Resumo Fundamento A doença de Chagas (DC) constitui uma causa potencial negligenciada de doença microvascular coronariana (DMC). Objetivos Comparar pacientes com DMC relacionada à DC (DMC-DC) com pacientes com DMC ligada a outras etiologias (DMC-OE). Métodos De 1292 pacientes estáveis, encaminhados para angiografia coronária invasiva para elucidar o padrão hemodinâmico e a causa de angina, 247 apresentaram coronárias subepicárdicas normais, e 101 foram incluídos após aplicação dos critérios de exclusão. Desses, 15 compuseram o grupo de DMC-DC e suas características clínicas, hemodinâmicas, angiográficas, e cintilográficas foram comparadas às do grupo de 86 pacientes com DMC-OE. O nível de significância estatística para todas as comparações adotado foi de 0,05. Resultados Pacientes com suspeita de DMC-DC apresentaram características antropométricas, clínicas e angiográficas, além de alterações hemodinâmicas e de perfusão miocárdica estatisticamente comparáveis às detectadas nos 86 pacientes com DMC-OE. Disfunção ventricular diastólica, expressa por elevada pressão telediastólica do ventrículo esquerdo, foi igualmente encontrada nos dois grupos. Entretanto, em comparação a esse grupo com DMC-OE, o grupo com DMC-DC exibiu fração de ejeção ventricular esquerda mais baixa (61,1 ± 11,9 vs 54,8 ± 15,9; p= 0,049) e mais elevado escore de mobilidade da parede ventricular (1,77 ± 0,35 vs 1,18 ± 0,26; p= 0,02). Conclusão A cardiomiopatia crônica da doença de Chagas esteve associada à etiologia de possível doença microvascular coronariana em 15% de amostra de 101 pacientes estáveis, cujo sintoma principal era angina requerendo elucidação por angiografia invasiva. Embora os grupos DMC-DC e DMC-OE apresentassem características clínicas, hemodinâmicas, e de perfusão miocárdica em comum, a disfunção global e segmentar do ventrículo esquerdo foi mais grave nos pacientes com DMC associada à DC em comparação à DMC por outras etiologias. (Arq Bras Cardiol. 2020; 115(6):1094-1101)

Abstract Background Chagas disease (CD) as neglected secondary form of suspected coronary microvascular dysfunction (CMD). Objectives Comparison of patients with CMD related to CD (CMD-CE) versus patients with CMD caused by other etiologies (CMD-OE). Methods Of 1292 stable patients referred for invasive coronary angiography to elucidate the hemodynamic pattern and the cause of angina as a cardinal symptom in their medical history, 247 presented normal epicardial coronary arteries and 101 were included after strict exclusion criteria. Of those, 15 had suspected CMD-CE, and their clinical, hemodynamic, angiographic and scintigraphic characteristics were compared to those of the other 86 patients with suspected CDM-OE. Level of significance for all comparisons was p < 0.05. Results Patients with suspected CMD-CE showed most anthropometric, clinical, angiographic hemodynamic and myocardial perfusion abnormalities that were statistically similar to those detected in the remaining 86 patients with suspected CMD-OE. LV diastolic dysfunction, expressed by elevated LV end-diastolic pressure was equally found in both groups. However, as compared to the group of CMD-OE the group with CMD-CE exhibited lower left ventricular ejection fraction (54.8 ± 15.9 vs 61.1 ± 11.9, p= 0.049) and a more severely impaired index of regional wall motion abnormalities (1.77 ± 0.35 vs 1.18 ± 0.26, p= 0.02) respectively for the CMD-OE and CMD-CE groups. Conclusion Chronic Chagas cardiomyopathy was a secondary cause of suspected coronary microvascular disease in 15% of 101 stable patients whose cardinal symptom was anginal pain warranting coronary angiography. Although sharing several clinical, hemodynamic, and myocardial perfusion characteristics with patients whose suspected CMD was due to other etiologies, impairment of LV segmental and global systolic function was significantly more severe in the patients with suspected CMD related to Chagas cardiomyopathy. (Arq Bras Cardiol. 2020; 115(6):1094-1101)

Abstract Background: Drug-induced esophagitis is an uncommon diagnosis in the pediatric population. The following is a report of six adolescents with L-arginine-induced esophagitis. Case reports: All patients were under treatment with L-arginine for short stature. After using the prescribed medication for 1-3 months, all cases started with severe retrosternal pain, odynophagia, and dysphagia. The upper gastrointestinal endoscopies showed ulcers located in the mid esophageal mucosa. Conclusions: In the presence of acute severe odynophagia, dysphagia, and retrosternal pain, drug-induced esophagitis should be considered as a possible diagnosis. Treatment includes liquid diet, pain control, sucralfate, omeprazole, and interruption of L-arginine. In addition, the physician should explain preventive measures focused on patient and family education on the drug side effects and precise instructions on how to take medications, as well as a careful balance of risk and benefits of any medication. At present, there are no clinical trials that support the use of L-arginine in treatment of short stature.

