Paralisia cerebral tetraplégica e constipação intestinal: avaliação da reeducação intestinal com uso de massagens e dieta laxante

A constipação intestinal afeta 74% dos indivíduos com paralisia cerebral. O objetivo deste estudo foi avaliar resultados das intervenções de enfermagem no tratamento da constipação intestinal associada à paralisia cerebral. Trata-se de um estudo quantitativo, prospectivo e comparativo (antes-depois). A amostra foi composta por 50 pacientes com paralisia cerebral tetraplégica e constipação intestinal. As principais orientações conservadoras foram: consumo diário de alimentos laxantes e óleos vegetais, aumento da ingestão hídrica e execução de manobras intestinais diárias. Houve alívio total ou parcial da constipação em 90% dos participantes, com melhora de aspectos da qualidade de vida, como sono, apetite e irritabilidade, além de diminuição significativa de sangramento retal, fissura anal, retenção voluntária de fezes, choro e dor ao evacuar. Apenas 10% necessitaram de medicações laxantes. Recomenda-se que medidas conservadoras sejam preferencialmente utilizadas para o tratamento da constipação intestinal associada à paralisia cerebral e que medicamentos sejam apenas adjuvantes, quando necessário.

Cancer risk in the Swiss HIV Cohort Study: associations with immunodeficiency, smoking, and highly active antiretroviral therapy.

BACKGROUND: Persons infected with human immunodeficiency virus (HIV) have an increased risk for several cancers, but the influences of behavioral risk factors, such as smoking and intravenous drug use, and highly active antiretroviral therapy (HAART) on cancer risk are not clear. METHODS: Patient records were linked between the Swiss HIV Cohort Study and Swiss cantonal cancer registries. Observed and expected numbers of incident cancers were assessed in 7304 persons infected with HIV followed for 28,836 person-years. Relative risks for cancer compared with those for the general population were determined by estimating cancer registry-, sex-, age-, and period-standardized incidence ratios (SIRs). RESULTS: Highly elevated SIRs were confirmed in persons infected with HIV for Kaposi sarcoma (KS) (SIR = 192, 95% confidence interval [CI] = 170 to 217) and non-Hodgkin lymphoma (SIR = 76.4, 95% CI = 66.5 to 87.4). Statistically significantly elevated SIRs were also observed for anal cancer (SIR = 33.4, 95% CI = 10.5 to 78.6); Hodgkin lymphoma (SIR = 17.3, 95% CI = 10.2 to 27.4); cancers of the cervix (SIR = 8.0, 95% CI = 2.9 to 17.4); liver (SIR = 7.0, 95% CI = 2.2 to 16.5); lip, mouth, and pharynx (SIR = 4.1, 95% CI = 2.1 to 7.4); trachea, lung, and bronchus (SIR = 3.2, 95% CI = 1.7 to 5.4); and skin, nonmelanomatous (SIR = 3.2, 95% CI = 2.2 to 4.5). In HAART users, SIRs for KS (SIR = 25.3, 95% CI = 10.8 to 50.1) and non-Hodgkin lymphoma (SIR = 24.2, 95% CI = 15.0 to 37.1) were lower than those for nonusers (KS SIR = 239, 95% CI = 211 to 270; non-Hodgkin lymphoma SIR = 99.3, 95% CI = 85.8 to 114). Among HAART users, however, the SIR (although not absolute numbers) for Hodgkin lymphoma (SIR = 36.2, 95% CI = 16.4 to 68.9) was comparable to that for KS and non-Hodgkin lymphoma. No clear impact of HAART on SIRs emerged for cervical cancer or non-acquired immunodeficiency syndrome-defining cancers. Cancers of the lung, lip, mouth, or pharynx were not observed among nonsmokers. CONCLUSION: In persons infected with HIV, HAART use may prevent most excess risk of KS and non-Hodgkin lymphoma, but not that of Hodgkin lymphoma and other non-acquired immunodeficiency syndrome-defining cancers. No cancers of the lip, mouth, pharynx, or lung were observed in nonsmokers.

