LIVER BIOPSY: IMPORTANCE OF SPECIMEN SIZE IN THE DIAGNOSIS AND STAGING OF CHRONIC VIRAL HEPATITIS

Liver biopsy is the gold standard method for the grading and staging of chronic viral hepatitis, but optimal biopsy specimen size remains controversial. The aim of this study was to evaluate the quality of liver specimen (number of portal tracts) and to evaluate the impact of the number of portal tracts in the staging of chronic hepatitis. Material and Methods: 468 liver biopsies from consecutive patients with hepatitis C virus and hepatitis B virus infection from 2009 to 2010 were evaluated. Results: The length of fragment was less than 10 mm in 43 cases (9.3%), between 10 and 14 mm in 114 (24.3%), and ≥ 15 mm in 311 (64.4%); of these, in 39 (8.3%) cases were ≥ 20 mm. The mean representation of portal tracts was 17.6 ± 2.1 (5-40); in specimens ≥ 15 mm the mean portal tract was 13.5 ± 4.7 and in cases ≤ 15 mm was 11.4 ± 5.0 (p = 0.002). Cases with less than 11 portal tracts were associated with F3, and cases with 11 or more portal tracts with F2 (p = 0.001). Conclusion: this study demonstrated the good quality of liver biopsy and a relationship between the macroscopic size of the fragment and the number of portal tracts.

Eros platónico e amore dantesco

Tese de Doutoramento em Filosofia

Reavaliação da suscetibilidade de Candida à anfotericina B: estudo comparativo com isolados de três hospitais do estado do Rio Grande do Sul

Comparou-se a suscetibilidade à anfotericina B de Candida spp isoladas de candidemias, sendo: 41 do Hospital Universitário de Santa Maria, 56 do Hospital de Clínicas de Porto Alegre e 47 da Santa Casa, Complexo Hospitalar de Porto Alegre. Os testes foram baseados no documento M27-A2 do Clinical Laboratory Standards Institute. Todavia, foram empregadas 20 concentrações de anfotericina B, variáveis entre 0,1 e 2µg/ml. Os testes foram realizados nos meios RPMI 1640 com glicose, antibiotic medium 3 e yeast nitrogen base dextrosado. O caldo antibiotic medium 3 gerou amplas faixas de concentrações inibitórias mínimas e concentrações fungicidas mínimas quando comparado aos demais. As variações de suscetibilidade entre os hospitais foram melhor detectadas no antibiotic médium 3; os isolados do Hospital Universitário de Santa Maria evidenciaram menor sensibilidade do que os da Santa Casa, Complexo Hospitalar de Porto Alegre (p < 0,05). As causas das variações de suscetibilidade não foram avaliadas mas apontam para a necessidade de vigilância da suscetibilidade a anfotericina B.

Infecção pelo HTLV 1/2: atuação no pré-natal como estratégia de controle da doença no Estado de Mato Grosso do Sul

Neste estudo, foi estimada a prevalência da infecção pelo HTLV 1/2 em gestantes no Estado de Mato Grosso do Sul, por meio das técnicas ELISA, Western Blot e PCR, em amostras de sangue obtidas por punção venosa periférica. Foram examinadas 116.689 gestantes, sendo diagnosticadas 153 infectadas pelo HTLV 1/2, com prevalência de 0,13%. Deste total, 133 (86,9%) eram do tipo 1 e 20 (11,1%) do tipo 2. Das 153 gestantes, 73,2% eram negras, pardas ou índias, cerca de 90% tinham atividades domésticas e 75,8% (116/153) tinham 7 anos ou menos de escolaridade. As 153 gestantes tiveram 172 gestações, durante o período do estudo, sendo que 164 tiveram acompanhamento. Das gestações acompanhadas, 6,7% (11/164) evoluíram para aborto, 26,8% (41/153) gestantes relataram abortos anteriores, sendo que 31,7% (13/41) apresentaram mais de dois abortos. Co-morbidades foram detectadas em 17% (26/153) sendo 3,3% (5/153) com HIV (p<0,000002). Os autores enfatizam a importância da identificação das gestantes infectadas pelo HTLV1/2 na estratégia de controle e prevenção da doença.

D. Dinis del Portogallo e Isabel d'Aragona in vita e in morte. Creazione e trasmissione della memoria nel contesto storico e artistico europeo.