Resumen Introducción: La esofagitis inducida por medicamentos es un diagnóstico poco frecuente en pacientes pediátricos. A continuación, se describe una serie de seis casos de pacientes menores de 15 años con esofagitis inducida por L-arginina. Casos clínicos: Los seis casos se encontraban en tratamiento con L-arginina por talla baja e iniciaron con dolor retroesternal, odinofagia y disfagia de rápida instalación. Cuatro de ellos acudieron al servicio de urgencias por la intensidad de los síntomas. Los hallazgos en la endoscopia del tubo digestivo alto fueron úlceras en la mucosa del esófago a la altura del tercio medio, zona de estrechez natural por la compresión del bronquio izquierdo. Conclusiones: En presencia de odinofagia, disfagia, dolor retroesternal y el antecedente de la ingesta de L-arginina, la esofagitis inducida por fármacos debe considerarse como una posibilidad diagnóstica. El tratamiento está basado en el manejo del dolor, sucralfato, omeprazol, así como la suspensión del medicamento y medidas preventivas centradas en la educación del paciente y los familiares sobre los riesgos y beneficios de un medicamento y la forma correcta de administrarlo.

ABSTRACT The need for treated water is essential for life. With the constant increase in population, the most common way to purify surface water is through conventional water treatment plants (WTPs). The high volume of residue (sludge) generated in this process is most often returned to the catchment site, negatively affecting the ecosystem. The sludge of WTPs is similar to soil because it is composed of inorganic solids. Adobe is a construction material made from water and soil without the burning process, so it is considered sustainable, recyclable, and energy-efficient and can be stabilized with various materials. Therefore, the objective of this work is to develop adobes using the sludge of WTPs and to analyse their physical, mechanical and thermal properties. Adobes were produced with five concentrations of sludge by mass: 0, 1, 3, 5 and 7%. It was observed that with the increase in the sludge concentration, there was an increase in the capillarity and a decrease in mass, the water absorption was limited to 3% of sludge, and there was an increase in the bulk density. The linear shrinkage, thermal conductivity and compressive strength were not influenced. The addition of WTP sludge altered some properties of adobe. The use of WTP sludge in adobe is limited to 3%; above that, the adobe becomes unstable in relation to water. Therefore, the use of WTP sludge in the manufacture of adobe is feasible in controlled concentrations and is a sustainable use of the residue.

ABSTRACT Adobe is an efficient construction material for several reasons, such as its thermal comfort, sustainability, and lower energy cost, as well as the simplicity of its production and execution. However, challenges such as water absorption, capillarity, and compressive strength should be investigated to improve its physical and mechanical properties. “Synthetic termite saliva” (STS) is an excellent stabilizer with high cohesive and hydrophobic power. Therefore, the objective of this work was to evaluate the effects of STS incorporation into adobe, analyzing its physical, mechanical and thermal properties. Five treatments were studied: 0 (control); 0.1; 0.2; 0.4 and 0.8% STS by mass. These adobe samples were evaluated according to bulk density, linear shrinkage, capillarity, water absorption, thermal conductivity and compressive strength, according to Norma Técnica de Edificación (NTE) E0.80 testing using a new methodology. Linear shrinkage decreases from 2.7 to 1.91 cm with 0.4% STS. Capillarity decreases with the increasing amounts of STS. Water absorption decreased from 12.03 to 6.31% using 0.4% STS, and its mass was reduced from 779 to 19 grams. The thermal conductivity showed no differences between concentrations. The compressive strength was reduced but was still acceptable based on NTE E.080. The stabilization of the adobe using STS showed an improvement in its physical properties, mainly due to its hydrophobic power.

