátrico é uma neoplasia de patogênese incerta caracterizada por uma arquitetura multilocular, que ocorre maioritariamente em crianças. Alguns casos podem ser esporádicos e outros podem apresentar associação familiar, juntamente com outras neoplasias, constituindo a síndrome DICER1. Apresentamos o caso de um nefroma quístico pediátrico com uma mutação do gene DICER1 não reportada na literatura e exploramos o diagnóstico diferencial, principalmente com o nefroblastoma quístico parcialmente diferenciado.

ABSTRACT Paediatric cystic nephroma is a neoplasm of uncertain pathogenesis characterized by a multilocular architecture that develops in children. Some cases may be sporadic, and others may present a familial association, together with other neoplasms, as part of a DICER1 syndrome. We present a case of a paediatric cystic nephroma with an unreported DICER1 mutation and explore the differential diagnosis mainly with cystic partially differentiated nephroblastoma.

C3 Glomerulopathy is a rare disease caused by abnormal control of the alternative complement pathway, resulting in a predominant glomerular C3 deposition. Its association with multiple myeloma has been reported in recent literature. We present a case of a 66-year-old women, referred for a nephrology consultation with a stage 4 chronic kidney disease, microhematuria, leukocyturia, sub-nephrotic range proteinuria (1.3 g/24hours), albumin 3.7 g/dl and dyslipidemia. She had been previously studied in a Hematology consultation for a normocytic anemia and an IgG Kappa monoclonal gammopathy, with 16% of plasma cells in bone marrow aspiration, but no hypercalcemia or lytic bone lesions. Autoimmune tests (ANCA, ANA, Anti-dsDNA antibody), C3 and C4 were negative. Eight months later, the patient complained of hypertension and edema, and presented a mild decrease in serum C3 (0.86 g/L [0.90-1.80]) and progressive nephrotic proteinuria (from 4.5 to 6.1 g/24h), with hypoalbuminemia. A kidney biopsy was performed, and we found mild chronic non-specific glomerular and tubule-interstitial findings, on light microscopy, and mesangial C3 deposits (+++), without immunoglobulin deposits, on immunofluorescence. Immunofluorescence with protease-digested paraffin sections was also negative. Genetic study found no complement gene mutation. She was treated with prednisone 1mg/Kg/day, with a favorable clinical and laboratorial response, but whether this treatment is enough it is still being pondered between nephrologists and hematologists

RESUMO Carcinoma urotelial invasor da bexiga, variante plasmocitoide, é uma entidade rara, com poucos casos descritos na literatura. Relatamos o caso de um homem, 79 anos, submetido à resseção transvesical de tumor da bexiga, cuja histologia revelou carcinoma urotelial de alto grau pT1. Posteriormente, foi submetido à cistoprostatectomia radical, que mostrou carcinoma urotelial invasor, descoeso, de tipo plasmacitoide, positivo para citoqueratina 7 (CK7), citoqueratina 20 (CK20) e fator de transcrição de ação"trans" específico de células T (GATA-3) e negativo para E-caderina e CD138. É importante reconhecer a variante plasmocitoide do carcinoma urotelial invasor, uma vez que se evita potencial diagnóstico errado de doença metastática.

ABSTRACT Invasive bladder urothelial carcinoma, plasmacytoid variant is a rare entity with scarce cases reported in the literature. We report a case of a 79 years old male, subjected to transurethral resection of bladder tumor, which histological examination revealed a pT1 high-grade urothelial carcinoma. Subsequently, he underwent radical cystoprostatectomy, which showed urothelial carcinoma with lack of cohesion, plasmacytoid variant, positive for citokeratin 7 (CK7), citokeratin 20 (CK20) and trans-acting T-cell-specific transcription factor (GATA-3), and negative for E-cadherin and CD138. It is important to recognize the plasmacytoid variant of the invasive urothelial carcinoma, since it avoids a potential misdiagnosis of metastatic cancer.

Interface integrity can be maintained by setting the composite in a layering technique and using liners. Objective The aim of this in vitro study was to verify the effect of resin-modified glass-ionomer cement (RMGIC) lining and composite layering technique on the bond strength of the dentin/resin adhesive interface of lateral walls of occlusal restorations. Material and Methods Occlusal cavities were prepared in 52 extracted sound human molars, randomly assigned into 4 groups: Group 2H (control) – no lining + two horizontal layers; Group 4O: no lining + four oblique layers; Group V-2H: RMGIC lining (Vitrebond) + two horizontal layers; and Group V-4O: RMGIC lining (Vitrebond) + four oblique layers. Resin composite (Filtek Z250, 3M ESPE) was placed after application of an adhesive system (Adper™ Single Bond 2, 3M ESPE) dyed with a fluorescent reagent (Rhodamine B) to allow confocal microscopy analysis. The teeth were stored in deionized water at 37oC for 24 hours before being sectioned into 0.8 mm slices. One slice of each tooth was randomly selected for Confocal Laser Scanning Microscopy (CLSM) analysis. The other slices were sectioned into 0.8 mm x 0.8 mm sticks to microtensile bond strength test (MPa). Data were analyzed by two-way ANOVA and Fisher's test. Results There was no statistical difference on bond strength among groups (p>0.05). CLSM analysis showed no significant statistical difference regarding the presence of gap at the interface dentin/resin among groups. Conclusions RMGIC lining and composite layering techniques showed no effect on the microtensile bond strength and gap formation at the adhesive interface of lateral walls of high C-factor occlusal restorations.

O atingimento renal nas vasculites associadas aos anticorpos anticitoplasma de neutrófilo (ANCA) traduz-se, tipicamente, por uma glomerulonefrite crescentica pauci-imune. O achado de alguns depósitos de imunocomplexos nestas glomerulonefrites nao e incomum, mas os casos em que esta deposição e mais acentuada, sugerem a presença de uma segunda doença glomerular mediada por imunocomplexos. O significado dos depósitos de imunocomplexos e o seu papel nas vasculites associadas a ANCA e ainda um tema de debate, contudo, nestes doentes foram descritos niveis superiores de proteinuria e um pior prognostico em relação a preservação da função renal. Descrevemos o caso clinico de um doente com uma glomerulonefrite mesangioproliferativa em relação com uma crioglobulinemia mista secundaria a uma infeção cronica pelo vírus da hepatite C, que desenvolve posteriormente uma glomerulonefrite rapidamente progressiva associada a vasculite com ANCA anti-mieloperoxidase positivo.

Renal involvement of antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis typically occurs in the form of a pauci-immune crescentic glomerulonephritis. The finding of some immune complex deposits in these glomerulonephritis is not unusual, but the cases with greater than mild deposition suggest the presence of a second and immune complex related glomerular disease. The significance of the immune complex deposits and their role in ANCA associated vasculitis is still a topic of debate, but higher levels of proteinuria and worse prognosis with respect to renal function have been described in these patients. We report a case of a patient with a known mesangial proliferative glomerulonephritis related to a mixed cryoglobulinemia secondary to a chronic hepatitis C infection that later developed a rapidly progressive glomerulonephritis due to a superimposed anti-myeloperoxidase ANCA positive glomerulonephritis.