La Tesi è incentrata sulle figure di D. Dinis e Isabel d’Aragona, reali del Portogallo (fine del XIII-prima metà del XIV secolo), e si focalizza sul processo di creazione e trasmissione della memoria, elaborato e messo in atto dai sovrani nel corso della loro esistenza. L’atto finale di questo annoso processo fu la realizzazione dei loro monumenti funebri creati per essere conservati nella chiesa del monastero cistercense di São Bernardo e São Dinis di Odivelas, la tomba del re, e nella chiesa del monastero di Santa Clara e Santa Isabel di Coimbra, quella della regina. Infatti, in modo del tutto inedito rispetto alla tradizione precedente, i re commissionarono e videro in vita realizzati i sepolcri che avrebbero dovuto preservare la loro memoria per l’Eternità. Essi furono concepiti a priori come parte integrante del progetto monumentale più vasto costituito dagli edifici monastici che li avrebbero dovuti custodire. In tale prospettiva, è stata rivolta particolare attenzione alla storia del monastero di Odivelas, assurto a pantheon della Monarchia, seppure per breve tempo, e al monastero di Coimbra, ultima dimora della regina Isabel una volta fallito il progetto del pantheon reale a causa della guerra civile che sconvolse il regno del Portogallo tra il 1319 e il 1324. Oltre ai sepolcri reali, sono state prese in esame alcune opere di architettura e di scultura legate alla committenza regia – in coppia o individualmente –, in particolare tre tombe coeve, due delle quali destinate ad altrettanti membri della famiglia reale. All’interno di questa Tesi, i monumenti funebri esaminati sono stati considerati non solo come strumento privilegiato per la commemorazione del defunto, ma anche come forieri di un preciso messaggio indirizzato a tutti coloro che avrebbero fruito della loro visione. Così, l’iconografia dei sepolcri è stata analizzata alla luce della spiritualità e della religiosità dei sovrani, oltre che dal punto di vista stilistico e formale. Come premessa allo studio prettamente storico-artistico, inizialmente sono stati approfonditi i rapporti tra il regno del Portogallo e la Sede Apostolica al momento dell’ascesa al trono di D. Dinis e, successivamente, il tema della guerra civile che vide contrapporsi il re e il principe, il futuro Alfonso IV. A questo scopo, integra la Tesi un’Appendice documentaria che presenta 64 documenti, la maggior parte dei quali inediti. Questo studio intende dimostrare come il Portogallo dionisino si collochi pienamente nell’orbita culturale mediterranea e proporre nuove affermazioni, considerazioni ed ipotesi rispetto ai re Dinis e Isabel, alle loro vicende storiche e personali e alla memoria di sé che vollero trasmettere ai posteri.

Prevalência das famílias TEM, SHV e CTX-M de β-lactamases de espectro estendido em Escherichia coli e Klebsiella spp no Hospital Universitário de Santa Maria, Estado do Rio Grande do Sul

Neste estudo estimou-se a distribuição e prevalência de β-lactamases de espectro estendido pertencentes às famílias TEM, SHV e CTX-M entre amostras de Escherichia coli e Klebsiella spp. no Hospital Universitário de Santa Maria, Rio Grande do Sul. Durante 14 meses, 90 microrganismos foram selecionados como prováveis produtores de ESBL. Os isolados foram submetidos a testes fenotípicos confirmatórios para a presença de ESBL. A seguir, os tipos de ESBLs presentes em cada microrganismo foram determinados através da pesquisa dos respectivos genes através da reação em cadeia da polimerase. Empregando-se o método do disco combinado, a presença de ESBLs foi confirmada em 55 (61,1%) amostras; quando o método do duplo disco foi utilizado, 57 (63,3%) amostras foramprodutoras de ESBLs. Com base na PCR, as ESBLs do tipo TEM e SHV foram mais presentes em Klebsiella pneumoniae enquanto que ESBL do tipo CTX-M foram mais presentes em Klebsiella oxytoca.

A SARIMA forecasting model to predict the number of cases of dengue in Campinas, State of São Paulo, Brazil

INTRODUCTION: Forecasting dengue cases in a population by using time-series models can provide useful information that can be used to facilitate the planning of public health interventions. The objective of this article was to develop a forecasting model for dengue incidence in Campinas, southeast Brazil, considering the Box-Jenkins modeling approach. METHODS: The forecasting model for dengue incidence was performed with R software using the seasonal autoregressive integrated moving average (SARIMA) model. We fitted a model based on the reported monthly incidence of dengue from 1998 to 2008, and we validated the model using the data collected between January and December of 2009. RESULTS: SARIMA (2,1,2) (1,1,1)12 was the model with the best fit for data. This model indicated that the number of dengue cases in a given month can be estimated by the number of dengue cases occurring one, two and twelve months prior. The predicted values for 2009 are relatively close to the observed values. CONCLUSIONS: The results of this article indicate that SARIMA models are useful tools for monitoring dengue incidence. We also observe that the SARIMA model is capable of representing with relative precision the number of cases in a next year.