A necessidade precípua de estudos que abordem o aproveitamento de resíduos líquidos na irrigação de culturas em condições semiáridas, é evidente. Buscou-se, com o presente trabalho, analisar a viabilidade do aproveitamento da urina humana diluída em efluente doméstico (0; 1,5; 3,0 e 4,5%) na irrigação de plantas de milheto cultivadas em três solos (Luvissolo, Neossolo e Planossolo) oriundos de áreas degradadas do Núcleo de Desertificação dos Cariris, PB. Esses tratamentos foram distribuídos em um delineamento inteiramente casualizado, analisado em esquema fatorial 4 x 3 + 6, ou seja, quatro diluições de urina em efluente doméstico, três tipos de solo e seis testemunhas (utilizando-se água de abastecimento municipal na irrigação das plantas com e sem aplicação de NPK nos três solos estudados), com quatro repetições, totalizando 72 unidades experimentais. Concluiu-se que a adição de 4,5% de urina humana no efluente doméstico aplicado via irrigação em plantas de milheto cultivadas em Luvissolo crômico, proporciona resultados de massa de grãos e eficiência do uso da água semelhante ao observado em plantas com fertilização mineral recomendada e irrigadas com água de abastecimento.

The imminent need of studies that address the use of liquid residue in irrigation of crops grown in semi-arid conditions is evident. In this context, the feasibility of the use of human urine diluted in domestic effluent (0, 1.5, 3.0 and 4.5%) for the irrigation of plants of millet cultivated in three soils (Luvisol, Neossol and Planossol) collected from degraded areas of the Nucleus of Desertification of Cariris, PB was studied. These treatments were distributed in a completely randomized design, analysed in a factorial 4 x 3 + 6, four urine dilutions in domestic effluent, three types of soil and six controls (using water of municipal supply in the irrigation of the plants with and without application of NPK with four replications, totalizing 72 experimental plots. It was concluded that the addition of 4.5% of human urine in domestic effluent applied in irrigation of the plants of millet cultivated in chromic Luvisol, provides results of viable grain mass and efficiency of water use similar to observed in plants under recommended doses of mineral fertilizer and irrigated with water of municipal supply.

En la actualidad existe evidencia de los efectos deletéreos de la exposición de diferentes especies animales a xenobióticos, incluyendo herbicidas, pesticidas y plaguicidas.. En la literatura se han descrito los efectos de herbicidas tales como el glifosato en sistemas orgánicos como el respiratorio y el tegumentario en peces, sin embargo, reportes acerca del efecto de dichos productos en el sistema inmune de animales acuáticos son tan escasos como necesarios. La alteración de la dinámica y equilibrio de la respuesta inmune pudiera estar generando efectos importantes sobre la capacidad del pez para sobrevivir en el medio. El presente trabajo evaluó el efecto del glifosato (Roundup®) y surfactantes acompañantes (Cosmoflux® 411F), sobre el estado oxidativode la cachama blanca (Piaractus brachypomus) en un periodo de 14 días de exposición crónica subletal. Se evidenció que el glifosato(Roundup®) así como la mezcla de este con el surfactante induce aumento de la actividad oxidativa (estrés oxidativo) en los animales expuestos. Estos efectos fueron mayores cuando se expusieron a la mezcla atribuyendo un efecto importante al surfactante. De la misma manera el artículo se aproxima al soporte fisiopatológico de estos hallazgos.

Currently, there is evidence of deleterious effects of xenobiotic exposure (including herbicides, pesticides and plaguicides) in several animal species. Effects of glyphosate on organic systems such as respiratory and tegumentary system have been described; however, the effects of this kind of xenobiotics on immune system of non-target animals, including aquatic animals are as scarce as necessary. Dynamic and equilibrium alterations of the immune response could be eliciting important effects on ability of fish to survive in the environment challenge. This current work assessed the effect of glyphosate (Roundup®) and added surfactants (Cosmoflux® 411F), on oxidative status of red-bellied pacu (Piaractus brachypomus) in a 14-day period of chronic sublethal exposure. It was evident that glyphosate Roundup® as well as its mixture with surfactant induce an increase on oxidative activity (oxidative stress) in exposed animals. These effects were higher in animal exposed to the mixture than Roundup® alone, giving an important role of surfactant on the effect. In the same way, article approaches to pathophysiological support of these findings.