The hematology laboratory in blood doping (bd): 2014 update on the athlete biological passport (APB)

Introduction: Blood doping (BD) is the use of Erythropoietic Stimulating Agents (ESAs) and/or transfusion to increase aerobic performance in athletes. Direct toxicologic techniques are insufficient to unmask sophisticated doping protocols. The Hematological module of the ABP (World Anti-Doping Agency), associates decision support technology and expert assessment to indirectly detect BD hematological effects. Methods: The ABP module is based on blood parameters, under strict pre-analytical and analytical rules for collection, storage and transport at 2-12°C, internal and external QC. Accuracy, reproducibility and interlaboratory harmonization fulfill forensic standard. Blood samples are collected in competition and out-ofcompetition. Primary parameters for longitudinal monitoring are: - hemoglobin (HGB); - reticulocyte percentage (RET); - OFF score, indicator of suppressed erythropoiesis, calculated as [HGB(g/L) * 60-√RET%]. Statistical calculation predicts individual expected limits by probabilistic inference. Secondary parameters are RBC, HCT, MCHC-MCH-MCV-RDW-IFR. ABP profiles flagged as atypical are review by experts in hematology, pharmacology, sports medicine or physiology, and classified as: - normal - suspect (to target) - likely due to BD - likely due to pathology. Results: Thousands of athletes worldwide are currently monitored. Since 2010, at least 35 athletes have been sanctioned and others are prosecuted on the sole basis of abnormal ABP, with a 240% increase of positivity to direct tests for ESA, thanks to improved targeting of suspicious athletes (WADA data). Specific doping scenarios have been identified by the Experts (Table and Figure). Figure. Typical HGB and RET profiles in two highly suspicious athletes. A. Sample 2: simultaneous increases in HGB and RET (likely ESA stimulation) in a male. B. Samples 3, 6 and 7: "OFF" picture, with high HGB and low RET in a female. Sample 10: normal HGB and increased RET (ESA or blood withdrawal). Conclusions: ABP is a powerful tool for indirect doping detection, based on the recognition of specific, unphysiological changes triggered by blood doping. The effect of factors of heterogeneity, such as sex and altitude, must also be considered. Schumacher YO, et al. Drug Test Anal 2012, 4:846-853. Sottas PE, et al. Clin Chem 2011, 57:969-976.

Organizing principles across the senses

ABSTRACT This thesis is composed of two main parts. The first addressed the question of whether the auditory and somatosensory systems, like their visual counterpart, comprise parallel functional pathways for processing identity and spatial attributes (so-called `what' and `where' pathways, respectively). The second part examined the independence of control processes mediating task switching across 'what' and `where' pathways in the auditory and visual modalities. Concerning the first part, electrical neuroimaging of event-related potentials identified the spatio-temporal mechanisms subserving auditory (see Appendix, Study n°1) and vibrotactile (see Appendix, Study n°2) processing during two types of blocks of trials. `What' blocks varied stimuli in their frequency independently of their location.. `Where' blocks varied the same stimuli in their location independently of their frequency. Concerning the second part (see Appendix, Study n°3), a psychophysical task-switching paradigm was used to investigate the hypothesis that the efficacy of control processes depends on the extent of overlap between the neural circuitry mediating the different tasks at hand, such that more effective task preparation (and by extension smaller switch costs) is achieved when the anatomical/functional overlap of this circuitry is small. Performance costs associated with switching tasks and/or switching sensory modalities were measured. Tasks required the analysis of either the identity or spatial location of environmental objects (`what' and `where' tasks, respectively) that were presented either visually or acoustically on any given trial. Pretrial cues informed participants of the upcoming task, but not of the sensory modality. - In the audio-visual domain, the results showed that switch costs between tasks were significantly smaller when the sensory modality of the task switched versus when it repeated. In addition, switch costs between the senses were correlated only when the sensory modality of the task repeated across trials and not when it switched. The collective evidence not only supports the independence of control processes mediating task switching and modality switching, but also the hypothesis that switch costs reflect competitive interterence between neural circuits that in turn can be diminished when these neural circuits are distinct. - In the auditory and somatosensory domains, the findings show that a segregation of location vs. recognition information is observed across sensory systems and that these happen around 100ms for both sensory modalities. - Also, our results show that functionally specialized pathways for audition and somatosensation involve largely overlapping brain regions, i.e. posterior superior and middle temporal cortices and inferior parietal areas. Both these properties (synchrony of differential processing and overlapping brain regions) probably optimize the relationships across sensory modalities. - Therefore, these results may be indicative of a computationally advantageous organization for processing spatial anal identity information.