Clinical and laboratory findings in patients with dengue associated with hepatopathy

INTRODUCTION: Hepatic disorders caused by dengue infection may progress to severe manifestations, including mortality and morbidity. Cytokines are involved in it, such as the migration inhibitory factor of macrophages (MIF), tumor necrosis factor (TNF), natural killer cells (NK), B lymphocytes, and macrophages. METHODS: This study was carried out from January to April 2007 at a public hospital from the Federal University of Mato Grosso do Sul, Campo Grande, Brazil. Sixty-eight patients were studied concerning hepatic alterations, with 56 reported having classic dengue, 6 with hemorrhagic dengue grade I, and 6 with hemorrhagic dengue grade II. RESULTS: Among the 56 with classic dengue, 83.3% had aspartate aminotransferase (AST) alterations, and 69.6% had altered alanine aminotransferase (ALT). For those with hemorrhagic dengue grade I, 100% had AST alterations, and 83.3% had altered ALT. All the patients with hemorrhagic dengue grade II had AST and ALT alterations. AST variations reached 22.0 and 907.0, with an average value of 164.6. For ALT, we found variations between 25.0 and 867.0, with an average value of 166.07. There had been statistical significance between dengue clinical shapes and hepatic function markers. CONCLUSIONS: We conclude that the infection was predominant in adults, females, and in those with low income and education. The liver enzymes were of larger amount in hemorrhagic dengue, but there was weak statistical evidence of the clinical manifestations and transaminases. Major signs and clinical symptoms were fever, headache, myalgia, arthralgia, weakness, severe pain behind the eyes, and rashes.

Invasive aspergillosis in a user of inhaled cocaine: rhinosinusitis with bone and cartilage destruction

Aspergillosis is an infection caused by saprophytic fungi of the genus Aspergillus, which typically occurs in immunosuppressed individuals, but has also been reported in immunocompetent patients. The main routes of entry are the respiratory tract, skin, cornea, and ear, and the infection may be localized or disseminated by contiguity or vascular invasion. We report a severe case of rhinosinusitis with cutaneous involvement, caused by invasive aspergillosis, in an immunocompetent user of inhaled cocaine. Invasive aspergillosis related to cocaine abuse has not yet been reported in the literature. After itraconazole treatment and surgical debridement, complete clinical remission was achieved. Nasal reconstruction with a skin graft over a silicone prosthesis resulted in a satisfactory esthetic outcome.

First report of hepatic hematoma after presumed Bothrops envenomation

ABSTRACTIn Latin America, Bothrops envenomation is responsible for the majority of accidents caused by venomous snakes. Patients usually present local edema, bleeding and coagulopathy. Visceral hemorrhage is extremely rare and considered a challenge for diagnosis and management. We report the first case of hepatic hematoma owing to the bothropic envenomation in a 66-year-old man who was bitten in the left leg. He presented local edema, coagulopathy, and acute kidney injury. Radiological findings suggested hepatic hematoma, with a volume of almost 3 liters. The hepatic hematoma was gradually absorbed without the need for surgical intervention with complete resolution in 8 months.

Knowledge and practices related to dengue and its vector: a community-based study from Southeast Brazil

Abstract INTRODUCTION: This study investigated the knowledge of users of primary healthcare services living in Ribeirão Preto, Brazil, about dengue and its vector. METHODS: A cross-sectional survey of 605 people was conducted following a major dengue outbreak in 2013. RESULTS: Participants with higher levels of education were more likely to identify correctly the vector of the disease. CONCLUSIONS: The results emphasize the relevance of health education programs, the continuous promotion of educational campaigns in the media, the role of the television as a source of information, and the importance of motivating the population to control the vector.

Necrolytic migratory erythema associated with glucagonoma syndrome: a case report

Necrolytic migratory erythema is a rare skin condition that consists of migrating areas of erythema with blisters that heal with hyperpigmentation. It usually occurs in patients with an alpha islet cell tumor of the pancreas-or glucagonoma-and when associated with glucose intolerance, anemia, hyperglucagonemia, and weight loss defines the glucagonoma syndrome. We describe a 52-year-old female patient with necrolytic migratory erythema associated with glucagonoma syndrome who had metastatic disease at presentation and passed away one week after her admission. The autopsy showed a tumor in the body of the pancreas, which was diagnosed as a neuroendocrine tumor and confirmed by immunohistochemistry. The diagnosis of necrolytic migratory erythema is a matter of great importance, since it might be an auxiliary tool for the early detection of glucagonoma.