Actualmente, não existe evidência de efeitos deletérios da exposição xenobióticos (incluindo herbicidas, pesticidas, etc) em diversas espécies animais. Efeitos do glifosato em sistemas orgânicos, tais como as vias respiratórias e tegumentar têm sido descritos, no entanto, os efeitos deste tipo de xenobióticos sobre o sistema imune de animais não-alvo, incluindo os animais aquáticos são tão escassos que for necessário. Alterações dinâmicas e equilíbrio da resposta imunitária poderia ser provocando efeitos importantes sobre a capacidade de peixe para sobreviver no ambiente desafio. O presente trabalho avaliou o efeito de glifosato (Roundup®) e surfactantes (agregado Cosmoflux® 411F), sobre o estado oxidativo de Cachama blanca (Piaractusbrachypomus) em um período de 14 dias de exposição subletal crônica. Era evidente que Roundup®, assim como a sua mistura com um agente tensioactivo induzir um aumento na actividade oxidativa (stress oxidativo) nos animais expostos. Estes efeitos foram mais elevados em animais expostos à mistura de Roundup® por si só, dar um importante papel de agente tensioactivo sobre o efeito. Da mesma forma, o artigo aborda a apoio fisiopatológico dessas descobertas.

RESUMO Objetivou-se, com o presente trabalho, descrever e testar um método simplificado de baixo custo (IAF-LUX) para estimativa do índice de área foliar (IAF) em comparação com um equipamento comercial (LAI-2000, Li-Cor®). Ambos foram avaliados em um seringal e em árvores de lima ácida "Tahiti"; posteriormente, os dois métodos foram comparados com medidas destrutivas de área foliar realizadas em uma árvore adulta de lima ácida 'Tahiti'; notou-se, então, que os desvios dos resultados pelo IAF-LUX em relação aos do LAI-2000 foram no máximo de 7,4% na seringueira e de 3,6% em lima ácida "Tahiti". A estimativa da área foliar total utilizando-se o LAI 2000, mostrou boa concordância com as medidas diretas; resultados semelhantes foram obtidos com o IAF-LUX (5% de erro). Para as condições em que foi desenvolvido o trabalho os métodos com base em medida de radiação apresentaram boa precisão na estimativa da área foliar total das árvores de lima ácida, ficando patente que este método pode substituir vantajosamente as outras técnicas usadas, em comparação pelo baixo custo do equipamento, pela facilidade de operação no campo e análise dos dados.

ABSTRACT This paper aimed to describe and evaluate a low-cost simplified method (IAF-LUX method) for leaf area index (LAI) estimation, in comparison with well-tested commercial equipment (LAI-2000, Li-Cor®), being both applied for a rubber tree plantation and for a 'Tahiti' acid lime orchard. Later, the results of the both methods were also compared with destructive measurements of leaf area carried out in other 'Tahiti' acid lime adult tree. Considering LAI-2000 as reference, the proposed IAF-LUX method showed deviations of 7.4% for rubber tree and 3.6% for acid lime 'Tahiti'. Comparing the IAF-LUX with destructive measurements, a deviation of 5.0% was observed in acid lime, while LAI-2000 showed deviation of 7.0%. Based on these results, it is concluded that the IAF-LUX method may be used for determining leaf area in the two species, replacing advantageously the other destructive or non-destructive techniques because it is of low cost, easily operated and non-destructive procedure.

PURPOSE: Tumor banks have the primary responsibility for collecting, cataloging, storing and disseminating samples of tissues, cells and fluids, which are used by researchers to identify diagnostic molecular markers, prognostic indicators and therapeutic targets. The objective of this review was to describe a simple, reliable and reproducible protocol for obtaining and storing samples of urological tumors. MATERIALS AND METHODS: Urogenital tumor tissues were collected by the surgeons from the Urology Division of University of Sao Paulo Medical School. The obtained surgical specimens were immediately placed in liquid nitrogen, dry ice or in a tube containing RNAlater ®, and then stored by cryopreservation (-80°C). A mirror fragment was fixed in 10% formalin processed routinely and embedded in Paraplast®. RESULTS: We developed a protocol for the collection, cataloging, storage, conservation and use of tumor samples. During a period of one year the Urological Tumor Bank of the Urology Division stored 274 samples of prostate, bladder, kidney, penis and testicle tumors of different histological types, 74 urine and 271 serum samples. CONCLUSIONS: Having biological materials characterized and available along with the clinical patient information provides an integrated portrait of the patients and their diseases facilitating advances in molecular biology. It also promotes the development of translational research improving methods of diagnosis and cancer treatment.