Risk reduction practices in men who have sex with men in Switzerland: serosorting, strategic positioning, and withdrawal before ejaculation.

The aim of this study was to identify predictors of intentional use of the HIV risk reduction practices of serosorting, strategic positioning, and withdrawal before ejaculation during unprotected anal intercourse (UAI) with casual partners. A cross-sectional survey pertaining to the Swiss HIV behavioral surveillance system, using an anonymous self-administered questionnaire, was conducted in 2007 in a self-selected sample of men having sex with other men (MSM). Analysis was restricted to participants with UAI with casual partner(s) (N = 410). Logistic regression was used to estimate factors associated with intentional use of serosorting, strategic positioning, and withdrawal before ejaculation. In the previous 12 months, 71% of participants reported having UAI with a casual partner of different or unknown HIV-status. Of these, 47% reported practicing withdrawal, 38% serosorting, and 25% strategic positioning. In the 319 participants with known HIV-status, serosorting was associated with frequent Internet use to find partners (OR = 2.32), STI (OR = 2.07), and HIV testing in the past 12 months (OR = 1.81). Strategic positioning was associated with HIV-status (OR = 0.13) and having UAI with a partner of different or unknown HIV-status (OR = 3.57). Withdrawal was more frequently practiced by HIV-negative participants or participants reporting high numbers of sexual partners (OR = 2.48) and having UAI with a partner of unknown or different serostatus (OR = 2.08). Risk reduction practices are widely used by MSM, each practice having its own specificities. Further research is needed to determine the contextual factors surrounding harm reduction practices, particularly the strategic or opportunistic nature of their use.

Comportamento sexual de Anastrepha sororcula Zucchi (Diptera, Tephritidae) em laboratório

Anastrepha sororcula Zucchi, 1979, é uma das espécies de mosca-das-frutas mais disseminadas no País, sendo considerada a praga-chave que causa os maiores danos à produção de goiaba (Psidium guajava L., 1758) no Brasil. Em vista da importância desta espécie no complexo de pragas naturais da fruticultura brasileira e, em face à escassez de dados sobre sua biologia e comportamento, este trabalho teve por objetivo obter informações sobre a idade de maturação sexual de A. sororcula em laboratório e descrever seu comportamento reprodutivo. Os machos atingiram a maturidade sexual entre 7 e 18 dias após a emergência, com a maioria dos indivíduos tornando-se sexualmente maduros entre 10 e 13 dias de idade. Exibiram comportamento de sinalização às fêmeas, caracterizado pela distensão da região pleural do abdome, formando uma pequena bolsa de cada lado e, eversão de uma diminuta bolsa membranosa de cutícula retal que circunda a área anal. Durante este processo, os machos realizaram rápidos movimentos de vibração das asas, produzindo sinais audíveis. Uma gotícula foi liberada da região anal durante os movimentos de vibração alar. Após a atração das fêmeas, os machos realizaram uma série de movimentos elaborados de cortejo. As fêmeas alcançaram a maturação sexual entre 14 e 24 dias da emergência, com a maioria tornando-se sexualmente madura aos 19 dias de idade. A exibição diária das atividades sexuais foi confinada quase que exclusivamente ao período das 16:00-17:30h. A. sororcula apresentou um acentuado padrão de protandria.

Coronalidia, gênero novo de Neocoelidiinae (Hemiptera, Cicadellidae) do Equador

Um gênero novo de Neocoelidiinae, Coronalidia gen. nov., e duas espécies novas, Coronalidia pictapennis sp. nov. e Coronalidia sagittata sp. nov., são descritos. Coronalidia gen. nov. pode ser separado dos demais gêneros de Neocoelidiinae pela longa sutura coronal, quase atingindo a margem anterior da coroa, pela presença de um processo alongado na base do tubo anal e margem ventral do edeago com dentículos. As fêmeas deste gênero não são conhecidas. Ilustrações e a distribuição geográfica conhecida das espécies estudadas são fornecidas.

