RESUMO A reconstrução do terço distal da tíbia devido à ressecção de tumor maligno apresenta alguns fatores que dificultam sua realização, como camada subcutânea delgada, feixes neurovasculares que transpassam os compartimentos, tempo cirúrgico prolongado, material ortopédico específico e equipe multidisciplinar treinada. O aloenxerto de banco de tecido faz parte deste arsenal ortopédico. Objetivo: Descrever o protocolo realizado no Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad. Métodos: Série de seis casos submetidos à ressecção com margens oncológicas, reconstrução com aloenxerto e uso de haste retrógrada de tornozelo como cirurgia preservadora do membro. Três dos seis pacientes eram do sexo feminino, as lesões tinham em média 9,3 cm de comprimento e o tempo cirúrgico médio foi de 3,25 horas. Resultados: A principal complicação de curto prazo (≤ 30 dias) foi a paralisia do nervo fibular, enquanto a principal complicação de longo prazo (> 30 dias) foi a infecção do sítio cirúrgico (dois casos). A consolidação dos dois focos ocorreu em três pacientes, e dois pacientes evoluíram para pseudoartrose assintomática do foco proximal com consolidação do foco distal. Conclusão: Apesar das complicações, a cirurgia proposta permite ao paciente a chance de preservar seu membro diante de uma cirurgia radical imediata. Nível de Evidência IV, Série de Casos.

ABSTRACT Objectives The increase in HIV transmissibility in non-ulcerative sexually transmitted infection is already well-established. It is estimated that symptomatic carriers of N. gonorrhoeae and C. trachomatis have a relative risk of 4.8-fold and 3.6-fold, respectively, for the sexual acquisition of HIV. This type of evaluation for asymptomatic urethritis is necessary to reinforce strategies to combat HIV transmission. This study aims to assess the prevalence of patients with asymptomatic urethritis among men diagnosed with HIV-1 and determine the risk factors associated with this infection. Methods We enrolled a total of 115 male patients aged 18 years or older who have been diagnosed with HIV infection and have no symptoms of urethritis or other sexually transmitted infections and who have been evaluated between May and August 2015 in a follow-up visit at the Immunology Outpatient Clinic of a Brazilian University Hospital. Results Four asymptomatic patients were positive for C. trachomatis and were considered asymptomatic carriers of urethritis. Prevalence was 3.47%. Patients who were positive for C. trachomatis urethritis had a lower mean age (p = 0.015). Conclusion The presence of asymptomatic sexually transmitted infection is a challenge in clinical practice. We recommend that, in outpatient practice, the habit of inquiring on previous sexual behavior to obtain more information about risks and associations with asymptomatic sexually transmitted infection, a routine physical examination and complementary tests to detect STI pathogens should be performed to discard these conditions. The development of rapid tests for this purpose should also be encouraged.

ABSTRACT It is essential that healthcare providers are familiar with the full spectrum of clinical presentations of syphilis. A rare manifestation of secondary syphilis is the corymbiform (or corymbose) arrangement, in which a central greater papule is surrounded by smaller satellite lesions. Very few reports of corymbiform syphilis are available in current biomedical databases. We present the case of a 28 year-old HIV-infected male patient on regular, successful antiretroviral therapy who developed an asymptomatic corymbiform maculopapular lesion in the medial aspect of the right thigh. There were also a few brownish macular lesions on the left sole. New serological tests for syphilis (which had been negative in the past) were reactive. The coymbiform lesion slowly regressed and the non-treponemal test reverted to negative after benzathine penicillin G treatment. A review of the literature is provided. This is the first report of corymbiform syphilis in an HIV-infected patient.

ABSTRACT A prevalence of 3.47% of asymptomatic Chlamydia trachomatis urethritis has been previously reported among males living with HIV infection in Brazil. This study aims to assess the recurrence of C. trachomatis urethritis three years later in the same cohort of patients and analyze associated risk factors. A total of 115 male patients diagnosed with HIV infection, with no symptoms of urethritis and observed since May of 2015 in followup visits were enrolled. They had urine samplers tested by PCR for C. trachomatis and N. gonorrhoeae between February and March 2018. Results: Three of the four patients who had asymptomatic C. trachomatis urethritis three years before were recurrently positive for C. trachomatis urethritis. Two new patients were diagnosed as positives, accounting for a total asymptomatic C. trachomatis urethritis prevalence of 4.34%. The prevalence during the whole study was 5.21%. The relative risk for a new urethritis episode among those previously diagnosed with urethritis is RR=41.62 (95% CI: 9.42-183.84), p < 0.01. Patients who presented asymptomatic urethritis anytime and who were recurrently positive for C. trachomatis had a lower mean age (p<0.01). Married individuals were protected regarding asymptomatic urethritis [p<0.01, OR = 0.04 (0.005-0.4)] and had lower risk to develop recurrence [p<0.01, RR = 0.86 (0.74-0.99)]. Illicit drugs users had risk associated to asymptomatic urethritis [p=0.02, OR= 5.9 (1.03-34)] and higher risk to develop recurrence [p<0.01, RR=1.1 (1-1.22)]. Conclusion: The recurrence of asymptomatic C. trachomatis urethritis after treatment among males living with HIV infection in Brazil can be considered high and should not be neglected.