INTRODUÇÃO: A intervenção coronária percutânea cresceu de modo expressivo nas últimas décadas. Entretanto, relatos de resultados imediatos e a longo prazo desse procedimento em instituições brasileiras são esporádicos e restritos a alguns centros. A presente proposta objetiva descrever um sistema nacional para a avaliação dos indivíduos tratados por intervenção coronária percutânea no Brasil. MÉTODOS: O Registro ICP-BR foi constituído por meio de rede informatizada para a captação de dados, via web, sobre angioplastias coronárias realizadas no dia a dia da cardiologia intervencionista, sem critérios de exclusão. Em sua fase piloto, 8 centros nacionais foram selecionados para a coleta inicial de dados. Relatamos o perfil clínico e a evolução intra-hospitalar dos primeiros pacientes incluídos. RESULTADOS: De março de 2009 a dezembro de 2009, foram incluídos 1.249 pacientes na base de dados. No total, 60% foram tratados pelo Sistema Único de Saúde, 38% por planos de saúde e 2% eram pagantes. A média de idade era de 63,7 ± 11,3 anos, 36% eram diabéticos, 12% tinham cirurgia prévia e 27% tinham angioplastia prévia. À admissão, 39% eram estáveis e 18% tinham infarto com supradesnivelamento do segmento ST. Ultrassom intracoronário ou reserva fracionada de fluxo foram utilizados em 2,8% dos casos. Stents foram utilizados em 93% dos procedimentos, sendo farmacológicos em 16,2% dos pacientes. A mortalidade foi de 0,2% nos pacientes estáveis, de 2,4% nos casos de coronariopatia aguda sem supradesnivelamento do segmento ST, de 6,1% nos pacientes com infarto com supradesnivelamento do segmento ST e de 3,6% naqueles com "equivalente anginoso". CONCLUSÕES: Descrevemos a construção e a efetiva implementação de sistema informatizado para a coleta detalhada de dados sobre procedimentos de intervenção percutânea coronária no Brasil. Em decorrência do caráter inclusivo sem restrições (all-comers) e do seguimento prospectivamente desenhado dos pacientes, esse sistema de captação e registro poderá contribuir de forma decisiva para que se trace o perfil das intervenções percutâneas coronárias em nosso País.

BACKGROUND: Percutaneous coronary intervention has grown dramatically in recent decades. However, reports of immediate and long-term results of this procedure in Brazilian institutions are sporadic and limited to some centers. This study is aimed at describing a national system to evaluate patients treated by percutaneous coronary intervention in Brazil. METHODS: The ICP-BR Registry was established by a computerized network for data capture on coronary angioplasties performed in day-to-day interventional cardiology, without exclusion criteria. In the pilot phase 8 national centers were selected for the initial data collection. We report the clinical profile and in-hospital evolution of the first patients included. RESULTS: From March 2009 to December 2009, 1,249 patients were included in the database. In total, 60% were treated by the Unified Health System, 38% by health insurance plans and 2% were private patients. Mean age was 63.7 ± 11.3 years, 36% were diabetic, 12% had prior surgery and 27% prior angioplasty. Upon admission, 39% were stable and 18% had ST elevation myocardial infarction. Intracoronary ultrasound or fractional flow reserve was performed in 2.8% cases. Stents were used in 93% of procedures, and drug-eluting stents in 16.2% of the patients. Mortality was 0.2% in stable patients, 2.4% in patients with acute coronary syndromes without ST elevation, 6.1% in patients with ST elevation myocardial infarction and 3.6% in those with anginal equivalent. CONCLUSIONS: We describe the development and implementation of a computerized system to collect detailed data on percutaneous coronary intervention procedures in Brazil. Given the inclusive unrestricted character (all-comers) and prospective follow-up of patients, this data capture and recording system may contribute decisively to profile percutaneous coronary intervention in our country.

