A Rare Variant of the Ulnar Artery with Important Clinical Implications: a Case Report

BACKGROUND: Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. CASE PRESENTATION: During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the brachial artery, pierced the brachial fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the antebrachial fascia. It then dipped into the forearm fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve. CONCLUSION: As far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.

Reorganização do Controlo Postural no Acidente Vascular Encefálico: Ajustes Posturais Antecipatórios e Stiffness da Tibiotársica

Introdução: A reorganização do Sistema Nervoso após Acidente Vascular Encefálico é dependente da experienciação de diferentes tipos de input no âmbito da intervenção em fisioterapia. A potenciação do controlo postural (CP) nestes sujeitos é importante para organização dos ajustes posturais antecipatórios nas tarefas funcionais levantar, sentar e início da marcha e pode ser acompanhado de uma regulação do stiffness. Objectivo(s): Reportar as modificações ocorridas nos tempos de inibição e ativação dos músculos solear e tibial anterior, respetivamente, nas sequências de movimento levantar, sentar e início da marcha, na linha temporal atribuída aos APA’s assim como descrever as modificações ocorridas no comportamento do stiffness passivo da tibiotársica. Métodos: Foi implementado um programa de fisioterapia durante 3 meses em 5 participantes com Acidente Vascular Encefálico. Estes foram avaliados previamente à implementação do programa e após (M0 e M1). Foi analisada a atividade eletromiográfica dos músculos solear e tibial anterior, em ambos os membros inferiores, na linha temporal atribuída aos APA’s nas referidas tarefas. O torque e a amplitude articular da tibiotársica foi monitorizada, através do dinamómetro isocinético, no movimento passivo de dorsiflexão, e registada a atividade muscular através de eletromiografia de superfície, nos músculos solear e gastrocnémio medial. Resultados: À exceção do músculo tibial anterior contralesional no paciente C, todos os participantes demonstraram modificações nos tempos dos músculos do membro contralesional na tarefa levantar. No membro ispsilesional todos os participantes demonstraram alterações, sem que seja possível definir uma tendência. Todos apresentaram uma diminuição do stiffness, embora nos participantes A e E mais evidente nas amplitudes intermédias. Conclusão: Entre os dois momentos de avaliação foi possível reportar modificações nos tempos de inibição dos músculos solear e nos tempos de ativação dos músculos tibial anterior na linha temporal atribuída aos APA’s, no entanto mais homogéneas no membro contralesional na tarefa levantar. Em todos os participantes o stiffness sofreu alterações no sentido da diminuição.

Mucopiocelo fronto-etmoidal, a propósito de um caso clínico

O mucocelo é uma lesão quística, benigna, expansiva dos seios perinasais. A sobreinfecção deste, designada de mucopiocelo, pode levar a um período de crescimento rápido, com maior risco de complicações. Relata-se o caso clínico de uma doente do sexo feminino, 59 anos, que recorreu ao Serviço de Urgência após crise inaugural de convulsão tónico-clónica generalizada, com queixas de aumento de volume periorbitário direito e febre desde há 1 semana. Apresentava à direita celulite orbitária e proptose ínfero-externa, com área de flutuação na parte medial da pálpebra superior, oftalmoplegia e quemose do olho direito acompanhada de rinorreia mucopurulenta. Realizou TC que demonstrou volumoso abcesso subperiosteal direito, ao nível da parede medial da órbita, tendo como ponto de partida aparente as células etmoidais anteriores homolaterais e seio frontal direito. Colocou-se a hipótese de mucopiocelo fronto-etmoidal. Foi submetida a drenagem de urgência do abcesso e a cirurgia endoscópica nasal com marsupialização da lesão fronto-etmoidal. Verificou-se resolução completa do quadro clínico. Apesar de consideradas lesões benignas, os mucocelos, apresentam potencial destrutivo, principalmente se infectados, necessitando, por vezes, de intervenção cirúrgica de urgência. A abordagem endoscópica destas lesões reafirma-se como tratamento de eleição.