ABSTRACT Bacillary angiomatosis (BA) is an angioproliferative disease of immunocompromised patients that usually presents as vascular tumors in the skin and subcutaneous tissues. It is caused by chronic infections with either Bartonella henselae or B. quintana. Oral cavity BA is exceedingly rare and even rarer without simultaneous cutaneous disease. We report herein the case of a 51-year-old HIV-infected man who presented severe odynophagia and an eroded lesion on the hard palate that progressed to an oronasal fistula. No cutaneous lesions were recorded. Doxycycline led to complete resolution. To the best of our knowledge, only six previous cases of oral BA without tegumentary disease have been previously reported and none of them progressed to fistula.

Objective This study aims to estimate the prevalence of thyroid diseases and anti-TPO status. We searched for an association among presence of immune reconstitution and use of stavudine, didanosine and protease inhibitors with thyroid diseases. Materials and methods A cross-sectional study was performed to analyze the records of 117 HIV-infected patients who had their CD4+ cell count, viral load, anti-TPO, TSH and free T4 levels collected on the same day. Immune reconstitution was considered in those whose T CD4+ count was below 200 cells/mm3, but these values increased above 200 cells/mm3 after the use of antiretrovirals. The odds ratio obtained by a 2x2 contingency table and a chi-square test were used to measure the association between categorical variables. Results The prevalence of thyroid disease was 34.18%; of these, 4.34% were positive for anti-TPO. There was an association of risk between stavudine use and subclinical hypothyroidism (OR = 4.19, 95% CI: 1.29 to 13.59, X2 = 6.37, p = 0.01). Immune reconstitution achieved protection associated with thyroid disease that was near statistical significance OR = 0.45, 95% CI: 0.19 to 1.04, X2 = 3.55, p = 0.059. Conclusion The prevalence of thyroid disease in the sample studied was higher than what had been found in the literature, with a low positive anti-TPO frequency. The historical use of stavudine has an association of risk for the presence of subclinical hypothyroidism, and immune reconstitution has trends towards protection for the presence of thyroid diseases.

Introduction Acquired immunodeficiency syndrome (AIDS) is being increasingly reported among the elderly and major depression (MD) may be associated with suboptimal adherence to treatment. Methods Cross-sectional study on factors associated with MD among 72 HIV-infected elderly individuals. Results Twenty (27.7%) patients were found to have MD. The female gender (odds ratio [OR] = 10.65; p = 0.00586), a low CD4 count during the study (OR = 1.005247; p = 0.01539), and current smoking status (OR = 12.89; p = 0.01693) were independently associated with MD. Conclusions Our data underscore the need to attentively search and treat MD among HIV-infected elderly patients.

Fluoroquinolone (FQ)-associated tendinopathy and myopathy are uncommon but well recognized complications of the use of this class of antibacterial agents. The case of a 63-year-old previously asymptomatic female patient who developed severe left shoulder tendinopathy after surreptitiously doubling the prescribed dose of levofloxacin for the treatment of community-acquired pneumonia is reported here. Surgical stabilization with suture anchors and subacromial decompression were needed.

A síndrome inflamatória da reconstituição imune (IRIS) observada quando do início da terapia antirretroviral em indivíduos com infecção pelo HIV envolve mais comumente manifestações novas ou piora clínica de desordens infecciosas, previamente subclínicas ou não. Muito mais raras são as descrições de casos de IRIS de natureza não-infecciosa, embora representem importantes desafios ao diagnóstico e tratamento. Neste relato descrevemos um paciente HIV-positivo do sexo masculino, de 34 anos, sem antecedentes de gota e que desenvolveu monoartrite de gota um mês após início de terapia antirretroviral de alta atividade.

Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected subjects initiating antiretroviral therapy most commonly involves new or worsening manifestations of previously subclinical or overt infectious diseases. Reports of non-infectious IRIS are much less common but represent important diagnostic and treatment challenges. We report on a 34-year-old HIV-infected male patient with no history of gout who developed acute gouty arthritis in a single joint one month after initiating highly active antiretroviral therapy.