Introduction: As eating disorders include both psychological and physiological components, appropriate management of these disorders requires input from a number of disciplines working together in a coordinated manner, following an integrated Programme. The Eating Disorders-Nutrition Education Programme has as its purpose achieving healthier habits and modifying eating behaviour. The Programme should take place as one part of Eating Disorders treatment. Objectives: To determine the efficacy of a Nutrition Education Programme about nutritional state and eating patterns in a group of patients diagnosed with Eating Disorders who follow the usual check-up protocol in the clinic for nutrition and mental health. Material and methods: 89 patients were included, including 5% men. They received individual nutritional education with weekly/fortnightly appointments during a period of 4-6 months. Educational counseling was carried out by a dietician. The mean age of the sample was 24 ± 8 years and the diagnoses were: Anorexia Nervosa Restrictive (ANR) 32.5% Anorexia Nervosa Purgative (ANP) 26.5%, Bulimia Nervosa (BN) 18%, Eating Disorder Not Otherwise Specified (EDNOS) 21% and Binge Eating Disorder (BED) 2%. The average evolution time since the diagnosis was 4.8 ± 5 years. An anthropometric assessment, assessment of daily oral intake, 24-hour dietary recall, and Eating Attitudes Test (EAT26) questionnaires were completed at the first appointment and again at the end of the programme. Results: The mean score of the EAT26 questionnaire was 32 ± 15 initially, and after 4-6 months the score was 23.7 ± 14 (p < 0.001). This change represents a significant improvement in the patients' symptoms after the Programme. Furthermore there were significant differences in the evaluation of the questionnaire by scales and by diagnosis. After 4-6 months, there was a meaningful reduction in episodes of vomiting per week (from 7.5 ± 10 to 1 ± 1.8 p < 0.001) in ANP and BN binge-purging (8 ± 9.7 vs 2.2 ± 3.2 p < 0,01). In addition, a favourable trend in the number of binges per week was observed for both diagnoses. The percentage of subjects that ate less than 4 meals per day decreased from 70% to 19% after the Education Programme (p < 0.001). Some 67% of the patients dedicated a specific time for eating and a 54% started to have complete meals. These results that show a very favourable tendency with respect to the normalization of eating patterns. There was improvement in the intake of dairy products, vegetables, fruits, cereals and oil (p < 0.05). At the beginning, 34% consumed at least 3 of the 6 food groups within the recommended range, but at the end 70% did (p < 0.001). After the nutritional education programme, an important increase in energy ingestion and carbonhydrate consumption took place (p < 0.001), as much with ANR as with ANP. With respect to micronutrients, the ingestion of vitamin B2 significantly increased, as well as folic acid and calcium (p < 0.001) in ANP, and magnesium and calcium (p < 0.001) in ANR. In ANR, we found a significant improvement in nutritional status (p < 0.001). Variables including weight, BMI, muscular circumference of the arm and tricipetal fold were at the limit of significance. Regarding ANP and EDNOS, the initial evaluation demonstrated that they were within normal limits, and they were maintained after nutritional education. In BN, progress towards normalization of BMI took place, increasing from 26.4 ± 6.6 to 25.5 ± 5.7 (-2.3 kg). Conclusions: The Nutritional Education Programme carried out by qualified professionals should be a part of Eating Disorders treatment, along with medical and psychological monitoring and as part of an interdisciplinary, multiprofessional team effort.

Introducción: Los Trastornos de la Conducta Alimentaria incluyen componentes psíquicos y físicos, por lo que para un adecuado abordaje de los mismos se debe trabajar dentro de un Programa integral con la participación de diferentes disciplinas. La Educación Nutricional busca la modificación de la conducta alimentaria hacia patrones más saludables y debe formar parte del Programa de tratamiento de esta enfermedad. Objetivo: Determinar el efecto de un programa de Educación Nutricional sobre el estado nutricional y el patrón alimentario de un grupo de pacientes con Trastornos de la Conducta Alimentaria que siguen con el protocolo habitual de seguimiento en consulta de Nutrición y deSalud Mental. Metodología: Se incluyeron 89 pacientes, 5% hombres, que recibieron Educación Nutricional individual con visitas semanales/quincenales por 4-6 meses, llevadas a cabo por una Dietista. La edad media 24 ± 8 años. La distribución por diagnóstico fue: Anorexia Nerviosa Restrictiva (ANR) 32,5% y Anorexia Nerviosa Purgativa (ANP) 26,5%, Bulimia Nerviosa (BN) 18%, Trastorno Alimentario No Específico (TANE) 21% y Trastorno por Atracón (TA) 2%. La media del tiempo de evolución desde el diagnóstico fue de 4,8 ± 5 años. Los pacientes completaban el cuestionario EAT26 (Eating Attitudes Test-26), se realizaba evaluación antropométrica, registro de 24 h y frecuencia habitual de consumo de alimentos en la primera consulta y tras recibir el programa de educación nutricional. Resultados: El valor medio del cuestionario EAT26 fue inicialmente 32 ± 15, tras la intervención fue 23,7 ± 14 (p < 0,001), lo que evidencia cambios significativos en la sintomatología de los pacientes muy positivos. También hubo diferencias significativas en el análisis del cuestionario por escalas y en la evaluación por diagnósticos. Tras los 4-6 meses del programa, disminuyó significativamente el número de vómitos/semana tanto en ANP (7,2 ± 10 vs 1 ± 1,8 p < 0,001) como en BN (8 ± 9,7 vs 2,2 ± 3,2 p < 0,01). También se observó una tendencia favorable en la disminución en el número de atracones/semana para ambos diagnósticos. El porcentaje de pacientes que consumían menos de 4 comidas/día se redujo de un 70% a un 19% (p < 0,001). El 67% de los pacientes logró dedicar un tiempo definido como correcto a comer y un 54% pasó a consumir una comida completa, resultados que muestran una tendencia muy favorable respecto a la normalización del patrón alimentario. Aumentó significativamente el consumo de lácteos, verduras, cereales, aceite (p < 0,001), carnes (p < 0,05) y frutas (p < 0,01). Inicialmente un 34% consumía por lo menos 3 de los 6 grupos de alimentos dentro del rango recomendado, al final lo hizo el 70% (p < 0,001). Tras la educación nutricional se produjo un incremento significativo en la ingesta energética y en el consumo de hidratos de carbono (p < 0,001) tanto en ANR como en ANP. Respecto a los micronutrientes aumentó significativamente la ingesta de vitamina B2, ácido fólico y calcio (p < 0,001) en ANP y de magnesio y calcio (p < 0,001) en ANR. Se produjo una mejoría significativa en el estado nutricional en ANR (p < 0,001) en las variables peso, IMC y circunferencia muscular del brazo y el pliegue tricipital estuvo en el límite de la significación. Para ANP y TANE su valoración inicial demostraba que se encontraban dentro de rangos de normalidad, situación que se mantuvo tras la educación nutricional. En BN se produjo una evolución hacia la normalización del IMC, que pasó de 26,4 ± 6,6 a 25,5 ± 5,7 (-2,3 kg). Conclusión: Los programas de educación nutricional llevados a cabo por profesionales cualificados y expertos, deben formar parte del tratamiento de los TCA, junto al seguimiento médico y psicológico y dentro del marco de la interdisciplina y el trabajo en equipo.