CLINICAL AND EPIDEMIOLOGICAL PROFILE OF ELDERLY PATIENTS WITH CHAGAS DISEASE FOLLOWED BETWEEN 2005-2013 BY PHARMACEUTICAL CARE SERVICE IN CEARÁ STATE, NORTHEASTERN BRAZIL

By controlling the transmission of Chagas disease, the challenge of providing assistance to millions of infected patients that reach old age arises. In this study, the socioeconomic, demographic and comorbidity records of all elderly chagasic patients followed at the Pharmaceutical Care Service of the Chagas Disease Research Laboratory were assessed. The information related to the clinical form of the disease was obtained from medical records provided by the Walter Cantídio University Hospital. The profile of the studied population was: women (50.5%); mean age of 67 years; retired (54.6%); married (51.6 %); high illiteracy rate (40.2%); and family income equal to the minimum wage (51.5%). The predominant clinical forms of Chagas disease were cardiac (65.3%) and indeterminate (14.7%). The main electrocardiographic changes were the right bundle branch block (41.0%), associated or not with the anterosuperior left bundle branch block (27.4%). The average number of comorbidities per patient was 2.23 ± 1.54, with systemic arterial hypertension being the main one found (67.0%). It was found that the elderly comprise a vulnerable group of patients that associate aging with cardiac and/or digestive disorders resulting from the evolution of Chagas disease and other comorbidities, which requires special attention from health services to ensure more appropriate medical and social care.

Camelid nanobodies raised against an integral membrane enzyme, nitric oxide reductase

Protein Sci. 2009 Mar;18(3):619-28. doi: 10.1002/pro.69.

Different Electroclinical Manifestations of the Epilepsy Associated with Hamartomas Connecting to the Middle or Posterior Hypothalamus

PURPOSE: The epilepsy associated with hypothalamic hamartomas (HHs) has typical clinical, electrophysiologic, and behavioral manifestations refractory to drug therapy and with unfavorable evolution. It is well known that only sessile lesions produce epilepsy, but no correlation has been established between the different types of sessile hamartomas and the diverse manifestations of the epilepsy. We correlate anatomic details of the hamartoma and the clinical and neurophysiologic manifestations of the associated epilepsy. METHODS: HHs of seven patients with epilepsy (ages 2- 25 years) were classified as to lateralization and connection to the anteroposterior axis of the hypothalamus by using high-resolution brain magnetic resonance imaging. We correlated the anatomic classification with the clinical and neurophysiologic manifestations of the epilepsy as evaluated in long-term (24 h) video-EEG recordings. RESULTS: HHs ranged in size from 0.4 to 2.6 cc, with complete lateralization in six of seven patients. Ictal manifestations showed good correlation with the lobar involvement of ictal/interictal EEGs. These manifestations suggest the existence of two types of cortical involvement, one associated with the temporal lobe, produced by hamartomas connected to the posterior hypothalamus (mamillary bodies), and the other associated with the frontal lobe, seen in lesions connecting to the middle hypothalamus. CONCLUSIONS: A consistent clinical and neurophysiologic pattern of either temporal or frontal lobe cortical secondary involvement was found in the patients of our series. It depends on whether the hamartoma connects to the mamillary bodies (temporal lobe cases) or whether it connects to the medial hypothalamus (frontal lobe cases).