Un análisis del número de vertebras de la anchoveta peruana (engraulis ringens j.)

Datos sobre recuentos vertebrales, branquiales y radios de las aletas dorsal y anal de las anchovetas peruanas. Como las variaciones del numero de vértebras son por lo general más usadas para la diferenciación de poblaciones de peces, en esta primera contribución se presenta el análisis estadísticos del número de vertebras en diferentes localidades, dejando los otros datos para un trabajo futuro.

Proximal 11p deletion syndrome (P11pDS): additional evaluation of the clinical and molecular aspects.

The combination of multiple exostoses (EXT) and enlarged parietal foramina (foramina parietalia permagna, FPP) represent the main features of the proximal 11p deletion syndrome (P11pDS), a contiguous gene syndrome (MIM 601224) caused by an interstitial deletion on the short arm of chromosome 11. Here we present clinical aspects of two new P11pDS patients and the clinical follow-up of one patient reported in the original paper describing this syndrome. Recognised clinical signs include EXT, FPP, mental retardation, facial asymmetry, asymmetric calcification of coronary sutures, defective vision (severe myopia, nystagmus, strabismus), skeletal anomalies (small hands and feet, tapering fingers), heart defect, and anal stenosis. In addition fluorescence in situ hybridisation and molecular analysis were performed to gain further insight in potential candidate genes involved in P11pDS.

Rectal and vaginal immunization of mice with human papillomavirus L1 virus-like particles.

Human papillomavirus (HPV) vaccines based on L1 virus-like particle (VLP) can prevent genital HPV infection and associated lesions after three intramuscular injections. Needle-free administration might facilitate vaccine implementation, especially in developing countries. Here we have investigated rectal and vaginal administration of HPV16 L1 VLPs in mice and their ability to induce anti-VLP and HPV16-neutralizing antibodies in serum and in genital, rectal and oral secretions. Rectal and vaginal immunizations were not effective in the absence of adjuvant. Cholera toxin was able to enhance systemic and mucosal anti-VLPs responses after rectal immunization, but not after vaginal immunization. Rectal immunization with Resiquimod and to a lesser extent Imiquimod, but not monophosphoryl lipid A, induced anti-HPV16 VLP antibodies in serum and secretions. Vaginal immunization was immunogenic only if administered in mice treated with nonoxynol-9, a disrupter of the cervico-vaginal epithelium. Our findings show that rectal and vaginal administration of VLPs can induce significant HPV16-neutralizing antibody levels in secretions, despite the fact that low titers are induced in serum. Imidazoquinolines, largely used to treat genital and anal warts, and nonoxonol-9, used as genital microbicide/spermicide were identified as adjuvants that could be safely used by the rectal or vaginal route, respectively.

Les réflexes sacrés etagés dans l'etude de la névralgie pudendalte: validation anatomique

Pudendal neuropathy is common. The diagnosis is clinical and the confirmation is electrophysiological. Distal pudendal nerve latencies have been used but they are unspecific and do not allow to localize the site of compression. A preliminary electrophysiological study has suggested separate innervations of the anterior and the posterior anal sphincter quadrants, so diverging from what main anatomy textbooks teach. By detailed dissections of pudendal nerve region we can confirm a dichotomy in the innervation of the two quadrants. Therefore, it seems feasible, by using the differences of staged sacral reflexes, to better localize the compressive neuropathy, with a stimulation of the clitoris and by recording latencies of different muscles.

Contribución a la identificación de dos especies de Cachema, Cynoscion analis y Cynoscion altipinnis (Pisces: Scianidae) de la costa norte del Perú

Caracteres merísticos y morfométricos de Cynoscion analis y altipinnis de la zona norte del Perú (03°52'-06°53') son analizados con el fin de contribuir en la identificación estas especies comunmente llamadas "cachemas". Los caracteres merísticos como el número de radios de la aleta anal y dorsal , utilizados por otros autores para la distinción entre las mencionadas especies, podrían causar algunos errores ya que ofrecen rangos que se superponen. Se recomienda utilizar la morfología de los otolitos (sagitae) y se sugiere tomar un nuevo carácter externo como util en la separación de estas especies muy parecidas.