OBJETIVO: Relatar nossa experiência inicial com utilização do dispositivo mecânico para realização de anastomose aorta-safena. MÉTODO: Entre junho/2002 e maio/2003, 17 pacientes (pts) foram selecionados para emprego de anastomose mecânica, sendo 13 homens, com idade média de 64,4±9,4 anos, portadores de doença arterial coronariana. Foram realizadas 2,9±0,5 anastomoses/paciente, totalizando 49, sendo 19 com utilização de enxertos arteriais e 30 com veia safena. Dentre as pontes de veia safena, 11 (36,7%) foram convencionais e 19 (63,3%) utilizaram sutura mecânica (SM) aorto-safena. No período pós-operatório, foram analisados evolução clínica, alterações enzimáticas e eletrocardiográficas, bem como estudo angiográfico das anastomoses. RESULTADOS: Dos 17 pts, a SM foi empregada em 16 (94,1%). Utilizou-se circulação extracorpórea em 6 (37,5%) dos 16 pts que receberam SM, com tempo médio de 102,9 ± 16,9 minutos. A evolução pós-operatória foi satisfatória em todos os pts. No pós-operatório, não foram observadas alterações isquêmicas ou IAM em nenhum paciente. O estudo angiográfico das anastomoses foi realizado em 9 (52,9%) pts. As anastomoses da artéria torácica interna esquerda para ramo interventricular anterior apresentavam-se pérvias em 100% dos casos. Das 15 anastomoses de veia safena estudadas, 11 (73,3%) eram de SM e 9 (81,8%) apresentavam-se pérvias. Todas anastomoses convencionais de veia safena estavam pérvias. Não se observou óbito hospitalar. No seguimento tardio, 88,2% dos pacientes apresentam-se livres de eventos cardiovasculares. CONCLUSÕES: A SM mostrou-se factível, mas é necessária uma análise mais ampla dos benefícios de sua utilização em relação ao tempo operatório, agressão ao paciente, perviabilidade do enxerto e custo final.