Pathology of complete atrioventricular block in chronic chagas' myocarditis

Sclero-atrophy, fibrosis, vascular ectasia, phlebosclerosis and mild non-specific chronic inflammatory changes were observed in variable location and proportion involving the atrioventricular conducting tissue of the heart in five human cases of chronic Chagas' myocarditis associated with complete atrioventricular block. One case presented complete destruction of the A-V conduction system. In three cases the lesions were disseminated all along the conducting tissue but did not cause anywhere a complete disruption in the continuity of the system. The distal portion of the bundle branches were the most damaged sector of the system, exceptfor the fasciculi of the posterior division of the left bundle branch which were relatively preserved. One case exhibited bilateral sclero-atrophy of the bundle branches as the main change; and another showed early and mild fibrocalcific damage of the penetrating portion of the His bundle. The A-V node appeared as the least involved part of the conducting system in the cases studied. Demonstration of the lesions in this series of cases seems important because: a) it reveals that complete atrioventriculr block in chronic Chagas' disease results from disseminated lesions and not from focal disruptive change as has been commonly observed in cases of other etiologies; b) it shows that chronic inflammation can produce at the end variable and widespread vascular, degenerative andfibrotic alterations within the conducting tissue of the heart, which may lead to its total destruction.

Does a spontaneous cure for chagas' disease exist?

Six Costa Rican Chagas' disease patients, with wellknown acute phase history and no specific treatment were examined in several occasions during 39, 24, 32, 16 and 14 years, respectively, from the onset. Nome of the patients presented heart abnormalities as revealed by the conventional EKG and ergometry, exceptfor one of them with an incomplete block of the right bundle branch. Also, no alterations of the oesophagus motility was detected manometrically except for another patient who presented a slight hypersensivity reaction to a pharmacological test (Mecholyl). Three out of six patients became serologically negative in 1981, remaining as such until 1986. Besides the conventional serology, the search of protective ("lytic") antibodies was also performed in 1985 and 1986, being completely negative in one of the "cured" patients and dubious in the other two. The hypothesis that these three patients had as spontaneous cure, based on the clinical, serological and parasitologica l findings is discussed.

Past/present and future worries: na fMRI study

For the past decade, numerous imaging techniques gave rise to remarka-ble progresses in the understanding of brain’s structure and function. Amongst the wide variety of studies onto the field of neuroscience, neuropsychiatric re-searches with resource to neuroimaging have attracted increasing attention. The present study will focus on the identification of brain areas recruited while normative subjects read sentences related to past/present or future wor-ries. Our main aim was to accurately characterize these brain areas while providing them with a time-stamp that would hopefully help us understand the implications of past/present memories and future envisioning in worrying episodes. With that purpose, functional magnetic resonance imaging data was collected from ten healthy individuals. The obtained data was processed and statistically treated using the General Linear Model and both Fixed and Ran-dom Effects Analysis for group-level results. Thereafter, a Multi-Voxel Pattern Analysis with Searchlight Mapping was performed in order to find patterns of activation that allow differentiation between conditions. The obtained results indicate higher brain activation while reading sen-tences related to past/present worries when compared to future worry or neu-tral sentences. The main areas include frontal cortex, posterior parietal, occipital and temporal areas. Worrying, per se, was characterized by activation of the medial posterior parietal cortex, left posterior occipital lobe and left central temporal lobe. With the searchlight mapping approach we were able to further identify patterns of distinction between conditions, which were located in the parietal, limbic and frontal lobes.

Serological survey for Chagas disease in the rural areas of Manaus, Coari, and Tefé in the Western Brazilian Amazon

INTRODUCTION: Deforestation, uncontrolled forest, human population migration from endemic areas, and the large number of reservoirs and wild vectors naturally infected by Trypanosoma cruzi promote the endemicity of Chagas disease in the Amazon region. METHODS: We conducted an initial serological survey (ELISA) in a sample of 1,263 persons; 1,095 (86.7%) were natives of the State of Amazonas, 666 (52.7%) were male, and 948 (75.1%) were over 20 years old. Serum samples that were found to be reactive, indeterminate, or inconclusive by indirect immunofluorescence (IFI) or positive with low titer by IFA were tested by Western blot (WB). Serologically confirmed patients (WB) were evaluated in terms of epidemiological, clinical, ECG, and echocardiography characteristics. RESULTS: Fifteen patients had serologically confirmed T. cruzi infection, and 12 of them were autochthonous to the state of Amazonas, for an overall seroprevalence of 1.2% and 0.9% for the state of Amazonas. Five of the 15 cases were males, and the average age was 47 years old; most were farmers with low education. One patient who was not autochthonous, having originated from Alagoas, showed right bundle branch block, bundle branch block, and anterosuperior left ventricular systolic dysfunction with an ejection fraction of 54%. CONCLUSIONS: The results of this study ratify the importance of monitoring CD cases in Amazonia, particularly in the state of Amazonas.