Mosaici parietali d’epoca giustinianea a Ravenna. Nuove scoperte

La fascia superiore dell’arco trionfale di S. Apollinare in Classe è stata accuratamente ispezionata durante l’ultimo intervento di restauro. Questa area musiva, col Cristo benedicente affiancato dai simboli degli Evangelisti, ritenuta omogenea e ascritta da tutti gli studiosi a un momento posteriore al VI secolo, è stata in buona parte ricondotta al periodo giustinianeo. I simboli degli Evangelisti e le nuvole limitrofe sono stati ricondotti ai mosaicisti bizantini attivi nella chiesa di San Vitale; mentre a una lavorazione successiva, determinata dalla necessità di reintegrare parti crollate, si deve attribuire il clipeo del Cristo e le nuvole circostanti. Il confronto fra le differenti morfologie delle nubi, le diverse tecniche esecutive e l’utilizzo di nuovi materiali, costituisce l’aspetto più visibile. Il restauro ha permesso di discriminare con certezza l’eterogeneità delle partiture e la convivenza di due interventi stilisticamente e cronologicamente differenti. Molteplici elementi mostrano come da un’esecuzione accurata si passi a una realizzazione sommaria; come dal rigore formale e materico iniziale, che comporta la selezione dei materiali più pregiati e delle tonalità cromatiche più funzionali, si passi ad una povertà materica e a una limitata gamma cromatica organizzate con semplificazione formale.

Discrimination of Brazilian propolis according to the seasoning using chemometrics and machine learning based on UV-Vis scanning data

Propolis is a chemically complex biomass produced by honeybees (Apis mellifera) from plant resins added of salivary enzymes, beeswax, and pollen. The biological activities described for propolis were also identified for donor plants resin, but a big challenge for the standardization of the chemical composition and biological effects of propolis remains on a better understanding of the influence of seasonality on the chemical constituents of that raw material. Since propolis quality depends, among other variables, on the local flora which is strongly influenced by (a)biotic factors over the seasons, to unravel the harvest season effect on the propolis chemical profile is an issue of recognized importance. For that, fast, cheap, and robust analytical techniques seem to be the best choice for large scale quality control processes in the most demanding markets, e.g., human health applications. For that, UV-Visible (UV-Vis) scanning spectrophotometry of hydroalcoholic extracts (HE) of seventy-three propolis samples, collected over the seasons in 2014 (summer, spring, autumn, and winter) and 2015 (summer and autumn) in Southern Brazil was adopted. Further machine learning and chemometrics techniques were applied to the UV-Vis dataset aiming to gain insights as to the seasonality effect on the claimed chemical heterogeneity of propolis samples determined by changes in the flora of the geographic region under study. Descriptive and classification models were built following a chemometric approach, i.e. principal component analysis (PCA) and hierarchical clustering analysis (HCA) supported by scripts written in the R language. The UV-Vis profiles associated with chemometric analysis allowed identifying a typical pattern in propolis samples collected in the summer. Importantly, the discrimination based on PCA could be improved by using the dataset of the fingerprint region of phenolic compounds ( = 280-400m), suggesting that besides the biological activities of those secondary metabolites, they also play a relevant role for the discrimination and classification of that complex matrix through bioinformatics tools. Finally, a series of machine learning approaches, e.g., partial least square-discriminant analysis (PLS-DA), k-Nearest Neighbors (kNN), and Decision Trees showed to be complementary to PCA and HCA, allowing to obtain relevant information as to the sample discrimination.

School governance and academic excellence: the representations of distinguished students in an annual award of excellence

Within a research project on «academic excellence in the state school», this paper is a contribution to the sociological reflection on the cultural and organisational characteristics of the school and its relationship with the academic success of students. The data we present stem from a case study underway at a secondary school in the north of Portugal, referring to the universe of students that since 2003 have distinguished themselves for achieving grades equal to or greater than 18 (on a scale of 0 to 20) and have thus been included in the school’s Framework of Excellence. From a contextual approach to this educational practice, we focused on the cultural characteristics of the school/subject as analytical support for the study of school and non-school dimensions in their mutual connections. To this end, we used the information from document analysis and data collected from a questionnaire survey administered to more than two-thirds of the students included in the above-mentioned Framework of Excellence. Subsequently, we will use the data from this survey to understand the extent to which academic excellence is perceived as an indivisible social construction of the school’s political and organisational matrix, particularly in terms of the educational and teaching guidelines adopted by the management body. We will conclude by questioning the meaning of the school’s management policies regarding the emphasis on educational outcomes, with particular focus on the representations of excellent students in the processes of school leadership, teaching organisation, school merit and justice.