Variaciones en la intensidad del desove de la sardina Sardinops sagax sagax (J) en la costa peruana en los años 1966-1973

Un marcado incremento den la extensión y densidad de las áreas de desove de la "sardina" en 1972 con respecto al los años anteriores así como el aumento considerable de las capturas comerciales de esta especie, nos indujo a efectuar un estudio de las variaciones del desove con el fin de analizar las fluctuaciones, como parte del Programa de Ictioplancton que desarrolla el Instituto del Mar del Perú (IMARPE). Con el propósito anterior hemos analizado un total de 3,389 muestras de zooplancton colectadas en 29 cruceros, desde febrero de 1966 hasta enero de 1973. Las muestras fueron colectadas a lo largo del litoral peruano, de 03°16 ' a 20°52 ' Latitud Sur y hasta una distancia máxima de 350 millas de la costa. Se describe el huevo de "sardina", en la diferentes fases de desarrollo y larva hasta la longitud de 16.6 mm. El huevo de "sardina" es característico por la presencia de una sola gota oleosa y amplio espacio perivitelínico y mide de 1.12 a 1.94 mm. La larva es diferenciable por las proporciones del cuerpo, especialmente, boca-ano en longitud estándar y posición de aletas dorsal y anal. Las temperaturas superficiales en las que fueron hallados los huevos, fluctúan entre 15.4 a 27.2 °C, y las más adecuadas para el desove de esta especie variaron entre 19 y 22 °C, y salinidades entre 35 y 35.26%, a juzgar por el hallazgo de las mejores y más frecuentes concentraciones de huevos en estos niveles.

Situación de los recursos Anchoveta (Engraulis Ringens) y Sardina (Sardinops sagax) a principios de 1994 y perspectivas para la pesca en el Perú, con particular preferencia a las regiones norte y centro de la costa peruana

Se analizan los cambios en los niveles poblacionales de anchoveta ( Engraulis ringens), entre 1961-1994 y sardina (Sardinops sagaX") entre 1978-1994, en la parte del mar peruano comprendido entre los 03 º23'S y los 14°S. Los resultados de los análisis de cohortes y la observación de información complementaria indican que la población de anchoveta muestra una tendencia ascendente, habiendo alcanzado niveles de biomasa total próximos al os 10 millones de toneladas, y encontrándose en recuperación luego de los valores mínimos históricos alcanzados entre 1975-1 984. la sardina en cambio, ha venido disminuyendo desde 1987. Se anal izan los cambios y fluctuaciones en la abundancia de estas dos especies, y se postula la ocurrencia de un cambio de "régimen" poblacional para la anchoveta, cuya población se encontraría en un nivel todavía no bien consolidado, entre un régimen medio, correspondiente al nivel de la fases de pre y post colapso, y un nivel de máxima abundancia. Se analizan las causas probables de la declinación del stock de sardina y se dan recomendaciones para el ordenamiento de la pesquería a corto y mediano plazo de estas dos especies.

A new species of Stilobezzia Kieffer from the neotropical region (Diptera, Ceratopogonidae)

A new species from the Neotropical Region, Stilobezzia (Stilobezzia) pseudopunctulata Cazorla & Ronderos, is described and illustrated based on male and female adults and pupal exuviae. Adults were collected in the Argentinian provinces of Chaco, Formosa, Corrientes and Buenos Aires, and in Santa Cruz, Bolivia. The pupa was collected from mats of floating aquatic macrophytes in a lagoon in Ilha da Marchantería, in the vicinities of Manaus, Brazil. This new species is compared with its similar congener Stilobezzia punctulata Lane, from which it can be mainly distinguished by the wing with only two dark spots, the parameres longer and hook-shaped, the pupal respiratory organ with 11-12 pores and the very short apicolateral processes of the anal segment.