Dois experimentos foram conduzidos com o objetivo de avaliar o efeito da inclusão de níveis crescentes (1,5; 3,0; 4,5 e 6,0%) de óleo de soja (OS) ou gordura animal (gordura de porco - GA) nas dietas sobre a digestibilidade aparente dos nutrientes e o desempenho de coelhos em crescimento. No ensaio de digestibilidade, foram utilizados 72 coelhos da raça NZB, distribuídos em um delineamento inteiramente casualizado, com nove tratamentos e oito repetições. A adição de diferentes níveis de OS ou GA às dietas não influenciou os coeficientes de digestibilidade de MS, MO, PB e EB e a ingestão de MS, mas provocou efeito positivo sobre a digestibilidade do EE e da FDN. Não foi observado efeito da inclusão de OS ou GA sobre a contribuição nutritiva de cecotrofos ou sobre a MS e PB, mas a inclusão de 3 e 6% de GA aumentou a contribuição nutritiva do EE. No experimento de desempenho, foram utilizados 45 coelhos NZB distribuídos em um delineamento inteiramente casualizado, com nove tratamentos e cinco repetições. Os animais foram alojados logo após o desmame em gaiolas individuais, onde foram controlados o consumo de ração e o ganho de peso até os 77 dias de idade. Os tratamentos não afetaram significativamente o peso final, o ganho de peso diário, a conversão alimentar, os pesos de carcaça, pele, rins e intestino, mas influenciaram negativamente o consumo médio diário e os pesos de fígado e coração.

Two assays were conducted to evaluate the effects of feeding increasing dietary levels (1.5, 3.0, 4.5, and 6%) of soybean oil (SO) or animal fat (pork lard - AF) on nutrient apparent digestibility and performance for growing rabbits. In the digestibility assay, 72 NZB rabbits were assigned to a completely randomized design with nine treatments and eight replicates. No treatment effect on the coefficients of digestibility of DM, OM, CP GE or the DM ingestion was observed, however it was observed positive effect on EE and NDF digestibilities. No effect of increasing dietary levels of SO or AF on cecotrophe nutritional contribution or DM and CP was observed, but the addition of 3 and 6% AF increased EE nutritional contribution. In the performance assay, 45 rabbits NZB were assigned to a completely randomized design with nine treatments and five replicates. The animals were individually caged immediately after weaning, where feed intake and weight gain were controlled up to 77 days old. No significant treatment effect on final weight, daily weight gain, feed: gain ratio and weights of carcass, leather, kidneys or intestine was observed. It was observed negative effect on daily feed intake and weights of liver and heart.

Com o objetivo de avaliar a influência da adaptação do método contínuo de secagem sobre a qualidade das sementes de arroz durante o armazenamento, quatro porções de sementes, pesando cada uma 2500 kg, foram secadas em secador de fluxo contínuo Kepler Weber, modelo KW-2, utilizando diferentes temperaturas do ar, respectivamente, nas câmaras de secagem, superior e inferior: 60/40ºC; 60/50ºC; 70/50º C; 70/60ºC e um tratamento testemunha, constituído por quatro amostras submetidas à secagem estacionária em estufa regulada à temperatura constante de 32ºC. A qualidade das sementes foi avaliada através dos seguintes testes: grau de umidade, germinação, envelhecimento artificial e emergência em campo, conduzidos em quatro épocas, correspondentes aos 0, 60, 120 e 180 dias de armazenamento em condições ambientais não controladas. Os componentes do beneficiamento industrial foram determinados na primeira época de avaliação. Os resultados obtidos permitiram concluir que lotes de sementes de arroz com alta porcentagem de grãos quebrados podem apresentar elevada qualidade fisiológica; na secagem contínua adaptada, as sementes de arroz podem ser submetidas a temperaturas do ar de até 60ºC e 50ºC, respectivamente, nas câmaras superior e inferior, apesar de causar redução acentuada na porcentagem de grãos inteiros.

To evaluate the effects of the adaptation of the continuous drying method on seed quality during storage, four portions of rice seeds of 2500 kg each, were dried, in a continuous flow dryer KW-2 Kepler Weber, using different temperatures in the upper and lower drying chambers: 60/40ºC; 60/50ºC; 70/50º C; 70/60ºC. As control, four samples were submitted to stationary drying in oven at 32ºC. Seed quality was evaluated through moisture content, germination, accelerated aging and field emergence tests, at the 0, 60, 120 and 180 days of storage, at room temperature. The industrial processing components were determined in the first evaluation. Rice seed lots with high percentage of broken grains can present high physiological quality. Maximum air temperatures of 60ºC and 50ºC at the upper and lower chambers could be used in continuous drying of rice seeds. The adapted continuous drying decreases the percentage of intact grains of rice.