Reduction of catheter-associated bloodstream infections through procedures in newborn babies admitted in a university hospital intensive care unit in Brazil

INTRODUCTION: Catheter-associated bloodstream infection (CA-BSI) is the most common nosocomial infection in neonatal intensive care units. There is evidence that care bundles to reduce CA-BSI are effective in the adult literature. The aim of this study was to reduce CA-BSI in a Brazilian neonatal intensive care unit by means of a care bundle including few strategies or procedures of prevention and control of these infections. METHODS: An intervention designed to reduce CA-BSI with five evidence-based procedures was conducted. RESULTS: A total of sixty-seven (26.7%) CA-BSIs were observed. There were 46 (32%) episodes of culture-proven sepsis in group preintervention (24.1 per 1,000 catheter days [CVC days]). Neonates in the group after implementation of the intervention had 21 (19.6%) episodes of CA-BSI (14.9 per 1,000 CVC days). The incidence of CA-BSI decreased significantly after the intervention from the group preintervention and postintervention (32% to 19.6%, 24.1 per 1,000 CVC days to 14.9 per 1,000 CVC days, p=0.04). In the multiple logistic regression analysis, the use of more than 3 antibiotics and length of stay >8 days were independent risk factors for BSI. CONCLUSIONS: A stepwise introduction of evidence-based intervention and intensive and continuous education of all healthcare workers are effective in reducing CA-BSI.