OBJECTIVE: To report on our initial clinical experience of the utilization of a mechanical anastomotic device (MAD) to perform saphenous vein graft to aorta anastomosis. METHOD: Between June 2002 and May 2003, 17 patients, including 13 male, with a mean age of 64.4 ± 9.4 years, were selected for coronary artery bypass grafting using MAD. A total of 49 anastomoses, 19 arterial and 30 vein grafts, were performed with a mean of 2.9 ± 0.5 anastomoses per patient. Eleven (36.7%) vein-graft anastomoses were performed with conventional sutures and 19 (63.3%) using MAD. The clinical evolution, enzymatic and electrocardiographic alterations as well as an angiographic study were analyzed in the postoperative period. RESULTS: Of the 17 patients, the mechanical device was used on 16 (94.1%). Six (37.5%) patients were operated on under cardiopulmonary bypass with a mean time of 102.9 ± 16.9 minutes. The postoperative evolution was satisfactory in all patients. No patient presented with enzymatic, myocardial infarction or other ischemic electrocardiographic alterations in the immediate postoperative period. Early postoperative angiography was performed in 9 (52.9%) patients. The anastomoses of the left internal thoracic artery to left anterior descending artery were patent in all cases. Of the 15 saphenous vein grafts studied, 11 (73.3%) were performed using MAD, 9 (81.8%) of which were patent. All the 4 conventionally sutured vein anastomoses were patent. No hospital deaths occurred. In the late follow-up, 88.2% of the patients were free of cardiac-related events. CONCLUSIONS: MAD for vein graft-to-aorta anastomosis proved to be feasible, but a wider analysis of the benefits of its utilization regarding operative time, aggression to the patient, patency of the grafts and final cost are necessary.

Macrophomina phaseolina é considerado como um dos fungos mais prevalecentes em infecções radiculares de soja, no Brasil. Nenhuma fonte de resistência genética foi ainda encontrada. Além disso, nenhuma informação foi obtida quanto à variabilidade genética deste patógeno, em regiões tropicais. Cinqüenta e cinco isolados de raízes de soja (Glycine Max), obtidos de diferentes regiões geográficas, foram analisados por RAPD para avaliação da diversidade genética. Análise de agrupamento (UPGMA), utilizando 74 loci, permitiu identificar três grupos, com uma média de 99%, 92% e 88% de similaridade genética, respectivamente. Os três grupos correspondem a 5,45%, 59,95% e 34,6% de todos os isolados utilizados. Apenas uma planta estava infetada por três diferentes haplotipos, enquanto 10,9% de todas as plantas estavam infetadas por haplotipos pertencentes a dois diferentes grupos. Em outro estudo a similaridade genética foi determinada entre isolados originários de diferentes hospedeiros [soja, sorgo (Sorghum bicolor), girassol (Helianthus annuus), caupi (Vigna unguiculata), milho (Zea mays) e trigo (Triticum aestivum)] e de duas amostras de solo de áreas virgens. Os resultados mostraram que isolados mais divergentes são oriundos de áreas com monocultura. Amplificação da região ITS produziram apenas um fragmento com 620 pb. Nenhum dos isolados foi diferenciado quando o produto amplificado por PCR foi digerido com enzimas de restrição. Os resultados demonstram a existência de variabilidade genética entre os isolados brasileiros de M. phaseolina e mostram que uma única raiz pode ter mais de um haplotipo. Além disso, a rotação de cultura induz menos diversidade genética entre os isolados. O conhecimento dessa variabilidade pode ser útil na seleção de genótipos resistentes à podridão de carvão.

Macrophomina phaseolina has been considered one of the most prevalent soybean (Glycine max) pathogens in Brazil. No genetic resistance has been determined in soybean and very little is known about the genetic diversity of this pathogen in tropical and sub-tropical regions. Fifty-five isolates from soybean roots were collected in different regions and analyzed through RAPD for genetic diversity. The UPGMA cluster analysis for 74 loci scored permitted identification of three divergent groups with an average similarity of 99%, 92% and 88%, respectively. The three groups corresponded to 5.45%, 59.95% and 34.6%, respectively of all isolates used. A single plant had three different haplotypes, while 10.9% of the analyzed plants had two different haplotypes. In another study the genetic similarity was evaluated among isolates from different hosts [soybean, sorghum (Sorghum bicolor), sunflower (Helianthus annuus), cowpea (Vigna unguiculata), corn (Zea mays) and wheat (Triticum aestivum)] as well as two soil samples from native areas. Results showed that more divergent isolates originated from areas with a single crop. Isolates from areas with crop rotation were less divergent, showing high similarity values and consequently formed the largest group. Amplification of the ITS region using primers ITS1 and ITS4 produced only one DNA fragment of 620 bp. None of the isolates were differentiated through PCR-RFLP. Our results demonstrated genetic variability among Brazilian isolates of M. phaseolina and showed that one single root can harbor more than one haplotype. Moreover, cultivation with crop rotation tends to induce less specialization of the pathogen isolates. Knowledge of this variation may be useful in screening soybean genotypes for resistance to charcoal rot.