Microvascularização arterial da cóclea

RESUMO: Na descrição deste estudo foi utilizada a terminologia anatómica da Sociedade Brasileira de Anatomia adaptada ao português por J. A. Esperança-Pina de acordo com o tratado Anatomia Humana da Relação. Os actuais estudos sobre hipoacusia sensorioneural implicam um grupo crescente de situações, em que a lesão se situa ao nível da microvascularização coclear, daí que o conhecimento exacto da angiomorfologia normal se torne essencial na fase actual do conhecimento. A autora tem vindo a estudar, desde 1986, a angiomorfologia do ouvido Interno no modelo experimental, o Cobaio, utilizando várias técnicas microvasculares. sendo dado enfâse particular neste estudo à técnica de microscopia electrónica de varrimento em moldes vasculares. Os animais usados no presente estudo pertencem à espécie cavia porcellus, cobaio, por serem considerados na comunidade cientifica internacional como o melhor modelo experimental para estudo do ouvido interno, pelo facto de a morfologia coclear ser muito semelhante à do Homem e por isso ser um modelo fiável para cirurgia experimental e microdissecção. Este estudo foi realizado em 100 cobaios, cavia porcellus, de ambos os sexos com peso médio de 450g. A vascularização do ouvido interno, no cobaio como no homem, faz-se através dos ramos de divisão da artéria auditiva interna ou labiríntica. A artéria labiríntica origina-se como ramo colateral da artéria cerebelosa ântero-inferior a qual tem origem na artéria basilar ou na artéria vertebral. Embora no homem a artéria auditiva interna possa também destacar-se da artéria basilar e até da artéria vertebral, no cobaio em todos os casos estudados a sua origem verificou-se sempre na artéria cerebelosa ântero-inferior. A artéria labiríntica, ao passar abaixo do meato auditivo interno, divide-se na artéria vestibular anterior e na artéria coclear comum.A artéria vestibular anterior dirige-se para o nervo vestibular, emite vasa nervorum para este nervo e vasculariza o utrículo e os canais semicirculares. A artéria coclear comum origina dois ramos principais, a artéria vestíbulo‑coclear ou vestibular posterior no cobaio, a qual se destaca junto à espira basal da cóclea e a artéria coclear, como ramo terminal, que passa a denominar-se de artéria modiolar ou espiralada, após entrar no modíolo. A artéria modiolar ascende no modíolo promovendo através dos seus ramos colaterais e dos seus ramos terminais a microvascularização coclear, numa vascularização de órgão de tipo terminal. Ao longo do seu trajecto verificou‑se de modo constante uma redução gradual de calibre em cada uma das espiras, por emissão de ramos colaterais, sendo que o calibre da artéria na base da cóclea apresenta um valor que diminui gradualmente até ao ápice. A artéria modiolar origina em todo o seu trajecto ramos colaterais, cujo número diminui em valor absoluto da base para o ápice: Arteríolas radiárias internas, arteríolas de trajecto flexuoso que caminham junto às estruturas sensorioneurais da parede interna da cóclea, junto ao lábio timpânico da lâmina espiral óssea e na parede do próprio modíolo, que se relacionam intimamente com este. As arteríolas radiárias internas originam‑se no flanco da artéria modiolar espiralada. Contam‑se dez a doze em cada espira, extraordinariamente flexuosas desde a sua origem. As arteríolas radiárias internas originam como ramos colaterais, vários grupos de arteríolas de menor calibre, que vascularizam distintas regiões da parede interna da cóclea, as arteríolas do gânglio espiral, a rede espiral interna, as arteríolas de origem dos glomérulos de Schwalbe e a arteríola da lâmina basilar. As arteríolas radiárias externas importantes ramos colaterais da artéria modiolar espiralada promovem a vascularização de importantes estruturas da parede externa. Ao atingir o limite externo do ligamento espiral, as arteríolas radiárias externas dividem‑se em vários ramos arteriolares de menor calibre, ao longo da convexidade do limite externo do ligamento espiral, originando a rede capilar pós-estriada que ocupa a porção lateral do ligamento espiral e a rede capilar ad‑ -estriada, na sua porção mais medial em íntima relação com a estria vascular. A espira basal da cóclea apresenta grande riqueza de vascularização, com características particulares apenas a esta espira, a qual é metabolicamente a mais exigente. A arteríola da janela da cóclea aborda a janela da cóclea pela sua convexidade e divide-se numa rica rede vascular da qual emergem arteríolas pré-capilares que se ramificam em capilares, os quais se dirigem em profundidade penetrando a rampa timpânica da cóclea ao nível da espira basal. Importou neste estudo verificar quais as semelhanças em termos de calibre de estruturas análogas, na parede interna e na parede externa da cóclea, com particular incidência na rede capilar. Do estudo estatístico realizado com testes paramétricos de Tamahane e não paramétricos de Mann-Whitney, verifica-se que comparando todas as estruturas consideradas estas têm calibres diferentes, com excepção dos capilares da estria vascular e do ligamento espiral, pertencentes à parede externa da cóclea que têm calibres iguais aos capilares da rede espiral interna e aos capilares da parede interna da cóclea, dependentes das arteríolas da rede espiral interna. As redes capilares dependentes das arteríolas radiárias internas que vascularizam as estruturas sensorioneurais junto á parede interna do modiolo são em tudo semelhantes em termos de calibre às redes capilares da parede externa da cóclea, incluindo os capilares da estria vascular. Esta particularidade traduz num órgão com vascularização de tipo terminal,um mecanismo de controlo do fluxo sanguíneo coclear tão importante na parede interna como na parede externa da cóclea. ------------ ABSTRACT:Current studies on sensorineural hearing loss, imply a growing group of situations in which the lesion is located at the level of the cochlear microvasculature, hence the exact knowledge of normal angiomorfology becomes essential in current state of knowledge. The author has been studying since 1986, the angiomorfology of inner on the experimental model, the guinea pig, using various microvascular techniques being given particular emphasis in this study to the results of the technique of scanning electron microscopy on corrosion casts. The animals used in this study belong to the species cavia porcellus, guinea pig, to be considered in the international scientific community as the best experimental model for the study of the inner ear, the cochlear morphology is very similar to human and therefore a reliable model for experimental surgery and microdissection. This study was performed in 100 guinea pigs of both sexes with average weight of 450g. There shall be a brief description of embryology, anatomy and cochlear physiology in the light of developmental biology, regarding also the spatial location of the cochlea and the determinism of morphogenetic fields in their development and function. The cochlear transduction mechanism converts the sound wave in stimuli sound and so afferent auditory nerve fibres and deafness are closely related to the cochlear microvasculature. Cochlear ischemia is accompanied by immediate hearing loss. The different type of cochlear injury that leads to sensorineural deafness is well studied in presbycusis where an objective link with the audiometric pattern as been established. The sensory type of deafness, is closely related to the degeneracy of the organ of Corti and damage to the outer hair cells at the basal turn of the cochlea. Keeping in mind cochlear tonotopy with location of high frequency sounds at the level of the base of the cochlea, it explains the audiometric pattern with loss in high frequencies. The neural type of deafness, is characterized by neuronal loss with loss of descendant important neuronal afferents, with audiometric translation on a gradually curve with important loss of auditory discrimination. The metabolic type of deafness results in atrophy of the vascular stria, with consequent change in the potential of the endolymph by decreasing the vascular stria cells and changes in K + recycling mechanism. There is also a change in the morphology of the spiral ligament and the audiometric patern as a flattened curve with loss at all frequencies. Bearing in mind cochlear tonotopy and being characterized all types of sensorineural deafness, we may inquire to what extent the cochlear microvasculature, considering not only the cochlea as a whole but different regions of the inner wall and the outer wall of the cochlea, contributes to deafness. We analysed the entire cochlear morphology on scanning electron microscopy with particular emphasis on bone and membranous cochlea. The inner wall of the cochlea and intramodiolar structures such as the spiral ganglion, the morphology of its cell bodies and their axons are analyzed. The morphology of Corti’s organ is described in detail, with description and large detail of the inner and outer hair cells. Is then presented the study of the microvasculature itself. The spiral modiolar artery is observed with the diaphanization technique and the technique of scanning electron microscopy on corrosion vascular casts. After emergence of collateral branches of the greatest importance, the radiating internal and external arterioles, the modiolar artery gives rise to its terminal branches, the arterioles of the cochear apex. Arterial vasa vasorum and vasa nervorum are displayed with a great detail, which was not yet described in such detail in previous microvascular studies. The arterial radiating arterioles originate in the flank of the spiral modiolar artery in number of ten to twelve in each loop, and they vascularize through their branches the inner wall cochlear sensorineural structures located in the modiolus as the spiral ganglion and structures near the organ of Corti. Their caliber is above 20 μm on the basal turn and in the second loop it decreases to values between 12 and 20 μm, decreasing progressively to the apex of the cochlea.They arise near the modiolus or on their way in the spiral lamina forming vascular loops, and divide without presenting vascular constrictions in their divisions, originating new vascular loops of lower caliber. Internal ratiating arterioles originate as collateral branches several groups of smaller caliber arterioles, which vascularize distinct regions of the inner wall of the cochlea namely, the arterioles of the spiral ganglion, the internal spiral network, the arterioles of origin of the glomeruli of Schwalbe and the arterioles of the basilar membrane. The glomeruli of Schwalbe play an important functional role as relay-stations, in hemodynamic terms, to control the cochlear microvasculature. External radiating arterioles have their origin in the spiral modiolar artery, they are directed towards the outer wall of the cochlea and run through the roof of the scala vestibuli. Above the insertion of Reissner’s membrane on the external wall the external radiating arterioles originate the spiral ligament arterioles, which vascularize the spiral ligament, they divide into several arteriolar branches of smaller caliber, along the convexity of the outer edge of the spiral ligament. The connective tissue of the spiral ligament forms a mesh with supporting function of the highly specialized epithelium, where pericytes were identifiable. Next to its base there is the microvascular network of stria vascularis. The adstriated vascular network which is divided into a capillary network, the capillary network of stria vascularis. The stria vascularis, the only vascularized epithelium of the human body, plays an important role, forming an haemato-labyrintine barrier to assure labyrinthine endocochlear potential and transport of ions, essential for the mechanism of transduction of external hair cells. The cochlear basal turn has a special feature on its external wall, the region of the windows, the round windows giving access to scala tympani and the oval window thatleads into scala vestibuli, and so it is metabolic demanding. For their role in cochlear tonotopy the sensorineural structures and those of the external wall of the cochlea, are particularly vulnerable to hypoxia. Although the complementarity of all the techniques was important for three- -dimensional reconstruction of the microvasculature of the cochlea, the scanning electron microscopy technique, especially when we used the system Semafore was fundamental to perform precise morphometric mesures regarding all vascular structures.Regarding the capillaries of the inner and outer wall of the cochlea networks this technique allowed their characterization in morphometric terms. To conclude the capillaries of the inner wall and of the external wall of the cochlea have similar size. So although located at different cochlear regions, with a different functional role, in cochlear physiology these networks consist of capillaries of similar caliber. It seems to translate a cochlear blood flow control mechanism that is so important in the inner wall as in and the external wall of the cochlea to provide for in inner ear homeosthasia.

Potential M&A between TIM Brazil and Oi S.A: The irreversible force of Telecommunications convergence

The intrinsic forces of market aiming for telecom industry convergence has arrived to Brazil. This case presents real characters, a sequence of events and other public information that has been impacting two corporations studied in this case. TIM Brazil and Oi S.A, two top players in the Brazilian telecom industry mobile and fixed segment respectively. While a merge between the two of them looks perfect and simple in an operational perspective due to its vertical complementarity, bring to them opportunities to win over a bundle offer (multi service package) that will consolidate their market predominance. Macroeconomic and internal corporate contrasts between these companies’ environment might signal that an impulsive could have a high price to pay in the future.

Outbreak of acute Chagas disease associated with oral transmission in the Rio Negro region, Brazilian Amazon

Introduction Chagas disease is considered as emerging in the Brazilian Amazon, usually occurring in acute outbreaks. Methods We describe 17 cases of acute Chagas disease in Rio Negro, Amazonas. Results There were 15 males (average age, 31.3 years), all positive for Trypanosoma cruzi in fresh blood smear examination, and 14 positive by xenodiagnosis and PCR. The top clinical manifestations were fever, asthenia, abdominal pain, and palpitations. Electrocardiograms featured low-voltage QRS, anterosuperior divisional block, and right bundle branch block associated with anterosuperior divisional block. Conclusions All patients had consumed açaí products from Monte Alegre in the rural area around Santa Izabel do Rio Negro, Brazil.

Uneventful benznidazole treatment of acute Chagas disease during pregnancy: a case report

This report describes the case of a patient with acute Chagas disease in Tocantins, Brazil, who was unaware of her pregnancy during benznidazole treatment. She presented with impaired cardiac function during the acute phase (pericarditis and incomplete right bundle-branch block) that resolved favorably after benznidazole therapy. Serological results also became negative, as determined by hemagglutination assays, enzyme-linked immunosorbent assays, and immunofluorescence assays. The child was born without sequelae and showed no evidence of congenital Trypanosoma cruzi infection at birth or 24 days later.